Engagement of private health sector in communicable disease and immunization programmes in Pakistan

Background

In Pakistan, where the burden of communicable diseases remains high, the private sector accounts for 62% of health care provision.

Aim

To describe the role of the private sector in communicable disease management in Pakistan and inform a more effective engagement towards achieving Universal Health Coverage.

Methods

We searched the literature and available documents on policies, regulations and experiences in private health sector engagement in Pakistan. We interviewed policy level experts regarding the formulation of national health policies and plans and a sample of private providers using a structured questionnaire to assess their awareness of and engagement in communicable disease programmes.

Results

Published reports described initiatives to engage the private sector in improving coverage for a package of care and programme-specific initiatives. Pakistan did not have a national policy for structural engagement, and regulations were limited. Policy level experts interviewed perceived the private sector as market-driven and poorly regulated. Thirty-nine percent of private sector providers interviewed were aware or had been trained in procedures or guidelines, and 23% of them had had their performance monitored by government.

Conclusion

We recommend that the Ministry of Health provide overall vision for the operations of the public and private health sectors so that both sectors can complement each other towards the achievement of Universal Health Coverage, including for communicable diseases.

A comparative study on perception and use of generic drugs between public and private health practitioners

Context

The perception of generic drugs may vary significantly between government and private doctors because physicians in the private sector have more prescribing choices and flexibility. Hence, this study was undertaken to analyse the knowledge, attitude and perception (KAP) of government and private physicians on generic drugs.

Materials and Methods

This was a questionnaire-based cross-sectional study conducted among physicians working in public and private health sectors. The questionnaire had 25 closed-ended questions related to the KAP of generic medicine. The overall scores were categorised using Bloom's cut-off point. The Chi-square or Mann-Whitney U-test was used to compare the differences between the two groups.

Results

About 80% of the participants in both groups agreed that generic medicines contain the same active ingredients as brand-name drugs, are less expensive and are available in the Indian market. Nearly 84% of government physicians and only 64% of private physicians believed that generic medicines are just as effective and secure as branded medicines (P - 0.003). The majority of physicians from both groups concurred that there is a lack of quality check in generic drug manufacturing, and they require more information about bioequivalence studies. In both categories, about 75% of participants preferred generic medications for their patients. However, in both groups, more than 50% of physicians were concerned about therapeutic failure and expressed reluctance to prescribe generic medications in life-threatening situations.

Conclusions

Knowledge and acceptance of generic drugs regarding efficacy, safety, bioequivalence and therapeutic failure are low among both government and private physicians.

Examining the Effect of Income-Based Inequalities and Dental Service Provision on Dental Service Utilization among Older Australians: A Multiple Mediation Analysis

INTRODUCTION

Public service provision is one of the keys to reducing inequalities in the utilization of dental services. Given the increase in the aging population, there should be a focus on older adults' oral health. However, this is often overlooked.

OBJECTIVES

This study investigates the effectiveness of public services in reducing income-related inequalities in dental service utilization among older South Australians.

METHODS

A multiple counterfactual mediation analysis using the ratio of mediator probability weighting approach was used to explore the proposed mediation mechanism using a South Australian population of older adults (≥65 y). The exposure variable in the analysis was income, and the mediators were concession cards and the last dental sector (public or private). The outcome variable was the time of last dental visit.

RESULTS

Half of the older adults with high income (≥$40,000) owned a concession card, and 10% of those who attended public dental services belonged to this group. Interestingly, only 16.3% of the study participants had visited the public dental sector at their last dental appointment. Results showed a negligible indirect effect (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.85-1.05) and a significant direct effect (OR, 3.09; 95% CI, 2.24-4.87). By changing the potential outcome distributions to the counterfactual exposure distributions and taking the mediators' distribution as a counterfactual exposure distribution, the odds of dental visits occurring before the past 12 mo approximately tripled for low-income compared to high-income individuals.

CONCLUSION

Income inequalities were associated with relatively delayed dental visits in older South Australians, and provision of public services could not improve this pattern. This might happen due to inequitable access to concession cards and public services. A review of policies is required, including addressing income inequalities and implementing short-term approaches to improve service utilization patterns in older South Australians.

KNOWLEDGE TRANSFER STATEMENT

The findings of this study can enable policymakers for informed decision-making about the provision of public dental services for older Australians. This study emphasizes the importance of reviewing the current public dental services and subsidies and implementing short-term approaches to reduce income inequalities for older Australians.

Income-based inequalities in dental service utilization: A multiple mediation analysis

OBJECTIVES

With elimination of the financial burden of dental services, one can expect an increase in utilization of dental services. This study aimed to investigate the effective mechanisms of financial barriers to the utilization of dental services in an Australian adult population.

METHODS

South Australian survey data from the Dental Care and Oral Health Study (2015) were analysed. Following the flexible mediation approach, the direct effect of income and indirect effect of income through mediators (insurance, concession card and service sector) on the outcomes (visit avoidance and treatment prevention due to the cost) were calculated.

RESULTS

Findings showed that around half of the low-income people and one-third of the high-income South Australians experienced a financial burden on receiving a dental visit or service. The indirect effect of income on both outcomes of financial burden was negligible, while the direct effect was significant. By changing the potential outcome distribution to their counterfactual exposure distribution and if the mediators are drawn from their counterfactual exposure (lower/higher income) distribution, the odds of visit avoidance and treatment prevention due to the cost were almost twice (Odds Ratio: 2.13, 95% CI 1.72-2.60) and 98% (Odds Ratio: 1.98, 95% CI 1.67-2.35) than in the lower-income individuals, respectively.

CONCLUSIONS

It can be concluded that the level of household income, directly and regardless of insurance status, concession card ownership and whether the service sector was public or private, affected the financial burden on utilization of dental services.

The Impact of COVID-19 on the Utilization of Public Sector Radiological Services in the Western Cape Province of South Africa

Background Coronavirus (COVID-19) was officially declared a pandemic in March 2020 and has had a major impact on global healthcare services, including radiology. However, little is known about the full impact of COVID-19 on the utilization of diagnostic imaging in Africa's public healthcare sector. Objectives The objective of this study was to compare public sector diagnostic imaging utilization by modality for the whole Western Cape Province (WCP) of South Africa (SA), as well as its metropolitan and rural areas, in 2019 and 2020 in terms of the absolute number of investigations and investigations per 1000 people. Method We performed a retrospective analysis of Western Cape Government Department of Health and Wellness and Stats SA District Council 2021 Mid-Year Population Estimates data. All diagnostic imaging investigations performed in 2019 and 2020 were collated and stratified by imaging modality, geographic region (metropolitan/rural), and calendar year. Data are presented as the total number of investigations and investigations per 1000 people. We calculated mammography utilization for women aged 40-70 years and compared data for 2019 and 2020. Results Between 2019 and 2020, the provincial population increased by 1.9%, while total imaging investigations and investigations per 1000 people decreased by 19% (1,384,941 vs. 1,123,508, -261,433) and 20% (262/103 vs. 208/103), respectively. Total numerical decline was highest in plain radiographs (1,005,545 vs. 800,641, -204,904), accounting for more than three-quarters (78%) of the total reduction. Percentage decline was most pronounced for mammography, as utilization was almost halved (15.7/103 vs. 8.9/103, -43%), whereas computed tomography was the least impacted (17.9/103 vs. 16.7/103, -12%) with the remaining modalities decreasing between approximately one-quarter and one-fifth (magnetic resonance imaging = 26%, fluoroscopy = 25%, general radiographs = 23%, ultrasound = 16%, chest radiographs = 18%). Proportional metropolitan (-18.7%) and rural decreases (-19.3%) were similar. Conclusion COVID-19 had a substantial impact on WCP imaging services, decreasing overall radiological investigations by almost one-fifth. The greatest impact was on elective investigations, particularly mammography. Although the proportional impact was similar for the metropolitan and rural areas, COVID-19 nonetheless exacerbated existing discrepancies in imaging utilization between the geographical regions. The medium- and long-term clinical impacts of decreased imaging are still to be defined.

