Can Cyprus overcome its health-care challenges?

Can Cyprus overcome its health-care challenges?

South Africa is an upper middle–income country with a population of 59.6 million people (1). Gauteng is the most densely populated province, and houses 26% of the population, followed by KwaZulu-Natal (19%), and the Western Cape (12%). About 29% of the population are <15 years old and 9% are ≥60 years. Approximately 13% of the population are seropositive for HIV. Life expectancy is estimated at 68.5 years for females and 62.5 years for males, whereas the infant mortality rate is 23.6 per 1000 live births. In 2019, the gross national income per capita was approximately $6040 (Atlas method, current US$), with 8% of the country’s gross domestic product spent on health care (2). Despite the transition to democracy in 1994, a high level of inequality remains, reflected in a Gini coefficient of 0.63 and an unemployment rate of 30% (2,3). This inequality is also reflected in a two-tiered health system. Access to a well-resourced private health care sector depends on the ability to pay for services, usually via medical insurance. Treatment for CKD is included in the set of “prescribed minimum benefits” that all registered medical insurance schemes in South Africa are obliged to provide for their members. The majority of South Africans (84%), however, are dependent on an under-resourced, government-funded, public health care sector. Public health care facilities use a sliding scale, where the fees charged are dependent on income. Indigent patients are able to access services free of charge (4). South Africa is faced with a high burden of infectious diseases (such as tuberculosis and HIV infection), noncommunicable diseases, maternal and childhood diseases, and injury-related diseases (5). These factors drive an epidemic of AKI and CKD. Two studies have estimated the population prevalence of CKD in South Africa. Adeniyi et al. (6) reported the …

Mothers and infants to get free health care in Sierra Leone

Global health governance and the World Bank

Investigating the most Important Advantages, Disadvantages and Obstacles of Public-Private Sector Partnership in Providing Primary Health Care Services from the Viewpoint of Health Managers

BACKGROUND Breast cancer is the most common cancer among Brazilian women. HER-2 targeted therapy improves overall survival in HER-2 overexpressing patients but immunohistochemistry testing for HER2 is not standardized in Brazil and is not available universally. In Brazil the health system includes a public and private sector. The aim of our study was to delineate the patterns of testing of HER-2 over time in Brazil in both of these settings and to determine if any disparities exist in testing and treatments received. METHODS Observational, retrospective study involving practice patterns of over 2000 cancer physicians in Brazil. We obtained de-identified data from a commercial database, which included 54,829 patients with breast cancer treated between 2012 and 2016. We analyzed the frequency of HER-2 testing, the percentage of positive results and the most common treatments used in the first line setting in both the private and public sector. The chi-squared test was used for proportions. RESULTS HER-2 testing was frequently performed in both the private and public sector (87% vs. 81%, p&amp;lt;0.0001. Between 2012 and 2016 most patients had HER-2 testing (88%, 73%, 79%, 90% and 88%, respectively) but coverage was not universal. The percentage of HER-2 positivity was 25%. The most common first line regimens used were docetaxel/trastuzumab, paclitaxel/trastuzumab and trastuzumab monotherapy. In the private sector trastuzumab/pertuzumab/docetaxel was the most commonly used regimen. In the public sector taxanes were frequently used as monotherapy without HER-2 targeted therapy. CONCLUSIONS To our knowledge this is the largest dataset assessing HER-2 testing and treatment patterns in Brazil. The frequency of testing has remained stable over the last 5 years, but is higher in the private sector and this finding was highly statistically significant. There are also differences in the regimens used in the private vs. public sector. Pertuzumab was approved in 2013 in the US and its use has increased in Brazil over the last two years. This trend however was only seen in the private sector. In the public sector there is still significant use of chemotherapy without HER-2 directed therapy despite HER-2 overexpression, which is possibly related to the restricted access of anti-HER2 therapy in the public health system for metastatic patients. Taxanes are used widely in both the public and private sector, which is possibly related to the availability of generics. HER 2 Testing in the Public Sector20122013201420152016Tested4,2853,7114,5924,6884,126%92%76%80%94%91%Non Tested36211441134322428%8%24%20%6%9%Total4,6474,8555,7265,0104,554 HER 2 Testing in the Public Sector20122013201420152016Tested5,3913,9964,9175,2084,945%85%71%78%87%85%Non Tested9491,6611,367761842%15%29%22%13%15%Total6,3405,6576,2845,9695,787 Citation Format: Palacio S, Torres A, Prado E, Lopes G. Breast cancer in Brazil: HER-2 testing and treatment patterns [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-20.