Quality of working life of employees in public healthcare organization in Finland: A cross-sectional study

AIM

Work dissatisfaction, burnout and workforce shortage are major problems in healthcare globally, all of which are associated with QWL. Previous studies have found that the QWL of healthcare professionals is moderate or low. The aim was to describe the quality of working life (QWL) of employees working in public healthcare and describe the association between QWL and background variables.

DESIGN

This study had a quantitative cross-sectional survey design.

METHODS

Data was collected from the employees of a Finnish healthcare organization in autumn 2021 using an online questionnaire (n = 837). Convenience sampling was used in the selection of the healthcare organization. The study was reported according to STROBE guidelines.

RESULTS

The QWL was moderate, and the mean QWL index calculated from the questionnaire responses was 0.524. The QWL index was lowest in healthcare professionals and highest in upper management, with some dissatisfaction towards leadership noted.

Talent management and job satisfaction of medical personnel in Polish healthcare entities

Background

There is a mass exodus of qualified medical personnel in countries such as Poland. As a result, it is becoming increasingly important to study the satisfaction of medical personnel employed in public healthcare entities and the factors influencing this satisfaction. One such factor is the quality of talent management.

Purpose

The study aimed to assess the quality of talent management in Polish healthcare entities and its impact on the job satisfaction of medical personnel. The study also considered the impact of other demographic, organizational and behavioral factors on medical personnel satisfaction, such as social competencies, job mobility, orientation toward the patient, gender and education stage.

Methods

A questionnaire for healthcare professionals was used to collect data. A total of 747 respondents (506 defined as medical talent) participated in the survey. A 5-point Likert scale was adopted to assess job satisfaction and talent management practices. Reliability analysis was conducted to investigate the properties of this scale and the items that comprise it. The data was analyzed using descriptive statistics and structural equation modeling.

Results

The survey showed that the quality of talent management in Polish healthcare institutions is not well assessed. Professional satisfaction of medical personnel working in Polish public healthcare entities depends mainly on talent management measured by talent motivation, talent development, employee appraisal and organizational culture. Among the factors that have a positive but smaller impact on job satisfaction are job mobility and the education stage. The impact of gender, patient orientation and social competence had the smallest but most significant impact on job satisfaction.

Conclusion

Healthcare organizations should improve their talent management strategy to meet healthcare professionals' current and future demands and improve their job satisfaction.

"Get on with it. Cope." The compassion-experience during COVID-19 in UK universities

Introduction

The COVID-19 pandemic caused major disruption to all sectors including higher education during the years of 2020 and 2021, thus providing a window into how different types of suffering can combine and the role of compassion in alleviating pain. Higher education within the United Kingdom provides a case example in this study, but the lessons about compassion are transferable to other contexts, particularly those in the neoliberal public sector. The impact of the pandemic period on teaching in universities has been well documented but there has been far less written about the wider experiences of staff who worked through this period, their suffering and the extent of compassion within their work lives.

Methods

29 interviews were conducted and individuals were invited to talk through the story of their pandemic experiences from March 2020 to the interview date of December 2021. Storytelling is a common method in organization studies and, although research into compassion in organizations is nascent, this method has been used in other studies.

Results and discussion

Previous research has examined organizational compassion in short periods of crisis and this study therefore provides a contrasting perspective on how compassion shifts over a longer period of suffering. A distinction is drawn in this study for the first time between "formalized" compassion processes in the organization which structurally prioritized compassion for students over that of staff, and "informal" compassion shown between staff to each other and between students and staff. The more that formalized compassion was evident, the less apparent it was in interpersonal interactions due to staff wellbeing being compromised and a systemic failure to recognize the dependence of student compassion on the wellbeing of staff. The findings therefore lead to theorizing that although neoliberal universities are perceived as being full of organizational neglect, compassion was structurally embedded for students but at the expense of staff.

Quality of care of patients with type 2 diabetes mellitus at a public sector district hospital

BACKGROUND

 Globally, diabetes mellitus (DM) remains one of the leading causes of mortality, with approximately 2 million deaths in 2019, the condition also contributes significantly to adverse health conditions and costs. The study aimed to describe the quality of care (QOC) rendered to patients with type 2 DM (T2DM) seeking care at Wentworth Hospital (WWH), a district hospital in KwaZulu-Natal province, South Africa.

METHODS

 A descriptive cross-sectional design was used, and all patients living with T2DM on treatment who had accessed care for at least 1 year were included. Data were collected through structured exit interviews, and their clinical data were extracted from their medical records. Their knowledge, attitudes and practices were assessed using a 5-point Likert scale.

RESULTS

 The mean age (standard deviation [s.d.]) was 59 (13.0) years and most (65.3%) were female, of African (30.0%) and Indian (38.6%) descent, with two-thirds (69.4%) obtaining a secondary school education. Their mean glycated haemoglobin (HbA1c) (s.d.) was 8.6 (2.4%). Over 82% had one or more comorbidity, while 30% had at least one DM-related complication. Generally, participants were pleased with the care received, but their knowledge and practices related to their T2DM was suboptimal.

CONCLUSION

 This study indicates that the QOC was suboptimal due to poor efficacy indicators, poor knowledge and lack of adequate lifestyle measures, despite the frequency of medical practitioner reviews.Contributions: This study identified gaps in QOC and will aid South African public sector policy-makers in devising quality improvement initiatives.

Current distribution of medical colleges in India and its potential predictors: A public domain data audit

Background

A teaching hospital or medical college may help provide better health care delivery to the people of the vicinity. Hence, building new medical colleges and upgrading existing hospitals to teaching hospitals are being implemented in India.

Objective

This study aimed to observe the current distribution of medical colleges in Indian states and find correlation with area, population, and net state domestic product (NSDP).

Methods

We collected data from public domain websites provided by government agencies. The State-wise number of government and private medical colleges and their annual intake were obtained from the National Medical Commission website. The state-wise number of medical colleges, geographical area, and population were calculated as the percentage of total Indian colleges, area, and population, respectively. Spearman's correlation was calculated to find any correlation of colleges and annual intake versus parameters such as area, population, and NSDP.

Results

India has a total of 612 [321 (52.45%) government-run and 291 (47.55%) private] medical colleges. Tamil Nadu (70), Uttar Pradesh (67), Karnataka (63), Maharashtra (62), and Telangana (34) are the top five states with 296 (48.37%) medical colleges. States and union territories such as Karnataka, Kerala, Maharashtra, Puducherry, Tamil Nadu, and Telangana have higher medical colleges, and states such as Assam, Bihar, Odisha, Madhya Pradesh, Rajasthan, and Uttar Pradesh have lower medical colleges when compared with their population percentages. There was significant positive correlation of number of medical colleges with area (rs = 0.769, P < 0.0001), population (rs = 0.91, P < 0.0001), and NSDP (rs = 0.91, P < 0.0001).

Conclusion

The current distribution of medical colleges in India is clustered over some states. Although geographical area and population are major predictors of medical colleges in Indian states, a more population-based balanced distribution of medical colleges would help distribute quality health care to the majority of the population.

Public sector's misinformation debunking during the public health campaign: a case of Hong Kong

For a public health campaign to succeed, the public sector is expected to debunk the misinformation transparently and vividly and guide the citizens. The present study focuses on COVID-19 vaccine misinformation in Hong Kong, a non-Western society with a developed economy and sufficient vaccine supply but high vaccine hesitancy. Inspired by the Health Belief Model (HBM) and research on source transparency and the use of visuals in the debunking, the present study examines the COVID-19 vaccine misinformation debunking messages published by the official social media and online channels of the public sector of Hong Kong (n = 126) over 18 months (1 November 2020 to 20 April 2022) during the COVID-19 vaccination campaign. Results showed that the most frequently occurring misinformation themes were misleading claims about the risks and side effects of vaccination, followed by (non-)effectiveness of the vaccines and the (un)-necessity of vaccination. Among the HBM constructs, barriers and benefits of vaccination were mentioned the most, while self-efficacy was the least addressed. Compared with the early stage of the vaccination campaign, an increasing number of posts contained susceptibility, severity or cues to action. Most debunking statements did not disclose any external sources. The public sector actively used illustrations, with affective illustrations outnumbering cognitive ones. Suggestions for improving the quality of misinformation debunking during public health campaigns are discussed.

COVID-19 Pandemic and Challenges Faced by Healthcare Professionals in India

Since the Great Influenza Pandemic of 1918, a pandemic of such magnitude as the COVID-19 pandemic was yet to be confronted. While the pandemic led to unforeseen challenges globally as well as at the country level, it also brought forth certain perennial issues. This editorial is an attempt to revisit some of the major challenges faced by healthcare professionals in India during the pandemic. Timely interventions by the government of India dealt with several challenges confronted by the healthcare sector. However, issues about working hours, mental health, safety, and security of healthcare professionals also need to be looked into in the future.

Digital Transformation and Local Government Response to the COVID-19 Pandemic: An Assessment of Its Impact on the Sustainable Development Goals

This paper analyzes how Digital Transformation (DT) processes have influenced the Attitude of local governments (LGs) toward the COVID-19 pandemic and their effect on achieving the United Nations' Sustainable Development Goals (SDGs). The data were collected from LGs in Spain (n = 124) through a questionnaire in which the IT skills of their workers, the DT processes, budgets, degree of regulatory compliance, and implementation of trust seals were measured, together with the IT security measures adopted. The contrast between the proposed model and the results showed that the direct influence of IT security influences the government's attitude toward COVID-19 and DT implementing actions to achieve SDGs. The findings of this work are of great value both for the actors involved in the design and implementation of public policies and for those responsible for local governance in their objective to improve citizens' experience of the services provided and in exceptional situations such as the one experienced as a result, of-COVID-19.

Contribution of age, gender and occupational group to the higher risk of disability retirement among Finnish public sector employees

BACKGROUND

The aim of this study was to examine the differences in disability retirement between public and private sector employees and to examine the contribution of age, gender and occupational group to the differences between the sectors.

METHODS

Our Finnish register data consisted of about two million non-retired men and women aged 30-62 years. Cox proportional hazard models were used to calculate hazard ratios for any, full and partial disability retirement in the public sector compared with the private sector.

RESULTS

The risk of any disability retirement was higher in the public sector than in the private sector in all occupational groups. The unadjusted hazard ratio ranged from 1.29 (95% CI 1.16-1.44) among teaching professionals to 2.25 (95% CI 1.95-2.58) among skilled agricultural, forestry and fishery workers. Adjustment for age and gender attenuated the differences between the sectors. After adjusting for age, gender and occupational group, the hazard ratio was 1.29 (95% CI 1.27-1.32) for any disability retirement and 2.02 (95% CI 1.96-2.08) for partial disability retirement, but there was no difference between the public sector and private sector employees for full disability retirement.

CONCLUSIONS

Adjustment of age and gender attenuated the higher risk of disability retirement in the public sector, while adjustment for occupational group widened the sector differences in any and full disability retirement. The risk of partial disability retirement was higher in all occupational groups in the public sector than in the private sector. For full disability retirement, the differences between the sectors were small or non-existent.

Let's put mental health problems and related issues appropriately in social media: A voice of psychiatric nurses

Social media is one convenient way to express ourselves. Much information is offered; most is difficult to filter and can be consumed by anyone, anywhere, anytime. However, sometimes it crosses the boundaries of someone else's life or privacy, especially when discussing sensitive issues, such as mental health problems. There are a lot of discussions about whether bringing the personal experiences of people with mental health problems to the public domain can potentially increase the community's attitudes toward them or not. Still, one thing is for sure, this kind of content has caught public attention by having more viewers. Unfortunately, it potentially brings other consequences for people with mental health problems, such as stigmatization, discrimination, and sadfishing. Therefore, this paper aims to provide the viewpoints of psychiatric nurses regarding how to address mental health-related issues and appropriately put content about mental health problems on social media.

What are the sources of contraceptives for married and unmarried adolescents: Health services or friends? Analysis of 59 low- and middle-income countries

Background

Despite the efforts to promote universal coverage for family planning, inequalities are still high in several countries. Our aim was to identify which sources of contraceptives women mostly rely on in low- and middle-income countries (LMICs). We also explored the different sources according to age and marital status.

Methods

We used data from national health surveys carried out in 59 LMICs since 2010. Among all sexually active women at reproductive age, we explored inequalities in demand for family planning satisfied by modern methods (mDFPS) and in the source of modern contraceptives according to women's age, classified as: 15-19, 20-34, or 35-49 years of age. Among adolescents, mDFPS and source of method were explored by marital status, classified as married or in union and not married nor in a union.

Results

mDFPS was lower among adolescents than among adult women in 28 of the 59 countries. The lowest levels of mDFPS among adolescents were identified in Albania (6.1%) and Chad (8.2%). According to adolescents' marital status, the pattern of inequalities in mDFPS varied widely between regions, with married and unmarried adolescents showing similar levels of coverage in Latin America and the Caribbean, higher coverage among unmarried adolescents in Africa, and lower coverage among unmarried adolescents in Asia. Public and private health services were the main sources, with a lower share of the public sector among adolescents in almost all countries. The proportion of adolescents who obtained their contraceptives in the public sector was lower among unmarried girls than married ones in 31 of the 38 countries with data. Friends or relatives were a more significant source of contraceptives among unmarried compared to married adolescents in all regions.

Conclusions

Our findings indicate lower levels of mDFPS and lower use of the public sector by adolescents, especially unmarried girls. More attention is needed to provide high-quality and affordable family planning services for adolescents, especially for those who are not married.

Nutritional Analysis of the Spanish Population: A New Approach Using Public Data on Consumption

Official population consumption data are frequently used to characterize the diet of countries; however, this information may not always be representative of reality. This study analyses the food consumption of the Spanish population by reconstructing the whole food chain. The results have been compared with the data provided by the National Consumption Panel to which the food losses/waste reported in the literature along the distribution chain have been added. The difference between them allowed a new calculation of the estimated food consumption that was subjected to a dietary-nutritional analysis. Most of the foods were consumed more than those officially reported (range of 5-50%). The unhealthy ratios of consumed foods and recommended servings were: meat products (Rcr = 3.6), fruits and legumes (Rcr = 0.5), and nuts (Rcr = 0.14). Caloric intake surpasses needs. The results were consistent with the data on the prevalence of overweight and obesity in Spain, as well as with the prevalence of associated diseases. To make a judgment about the quality of a country's diet, it is necessary to have reliable data on food consumption, as well as energy and nutrient intake. This study encourages other authors to implement this method to verify and quantify the possible difference between official and real consumption data.

Public Health Risk Evaluation through Mathematical Optimization in the Process of PPPs

The public sector is becoming increasingly appealing. In the context of declining public money to support health studies and public health interventions, public-private partnerships with entities (including government agencies and scientific research institutes) are becoming increasingly important. When forming this type of cooperation, the participants highlight synergies between the private partners and the public's missions or goals. The tasks of private and public sector actors, on the other hand, frequently diverge significantly. The integrity and honesty of public officials, institutions, trust, and faith in those individuals and institutions may all be jeopardized by these collaborations. In this study, we use the institutional corruption framework to highlight systemic concerns raised by PPPs affiliated with the governments of one of South Asia's countries. Overall analytical frameworks for such collaborations tend to downplay or disregard these systemic impacts and their ethical implications, as we argue. We offer some guidelines for public sector stakeholders that want to think about PPPs in a more systemic and analytical way. Partnership as a default paradigm for engagement with the private sector needs to be reconsidered by public sector participants. They also need to be more vocal about which goals they can and cannot fulfill, given the limitations of public financing resources.

Organizational and psychosocial environmental work factors associated with self-rated exhaustion disorder among municipal employees in rural northern Sweden

BACKGROUND

Research indicates that good organizational and psychosocial environments are vital to well-functioning workplaces and employee health. Working in the municipal sector and in the rural context may contribute to more health problems, poorer organizational and psychosocial work environments, and higher sick-leave rates.

OBJECTIVE

The aim of this study was to explore organizational and psychosocial environmental work factors among municipal employees with or without self-rated exhaustion disorder (s-ED) in rural northern Sweden.

METHODS

The Modern Work Life Questionnaire and the Self-Rated Exhaustion Disorder Scale were used among 1093 municipal employees.

RESULTS

The results showed that there were significant differences between the s-ED and the non-s-ED group in all but one of the organizational and psychosocial environmental work factors. Various demands, i.e. quantitative, emotional, intellectual, and IT demands were some factors associated with the s-ED group. Social support, resources, and time for work and reflection were some factors associated with the non-s-ED group. Both the s-ED and the non-s-ED groups assessed significantly higher emotional demands and less resources compared to national reference values.

CONCLUSION

Findings from this study are relevant to a better understanding what organizational and psychosocial work environmental work factor the employer need to pay extra attention to. Addressing risk and protective factors in the work environment could tribute to promote occupational well-being, preventing exhaustion disorder and long-term sick leave among municipal employees in rural northern Sweden.

The Nexus Between High-Involvement Work Practices and Employees' Proactive Behavior in Public Service Organizations: A Time-Lagged Moderated-Mediation Model

Purpose

Public service organizations may improve the quality of services they offer citizens by instilling proactive behavior in their employees. This study aimed to provide insights on how high-involvement work practices may indirectly facilitate proactive behavior in frontline government employees via employee commitment.

Methods

A time-lagged approach was used to collect data from 542 frontline employees in three waves at 3-week intervals. We tested the hypothesized moderated mediation model using a PROCESS macro bootstrap approach.

Results

A moderated-meditation model was applied in which public service motivation was theorized to increase the mediating effect of employee commitment on the relationship between high-involvement work practices and employee proactive behavior. As predicted, the findings show that supervisor' deviant behavior attenuated the mediating effect of employee commitment on the relationship between high-involvement work practices and employee proactive behavior.

Conclusion

The findings of this research contribute to the emerging literature on public management and have implications for public sector organizations seeking to improve the quality of services they offer citizens.

Geographic accessibility to childhood tuberculosis care in Pakistan

Background

Tuberculosis (TB) in children is difficult to detect and often needs specialists to diagnose; the health system is supposed to refer to higher level of health care when diagnosis is not settled in a sick child. In Pakistan, the primary health care level can usually not diagnose childhood TB and will refer to a paediatricians working at a secondary or tertiary care hospital. We aimed to determine the health services access to child TB services in Pakistan.

Objective

We aimed to determine the geographical access to child TB services in Pakistan.

Method

We used geospatial analysis to calculate the distance from the nearest public health facility to settlements, using qGIS, as well as population living within the World Health Organization’s (WHO) recommended 5-km distance.

Result

At primary health care level, 14.1% of facilities report child TB cases to national tuberculosis program and 74% of the population had geographical access to general primary health care within 5-km radius. To secondary- and tertiary-level health care, 33.5% of the population had geographical access within 5-km radius. The average distance from a facility for diagnosis of childhood TB was 26.3 km from all settlement to the nearest child TB sites. The population of one province (Balochistan) had longer distances to health care services.

Conclusion

With fairly good coverage of primary health care but lower coverage of specialist care for childhood TB, the health system depends heavily on a good referral system from the communities.

Retention of medical officers in district health services, South Africa: a descriptive survey

BACKGROUND

The health workforce is critical to strengthening district health services (DHS). In the public sector of South Africa, medical officers (MOs) are essential to delivering services in primary health care (PHC) and district hospitals. Family physicians, responsible for clinical governance, identified their retention as a key issue.

AIM

To evaluate factors that influence retention of MOs in public sector DHS.

DESIGN & SETTING

A descriptive survey of MOs working in DHS, Western Cape, South Africa.

METHOD

All 125 MOs working in facilities associated with the Stellenbosch University Family Physician Research Network (SUFPREN) were included in the survey. A questionnaire measured the prevalence of key factors that might be associated with retention (staying >4 years) and included the Satisfaction of Employees in Health Care (SEHC) tool and Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Data were collected in Research Electronic Data Capture (REDCap) and analysed in the Statistical Package for Social Sciences (SPSS).

RESULTS

Ninety-five MOs completed the survey. The overall rating of the facility (P = 0.001), age (P = 0.004), seniority (P = 0.015), career plans (P<0.001), and intention to stay in the public sector (P<0.001) were associated with retention. More personal factors such as social support (P = 0.007), educational opportunities for children (P = 0.002), and staying with one's partner (P = 0.036) were also associated with retention. Sex, rural versus urban location, district hospital versus primary care facility, overtime, remuneration, and additional rural allowance were not associated with retention.

CONCLUSION

The overall rating of the facility was important and subsequent qualitative work has explored the underlying issues. These findings can guide strategies in the Western Cape and similar settings to retain MOs in the DHS.

Geographic accessibility to public and private health facilities in Kenya in 2021: An updated geocoded inventory and spatial analysis

Objectives

To achieve universal health coverage, adequate geographic access to quality healthcare services is vital and should be characterized periodically to support planning. However, in Kenya, previous assessments of geographic accessibility have relied on public health facility lists only, assembled several years ago. Here, for the first time we assemble a geocoded list of public and private health facilities in 2021 and make use of this updated list to interrogate geographical accessibility to all health providers.

Methods

Existing health provider lists in Kenya were accessed, merged, cleaned, harmonized, and assigned a unique geospatial location. The resultant master list was combined with road network, land use, topography, travel barriers and healthcare-seeking behavior within a geospatial framework to estimate travel time to the nearest (i) private, (ii) public, and (iii) both (public and private-PP) health facilities through a travel scenario involving walking, bicycling and motorized transport. The proportion of the population within 1 h and outside 2-h was computed at 300 × 300 spatial resolution and aggregated at subnational units used for decision-making. Areas with a high disease prevalence for common infections that were outside 1-h catchment (dual burden) were also identified to guide prioritization.

Results

The combined database contained 13,579 health facilities, both in the public (55.5%) and private-for-profit sector (44.5%) in 2021. The private health facilities' distribution was skewed toward the urban counties. Nationally, average travel time to the nearest health facility was 130, 254, and 128 min while the population within 1-h was 89.4, 80.5, and 89.6% for the public, private and PP health facility, respectively. The population outside 2-h were 6% for public and PP and 11% for the private sector. Mean travel time across counties was heterogeneous, while the population within 1-h ranged between 38 and 100% in both the public sector and PP. Counties in northwest and southeast Kenya had a dual burden.

Conclusion

Continuous updating and geocoding of health facilities will facilitate an improved understanding of healthcare gaps for planning. Heterogeneities in geographical access continue to persist, with some areas having a dual burden and should be prioritized toward reducing health inequities and attaining universal health coverage.

Prozessmodularisierung und -standardisierung als Grundlage für die Digitalisierung von Prozessen im Öffentlichen Gesundheitsdienst

Die Digitalisierung des Öffentlichen Gesundheitsdienstes (ÖGD) in Deutschland weist nach wie vor Defizite auf, was nicht zuletzt im Kontext der Pandemiebewältigung zu Problemen führte. Zur Bewältigung ihrer Aufgaben benötigen die etwa 400 deutschen Gesundheitsämtern, eine entsprechende Softwareausstattung, deren Bereitstellung auch durch die Heterogenität des ÖGD erschwert wird. Entsprechend stellt die Standardisierung und Modularisierung von Prozessen die Grundlage für eine nachhaltige Digitalisierung des ÖGD dar. Aufbauend auf diesen Prozessmodellen können geeignete und breit anwendbare Softwaremodule für diverse Aufgabenbereiche der Gesundheitsämter entwickelt und bereitgestellt werden. Die durchgeführte Studie leistet einen ersten wichtigen Beitrag im Kontext der Digitalisierung des ÖGD, indem sie eine Vorgehensweise zur Prozessstandardisierung und -modularisierung entwickelt und beispielhaft anwendet. Im Rahmen dieser Studie erfolgte eine Standardisierung und Modularisierung von Prozessen im Bereich der Wasserhygiene basierend auf den Prozessen eines Gesundheitsamtes in Berlin. In einer Kombination von Design Science Research und Business Process Standardization (BPS) wurden stakeholderübergreifende Ende-zu-Ende Prozesse identifiziert, deren Ist-Zustände mit BPMN (Business Process Model and Notation) visualisiert und anschließend in generalisierbare Soll-Zustände überführt. Die Ergebnisse wurden schließlich mit zwei weiteren Gesundheitsämtern validiert. Die angewandte Methodik und die entwickelten Artefakte können einerseits zur Skalierung dieses Vorgehens in weiteren Gesundheitsämtern und andererseits als eine Grundlage für die Entwicklung von passenden und breit anwendbaren Softwarekomponenten genutzt werden.

Burnout and Quality of Work Life among Municipal Workers: Do Motivating and Economic Factors Play a Mediating Role?

This study analyzes the relationship between burnout and quality of work life among municipal workers subjected to higher levels of stress and emotional exhaustion, impacting their occupational health in the context of the COVID-19 pandemic. With a sample of 459 municipal workers, the relationship between burnout and quality of work life is tested by considering the isolated mediating effect of the feeling of contributing to productivity and the combined effects of two mediators representing the feeling of contributing to productivity and receiving an appropriate salary. The main findings include a negative association between the three dimensions of burnout: emotional exhaustion, feelings of cynicism, and a sense of being less effective, and the mediators: contribution to productivity and appropriate salary. Also detected was an important mediating role associated with the effects of not feeling contributive at work, as well as not being well paid, on the relation between the burnout syndrome dimension of low effectiveness and quality of work life. For future action by public authorities and public managers, the need is highlighted to create innovative human resource management frameworks and flexible work organization, with remuneration plans based on productivity goals and aimed at an improved balance between personal life and work.

Employees' personality traits and needs' frustration predicts stress overload during the COVID-19 pandemic

This study aimed at identifying significant associations between stress, personality traits, and basic psychological needs' satisfaction and frustration. In the study, a simple random sample consisted of 245 employees (mean age = 39.6; SD = 10.82). 138 (57.5%) employees worked in the public sector, and 102 (42.5%) employees worked in the private sector. This study found no statistically significant differences between the private and public sector employees in the stress overload. Private sector employees demonstrated higher autonomy and relatedness satisfaction, while public sector employees demonstrated higher autonomy frustration. Public sector employees demonstrated higher scores on agreeableness and conscientiousness, but no significant differences between public and private sectors were found comparing the scores on extraversion, neuroticism, and open-mindedness. The SEM identified some significant associations between neuroticism, unsatisfied needs, and stress overload; conscientiousness, unsatisfied needs, and stress overload; basic psychological needs' satisfaction and four personality traits, namely, extraversion, agreeableness, conscientiousness, and open-mindedness.

COVID-19 and Stroke Trends in A Tertiary Care Center from South India -Our Monsoon Experience

INTRODUCTION

The unprecedented challenges during the COVID pandemic and the subsequent lockdown had resulted in a delay in treatment metrics for acute stroke. There is a rising concern that COVID-19 co-infection can adversely affect stroke outcome. We aim to investigate the impact of COVID-19 in the management of stroke patients. We also compared the differences in stroke manifestations, etiological pattern, treatment course, and outcome of acute stroke patients in COVID-19 confirmed cases.

METHODOLOGY

A single-center retrospective study was done at the Stroke Unit, Government Medical College, Thiruvananthapuram. Consecutive patients of acute stroke confirmed by imaging, presenting within 24 hours of the onset of symptoms in May to July 2020 and May to July 2019, were included. The primary data variables included baseline demographics, risk factors, admission NIHSS, stroke timings, thrombolysis rate, TOAST etiology, mRS at discharge, and in-hospital mortality.

RESULTS

Strokes with higher NIHSS, arrival blood sugar and blood pressure, and delays in door-to-CT and door-to-needle time were more during the pandemic. Intravenous thrombolysis was less and mortality was higher in COVID-19 strokes during the pandemic. COVID-19-positive stroke patients had more hemorrhagic strokes, more severe strokes with low CT ASPECTS, more hemorrhagic transformation, high in-hospital mortality, and poor functional outcome at discharge and 3 months.

CONCLUSION

Our study was a hypothesis-generating study with a limited number of patients. This study has reconfirmed the higher severity of the stroke, with a higher mRS score and mortality during the pandemic, especially among COVID-19-positive stroke patients.

Occupational diseases compensated in the Tunisian public sector

AIM

Describe the epidemiological characteristics of occupational diseases (OD) recognized by the Central Medical Commission (CMC) of the first ministry during the period from 2012 to 2019.

METHODS

It was a descriptive and retrospective study covering all cases of diseases declared and recognized as occupational diseases by the CMC of the first ministry in the public sector and their repair during the period from the first of January 2012 to December 31, 2019.

RESULTS

During the study period, 294 OD were declared, of which, 213 were recognized by the CMC (72.4%). The average age of the population was 45.8 ± 10.9 years. A female predominance was noted (61%). Most employees (56%) were part of the health sector. Tuberculosis was the most common occupational disease (21.1%). Cancers were present in 5.6% of cases. In this series, 99 workers had a temporary total disability (TTD) (46.5%). A partial permanent disability rate (PPD) was attributed to 20 victims of OD (9.4%) with an average rate of 29% and extremes ranging from 8% to 70%.

CONCLUSION

The OD recognized in the public sector seemed to be low. This encourages better information for workers on occupational risks and better awareness of attending physicians to report the professional nature of PD.

The Predictors Influencing the Rational Use of Antibiotics Among Public Sector: A Community-Based Survey in Thailand

Background

The spread and emergence of antimicrobial resistance is the significant public health concerns over past decades. The major leading cause comes from irrational use of antibiotics.

Aim

To explore the characteristics of rational use of antibiotics and identify its predictive factors among public sector living in Nakhon Nayok Province, Thailand.

Methods

This project was conducted by using the data-source from Rational Use of Antibiotics (RUA) Survey Project at Nakhon Nayok Province. A cross-sectional community-based study method and face to face interviews were conducted. Two hundred fifty-four participants were selected by using Quota sampling method. Descriptive statistics were used to describe the sociodemographic and antibiotics use characteristics. Chi-square test were utilized to determine the association between explanatory variables and major outcome while multiple logistic regression was analysed to identify the predictors of antibiotics use behavior.

Results

The mean age of the participants was 42 years, those with aged between 35 and 56 had more rational use of antibiotics behavior than those with 13–34 years while older adults (57–78 years) were significantly associated with irrational use of antibiotics [AOR = 0.38; 95% CI (0.17–0.85)] than those with less than 34 years of age. Less than half (45.7%) and about one third of them (31.1%) showed adequate knowledge and appropriate attitude towards antibiotics use. An adequate knowledge [AOR = 3.37; 95% CI (1.92–5.90)], appropriate attitude [AOR = 2.90; 95% CI (1.54–5.43)], not using antibiotics within last 3 months [AOR = 1.89; 95% CI (1.04–3.43)], and not visiting drugstore when having three main diseases [AOR = 2.04; 95% CI (1.06–3.92)] were the significant predictors of rational antibiotics use (p-value <0.05).

Conclusion

Strategies development in terms of knowledge and attitude enhancement about antibiotics use particularly at the different ages together with RDU pharmacy encouragement and policy restriction of community drugstores antibiotics sales are the most effective method to promote rational antibiotics use behavior in the public sector.

Private Sector Investment in Infrastructure in Sub-Saharan Africa Post-COVID-19: The Role of Law

Sub-Saharan Africa (SSA) is the lowest income region of the world with a considerable number of low-income countries. The region is challenged by a massive infrastructure deficit. In recent years, the governments of the countries in the region have expressed the desire to bridge the huge gap in infrastructure assets through a partnership with the private sector using the public-private partnership model. However, the advent of the Coronavirus (COVID-19) pandemic which has resulted in unplanned public sector expenditure poses a new kind of hurdle to climb for states in the region. As such, there is a need for governments in SSA to create and sustain efficient opportunities for private sector investment in infrastructure procurement and maintenance. This article adopted the doctrinal legal research method as well as review of literature in the examination of the role of law in creating a healthy and sustainable business environment for private sector participation in infrastructure financing and operation in a post-COVID-19 era in the SSA region. The article recommends among others, the enactment of legislation to create an enabling environment for raising domestic capital for the purposes of private sector-led public infrastructure procurement as well as the implementation of strategies suited for developing economies to attain successful outcomes in private sector backed infrastructure procurement.

Local public health projectification in practice: a qualitative study of facilitators and barriers to a public health plan implementation

AIMS

To identify factors perceived by local government employees to affect the implementation of a municipal public health plan.

METHODS

Qualitative individual interviews (n=13) were carried out. Participants were sampled from three districts in Oslo municipality, Norway, and asked about their experiences with an ongoing implementation of the Oslo Public Health Plan (2017-2020). The conceptual framework of public sector projectification - a growing reliance on project organisation of policies - informed the study. The consolidated framework for implementation research was used to aid data coding and subsequent thematic analysis.

RESULTS

Implementation facilitators included factors perceived to support flexibility, including plan adaptability to the local setting, and factors perceived to enable structure and control during the implementation process, such as the articulation of specific goals and a shared understanding of public health work. Barriers were mainly related to complex aspects of the plan, such as the need to involve multiple stakeholders and levels of governance, and to tensions between the time-limited implementation process and the permanent organisational structures.

CONCLUSIONS

This study has demonstrated how research-based methods can be used for the evaluation of a local community implementation process. It has identified implementation determinants using a predetermined taxonomy of operationally defined factors that are likely to influence implementation. However, while implementing a time-limited public health plan can be seen as 'taking action' in relation to multidimensional and complex problems, further research is needed to investigate whether plan implementation has a long-term impact on the surrounding organisation and, eventually, on public health outcomes.

Public servants working from home: Exploring managers’ changing allowance decisions in a COVID-19 context

Before the COVID-19 pandemic forced large sections of the workforce to work from home, the uptake of working from home in the public sector had been limited and subject to the discretion or ‘allowance decisions’ of individual managers. Allowance decisions are influenced by factors at the organisational, group and individual levels. This research examines managers’ allowance decisions on working from home at each of these levels. It compares two qualitative datasets: one exploring managerial attitudes to working from home in 2018 and another dataset collected in mid-2020, as Australia transitioned out of the initial pandemic lockdown. The findings suggest a change in the factors influencing managers’ allowance decisions. We have identified a new factor at the organisational level, in the form of local organisational criteria. At the group level, previous concerns about employee productivity largely vanished, and managers experienced an epiphany that working from home could be productive. At the individual level, a new form of managerial discretion emerged as managers attempted to reassert authority over employees working remotely. These levels intersect, and we conclude that allowance decisions are fluid and not made solely by managers but are the result of the interactions between the organisational, group and individual levels.

JEL Codes J81, J32

Elucidating the effects of organisational practices on innovative work behavior in UAE public sector organisations: The mediating role of employees' wellbeing

In the context of the transitioning economy of the United Arab Emirates, which demands inculcating innovative behavior in public employees, this study investigates the relationship between high-involvement work practices and leaders' collaborative nature with employees' innovative behavior. Drawing on the social exchange and ability-motivation-opportunity theories, this research expounds the mediating effect of employees' wellbeing to examine the mechanisms through which high-involvement work practices and public leaders' collaborative nature affect employees' innovative behavior in public organisations. Using three-wave data from 207 individuals in public service organisations, this study tests the effects of employees' perceptions of high-involvement work practices and leaders' collaborative nature on their wellbeing and innovative work behaviors. Our findings have theoretical and practical implications for research on innovative work behavior in the milieu of public organisations.

Publicly versus privately funded cardiac rehabilitation: access and adherence barriers. A cross-sectional study

BACKGROUND

Cardiac rehabilitation (CR) barriers are well-understood in high-resource settings. However, they are under-studied in low-resource settings, where access is even poorer and the context is significantly different, including two-tiered healthcare systems and greater socioeconomic challenges.

OBJECTIVE

To investigate differences in characteristics of patients attending publicly versus privately funded CR and their barriers to adherence.

DESIGN AND SETTING

Observational, cross-sectional study in public and private CR programs offered in Brazil.

METHODS

Patients who had been attending CR for ≥ 3 months were recruited from one publicly and one privately funded CR program. They completed assessments regarding sociodemographic and clinical characteristics and the CR Barriers Scale.

RESULTS

From the public program, 74 patients were recruited, and from the private, 100. Participants in the public program had significantly lower educational attainment (P < 0.001) and lower socioeconomic status (P < 0.001). Participants in the private program had more cognitive impairment (P = 0.015), and in the public program more anxiety (P = 0.001) and depressive symptoms (P = 0.008) than their counterparts. Total barriers among public CR participants were significantly higher than those among private CR participants (1.34 ± 0.26 versus 1.23 ± 0.15/5]; P = 0.003), as were scores on 3 out of 5 subscales, namely: comorbidities/functional status (P = 0.027), perceived need (P < 0.001) and access (P = 0.012).

CONCLUSION

Publicly funded programs need to be tailored to meet their patients' requirements, through consideration of educational and psychosocial matters, and be amenable to mitigation of patient barriers relating to presence of comorbidities and poorer health status.

Trends in public sector radiological usage in the Western Cape Province, South Africa: 2009-2019

Background

Although global use of medical imaging has increased significantly, little is known about utilisation trends in low- and middle-income countries (LMICs).

Objectives

To evaluate changes over a decade in public sector diagnostic imaging utilisation at provincial level in a middle-income country.

Method

A retrospective analysis of medical imaging utilisation in the Western Cape Province of South Africa in 2009 and 2019. Use of conventional radiography, ultrasonography (US), fluoroscopy, CT, MRI, digital subtraction angiography (DSA) and whole-body digital radiography was assessed by total studies and studies/10³ people, for the whole province, the rural and metropolitan areas. Mammography utilisation was calculated for every 10³ females aged 40–70 years.

Results

The provincial population and total imaging investigations increased by 25% and 32%, respectively, whilst studies/10³ people increased by 5.5% (256 vs 270/10³), with marked variation by modality. Provincial US, CT and MRI utilisation/10³ people increased by 111% (20 vs 43/10³), 78% (10 vs 18/10³) and 32% (1.9 vs 2.5/10³) respectively, whilst use of fluoroscopy (3.6 vs 3.7/10³) and mammography (14.2 vs 15.9/10³ women aged 40–70 years) was steady and plain radiography decreased by 20% (216 vs 196/10³). For CT, mammography and fluoroscopy, percentage utilisation increases/10³ people were higher in the rural than metropolitan areas.

Conclusion

Population growth is the main driver of overall imaging utilisation in our setting. The relatively constant imaging workload per 1000 people, albeit with increasing ultrasound, CT and MR utilisation, and decreasing use of plain radiography, reflects improved provincial imaging infrastructure, and appropriate use of available resources.

The Role of Leadership in Public Sector Innovation: A Systematic Review and Meta-Analysis of the Management of COVID-19 in Asian Countries

Strong leadership in public sector innovation can empower governments to address community challenges in new ways in light of the challenges posed by the global coronavirus pandemic. Coronavirus management policy, pandemic responses, needs, and options are reflected in various Asian countries in respective published literature, but a summarized synthesis is not available. Using a systematic review approach (PRISMA), this study has analyzed the role of leadership in public sector innovation in COVID-19 management and synthesized 23 articles from 23 different Asian countries. In the light of available data, public sector innovation (PSI) and the role played by the leadership of each country' have been found to be largely inter-dependent. The current review provides a cross-section of the ongoing nature of the pandemic, as management responses and trend data in the countries are still emerging or evolving. Additionally, our study contributes a current state report regarding the barriers facing the leadership of Asian countries in mitigating the global pandemic through PSI. Our study found that a strong political leadership presence combined with a technocratic approach and a highly-skilled public sector workforce, could lead to more tremendous success in managing the outbreak. Furthermore, religious leadership was also found to have a potentially significant role in COVID-19 management strategies.

Assessment of Personality in Basque Public Sector Employees and Its Role in Predicting Organizational Citizenship Behaviors in Selection Processes

Organizational citizenship behaviors (OCBs) are an important aspect of job performance as they enhance the effectiveness of organizations. Research has shown that personality is a moderate predictor of job performance. This study, involving a sample of 678 public sector employees in the Basque Country (northern Spain), pursued two aims: First, to develop and validate a Basque-language version of the Overall Personality Assessment Scale (OPERAS), a scale designed to assess the Big Five personality factors in a wide range of settings; and second, to examine whether person-organization fit (PO fit) and adaptive performance improve the capacity of personality to predict OCBs. The results indicated that the adapted scale was a suitable instrument for assessing personality in the Basque-speaking population. Furthermore, PO fit and adaptive performance improved the capacity of personality to predict OCBs. Based on these results, we propose a new predictive model that may enhance the efficiency of personnel selection processes.

Assessment of self-reported adherence to ART and patient's virological/CD4 response in a tertiary care clinic and government free ART clinic

Introduction

Treatment adherence to antiretroviral treatment (ART) is critical in reducing morbidity, mortality, and improving the survival in HIV patients. ART is a life-long commitment, and the variety of factors can influence treatment adherence. We studied the factors affecting treatment adherence in the private sector and public sector outdoor clinic in Ahmedabad, India. The primary objective of this study is to compare the level of adherence and factors that influence adherence to ART in patients attending government run free ART program and private setup.

Methods

We conducted a cross-sectional study of 8 weeks among HIV-infected patients who were receiving ART from private clinic and free ART center from July 2019 to September 2019. We enrolled all consecutive patients >18 years of age attending both clinics. Statistical analysis was carried out using the SPSS software version 25.0. Multiple logistic regression was used to identify the factors that were independently associated with adherence to ART.

Results

The study enrolled 306 patients, 151 (49.34%) from the outpatient department of private hospital, and 155 (50.65%) from the free ART center. Patients attending private clinics were more likely to have been diagnosed with HIV since ≥10 years compared to free ART center. Higher opportunistic infection rates were found in free ART center (64.51%). Treatment adherence was significantly lower in the patients attending free ART center (P = 0.004). Patients taking concomitant medications for other comorbid conditions (≥4 pills/day) were more likely to exhibit inadequate adherence ([odds ratio] 1.216, 95% confidence interval 1.0171-1.454). Univariate analysis showed that age, education, habits of alcohol, tobacco, number of pills, and duration of disease played a significant role in predicting adherence to ART (P < 0.05).

Conclusions

Patients attending private clinic are surviving longer with HIV diagnosis, have fewer opportunistic infections, and have better treatment adherence compared to free ART clinic.

Work Engagement Among Public Employees: Antecedents and Consequences

This study is an investigation of the relationships among job meaningfulness, work engagement, and performance, including testing for a possible mediation effect of work engagement on the relationship between job meaningfulness and performance. We examine task interdependence as a boundary condition that facilitates employee engagement using two-stage multiple-source respondent data drawn from a sample of 183 Uzbek employees from public organizations and their 47 supervisors to test the hypotheses. The research findings confirm a positive association between job meaningfulness and engagement and the relationship between work engagement and performance. Mediation analysis using bootstrapping indicated that work engagement explained the influence of meaningfulness on performance. Furthermore, task interdependence negatively moderated the relationship between meaningfulness and engagement. This study responds to calls for researchers to identify the key and situational drivers of work engagement as well as examine the importance of meaningfulness in the public sector. It also increases the external validity of the findings by examining the relationship between engagement and performance in a non-Western context, namely, Islamic Uzbekistan. Despite the limitations of this research, the empirical findings contribute to the growing body of research on work engagement and meaningfulness in public organizations.

Should I Stay or Should I Go? Employment Discrimination and Workplace Harassment against Transgender and Other Minority Employees in Canada's Federal Public Service

There is a growing literature interested in the workplace experiences of transgender individuals. The biggest limitation for researchers in this field continues to be the dearth of population-level data that captures information on gender identity and employment characteristics. Using the 2017 Public Service Employee Survey, this paper explores employment discrimination and workplace harassment against gender diverse (transgender, non-binary, genderqueer) and other minority employees working in Canada's federal public service. This study finds that gender diverse employees are between 2.2 and 2.5 times more likely to experience discrimination and workplace harassment than their cisgender male coworkers. Cisgender women, visible minorities, Indigenous, and those with disabilities are also more likely to report discrimination and workplace harassment. Cisgender women and gender diverse employees who occupy multiple minority statuses may experience an additive likelihood of discrimination and harassment. This study also finds that employee retention can be improved by providing more inclusive and tolerant workplaces.

An audit of Zimbabwean public sector diagnostic ultrasound services

Introduction

the provision of basic diagnostic imaging services is pivotal to achieving universal health coverage. An estimated two-thirds of the world's population have no access to basic diagnostic imaging. Accurate data on current imaging equipment resources are required to inform health delivery strategy and policy at national level. This is an audit of Zimbabwean public sector diagnostic ultrasound resources and services.

Methods

utilising the Ministry of Health and Child Care (MHCC) database, sequential interviews were conducted with provincial health authorities and local facility managers. Ultrasound equipment, personnel and services in all hospitals and clinics, nationally were recorded, collated, and analysed for the whole country, and by province.

Results

of the 1798 Zimbabwean public sector healthcare facilities, sixty-six (n=66, 3.67%) have ultrasound equipment. Ninety-nine (n=99) ultrasound units are distributed across the sonar facilities, representing a national average of 8 units per million people. More than half the equipment units (n=53, 54%) are in secondary-level healthcare facilities (district and mission hospitals), and approximately one-fifth (n=22, 22%) in the central hospitals (quaternary level). The best-resourced province has twice the resources of the least resourced. One-hundred and forty-two (n=142) healthcare workers, from six different professional groups, provide the public sector ultrasound service. Most facilities with sonar equipment (n=64/66, 97%) provide obstetrics and gynaecology services, while general abdominal scanning is available at one third (n=22, 33%). Two facilities with ultrasound equipment have no capacity to offer a sonography service.

Conclusion

in order to reach the WHO recommendation of 20 sonar units per million people, an estimated 140 additional sonar units are required nationally. The need is greatest in Masvingo, Midlands and Mashonaland East Provinces. Task-shifting plays a key role in the provision of Zimbabwean sonar services. Consideration should be given to formal training and accreditation of all healthcare workers involved in sonar service delivery.

The intensity of COVID-19 nonpharmaceutical interventions and labor market outcomes in the public sector

This paper examines whether the intensity of nonpharmaceutical interventions (NPIs) during the coronavirus disease 2019 (COVID-19) pandemic has differentially impacted the public sector labor market outcomes. This extends the analysis of the already documented negative economic consequences of COVID-19 and their dissimilarities with a typical economic crisis. To capture the intensity of the NPIs, we build a novel index (COVINDEX) using daily information on NPIs merged with state-level data on out-of-home mobility (Google data). We show that among individuals living in a typical state, NPI enforcement during COVID-19 reduces the likelihood of being employed (at work) by 5% with respect to the pre-COVID period and the hours worked by 1.3% using data on labor market outcomes from the monthly Current Population Survey and difference-in-difference models. This is a sizable amount representing the sector with the higher job security during the pandemic. Public sector workers in a typical state are 4 percentage points more likely to be at work than salaried workers in the private sector and 7 percentage points more likely to be at work than self-employed workers (the worst so far). Our results are robust to the endogeneity of the NPI measures and present empirical evidence of heterogeneity in response to the NPIs, with those in local employment being the hardest hit.

Public-private relationship in surgical hospitalizations through the Unified Health System

OBJECTIVE

to characterize surgical hospitalizations, length of stay, cost and mortality, according to the legal nature (public and private) of the hospital institution linked to the Unified Health System (Sistema Único de Saúde, SUS). Method: a descriptive study, of the survey type, with retrospective data collection (2008 to 2017) and a quantitative approach. The dependent variables surgical hospitalizations in Brazil, costs, length of stay and mortality and the independent variables regime/legal nature (public and private) were obtained from the Informatics Department of the Unified Health System. The Mann-Whitney test was used for analysis.

RESULTS

the average number of hospitalizations through the Unified Health System was 4,214,083 hospitalizations/year, 53.5% occurred in private hired hospitals and 46.5% in public hospitals (p=0.001). The financial transfer was greater for the private sector (60.6%) against 39.4% for the public (p=0.001). The average stay was 4.5 days in the public hospital and 3.1 days in its private counterpart (p<0.001). Mortality was higher in the public (1.8%) than in the private hospital (1.4%) (p<0.001).

CONCLUSION

there was predominance of surgical hospitalizations through the Unified Health System in private hospitals with greater financial transfer to this sector, to the detriment of the public. The diverse evidence produced contributes to the debate and actions to avoid budgetary asphyxiation in the public sector in favor of the private sector.

The Implementation of a Remote Work Program in an Italian Municipality before COVID-19: Suggestions to HR Officers for the Post-COVID-19 Era

This case study describes the implementation stages and some outcomes of a remote work program that was adopted in an Italian municipality before the COVID-19 pandemic. This research used a qualitative case study approach, proposing a semi-structured interview with 14 staff members (six remote-worker employees, their respective managers, and two intermediate-level managers) about the experience with the remote work program. In addition, two researchers attended two preparatory program meetings. The evidence shows that, even before the COVID-19 pandemic, remote work was mainly performed at home, for one or two days a week. Together with their manager, remote workers decided the tasks to perform remotely and the criteria to monitor remote work. Furthermore, employees appreciated the remote work program, perceiving themselves to be more productive in their work. Elements of this case study may be relevant for companies that aim to move from an emergency to a more planned remote work.

Predictors of Parental Barriers to Reduce Excessive Child Screen Time Among Parents of Under-Five Children in Selangor, Malaysia: Cross-sectional Study

Background

Globally, there is an increasing prevalence of excessive screen time exposure among young children, including in Malaysia. Parents are advised to limit this exposure, but there are barriers for many of them to follow this recommendation. To date, there is a lack of research on the factors that cause these parental barriers.

Objective

This study aimed to determine the parental barrier toward the reduction of excessive child screen time and its predictors among parents of children aged younger than 5 years in the Petaling District, Selangor, Malaysia.

Methods

A cross-sectional study was conducted from April 2019 to June 2020 among 789 parent-child dyads attending child health clinics in the Petaling District. Validated self-administered questionnaires were used to capture information on sociodemographic, parental, child-related, and environmental factors and parental barriers. Stratified sampling with probability proportionate to size was employed. Data were analyzed using SPSS Statistics version 25 (IBM Corp). Descriptive analysis and bivariable analysis were performed before multiple linear regression was used to identify predictors of parental barriers.

Results

The overall mean score of parental barriers was 3.51 (SD 0.83), indicating that the average numbers of barriers experienced by parents were more than 3. The multivariable analysis showed that the predictors of parental barriers included monthly household income (adjusted β=–.03, 95% CI –0.05 to –0.02), parents who worked in public sectors (adjusted β=.18, 95% CI 0.06 to 0.29), positive parental attitude on screens (adjusted β=.68, 95% CI 0.58 to 0.79), low parent self-efficacy to influence child’s physical activity (adjusted β=–.32, 95% CI –0.43 to –0.20), and child screen time (adjusted β=.04, 95% CI 0.02 to 0.06).

Conclusions

The strongest predictor of parental barriers to reduce excessive child screen time was the positive parental attitude on screen time which could contribute to their abilities to limit child screen time. Thus, future intervention strategies should aim to foster correct parental attitudes toward screen time activities among young children.

Supportive management practice and intrinsic motivation go together in the public service

Drawing on over 4,000,000 individual and 2,000 agency observations across five countries, this paper examines the relationship between features of an employee's work environment and intrinsic motivation in public agencies. It finds that practices which foster employees' sense of autonomy, competence, and relatedness are associated with substantially higher levels of intrinsic motivation across a broad range of settings. This is true both at the individual and agency level and when examining changes within agency over time. These patterns appear to be at least partially a result of differential selection in and out of the agency, with lower levels of supportive practices associated with greater desire to exit for employees with higher levels of intrinsic motivation. Nonfinancial elements of job design are strongly associated with intrinsic motivation, as are potentially more difficult to alter features of an agency, such as satisfaction with compensation and managerial quality. There is also suggestive evidence that the relationship between agency practices and employee intrinsic motivation is stronger when tasks are more difficult to monitor.

Pain in Multiple Sites and Clusters of Cause-Specific Work Disability Development among Midlife Municipal Employees

This study investigates to what extent pain in multiple sites and common risk factors related to work environment, occupational class and health behaviours are associated with cause-specific work disability (WD) development clusters. The study population was derived from the Finnish Helsinki Health Study (n = 2878). Sequence analysis created clusters of similar subsequent cause-specific WD development in an eight-year follow-up period. Cross-tabulations and multinomial logistic regression were used to analyze the extent to which baseline factors, including pain in multiple sites, were associated with the subsequent WD clusters. A solution with five distinct WD clusters was chosen: absence of any WD (40%), low and temporary WD due to various causes (46%), WD due to mental disorders (3%), WD due to musculoskeletal (8%) and WD due to other causes (4%). Half of the employees in the musculoskeletal WD cluster had pain in multiple locations. In the adjusted model the number of pain sites, low occupational class and physical working conditions were linked to the musculoskeletal WD. The identified characteristics of the different WD clusters may help target tailored work disability prevention measures for those at risk.

Perspectives of the public dental workforce on the dental management of people with special needs

BACKGROUND

People with special health care needs continue to have difficulties accessing regular dental care partly due to oral health professionals feeling they lack the knowledge and experience to provide treatment to these individuals.

METHODS

Qualitative interviews and focus groups provided an insight into the types and nature of supports that oral health professionals working in the Australian public dental system desired and felt may improve their willingness and/or ability to treat patients with special needs.

RESULTS

Although participants did not identify one group of patients with special needs that were more difficult to treat, they did report a feeling of being unsupported. Clinicians felt that improved training and access to ongoing education in Special Needs Dentistry, opportunities for greater support from specialists or other health professionals, either through networking or other media such as telehealth, and fostering a more supportive clinical environment, particularly in relation to appointment lengths and productivity pressures, may improve their willingness and ability to treat patients with special needs.

CONCLUSIONS

Additional support, in the form of greater interaction with specialists and reduced time and productivity pressures, may improve the willingness of oral health professionals in the public dental system to treat patients with special needs.