The aim of this article is to examine the existing military balance of power on the island and whether Turkey, as one of the guarantors of the 1960 Cyprus Republic, would need to establish a military base on the island due to the hydrocarbon-derived crisis taking place in the Eastern Mediterranean and the special military agreements unilaterally signed by Greek Cypriot Administration (GCA) with other countries against Turkey and Turkish Republic of Northern Cyprus (TRNC). The scope of this article is to elaborate the military bases and forces on the island, the military agreements signed by the both parties, Greek Cypriots and Turkish Cypriots, the balance of power of each side, effects of the hydrocarbon resources within the Exclusive Economic Zones (EEZ) of Turkey, TRNC and GCA, the international crisis on the verge to arise from the overlapping EEZ’s of Turkey, TRNC and GCA and the military co-operation need of TRNC with Turkey, to withstand the possible military threats of GCA and allies. The major findings on the issue reveal a unique military structure in the island never seen in the history of the world before. According to the 1960 Constitution of the Republic of Cyprus, announced on 16 August 1960, there exists three different military forces on the Cyprus island. First one is the British Sovereign bases consisted of Akrotiri and Dhekelia. The second one is the Greek Regiment of 950 personnel and the third is the Turkish Regiment of 650 personnel. In addition to these, there is the Greek National Guard Army, which has approximately 120,000 personnel where 80 percent of the officers of the Greek Cypriot National Guards are officers from the Greek Armed Forces of Greece. The Turkish Cypriot Security Forces of 5000 personnel and the Turkish Peace Force of 24,000. And there is the United Nations Force in Cyprus (UNFICYP) as an unbiased, neutral military force. The Greek Cypriot Administration (GCA) is continuing its activities starting from 1963 to bring its presence on the island to the point of ownership and to take over the entire island of Cyprus. At the beginning of the twentieth century, with the encouragement and support of the powerful European States, the Greeks stepped on the shores of Anatolia on May 15, 1919, in order to seize the whole of Western Anatolia and reestablish the “Great Hellen Empire”. With the aim of capturing the island of Cyprus and realizing enosis, unification with motherland Greece, as one of the steps of their “Great Ideal”, on July 15, 1974, with the support of the Colonel’s junta in Greece, the Greeks had organized a coup in Cyprus and declared unilaterally “The Cyprus Hellenic Republic”. “The Cyprus Hellenic Republic” had lost its validity and took its place in the dusty pages of history, after the intervention of Turkey, under Article 4 of Addendum 1 of “Guarantees and Treaty of Alliance” in accordance with international law, who was one of the Guarantor powers of Republic of Cyprus, declared on August 16, 1960. After this intervention two different administrations, Greek Cypriot Administration and Turkish Cypriot Administration were formed on the island. Greek Cypriots have since adopted a strategy that seeks to take over the entire island, including its Exclusive Economic Zone. The Greek Cypriots and Greeks, who could not realize the unification of Cyprus with Greece according to the Megali Idea “Great ideal” which was declared in 1796, after the intervention of Turkey, in accordance with international law in July 20, 1974, have begun attempts to remove the relevant item in the Constitution of the Republic of Cyprus, to avoid the intervention of Turkey again in their next attempt to capture and dominate the Cyprus island. In addition to their attempts to avoid the intervention of Turkey in the future, the Greeks had determined the strategy to give permission to some of the member states of European Union to use their naval and air ports whenever they needed, to guarantee their military support, if one day they are forced to enter into armed conflict with Turkey. For this reason, some of the member countries of European Union and some others have the right to use military facilities or existing air and sea ports within the borders of Greek Cypriot Administration (GCA). As a result, it turns out that the Turkish Cypriots need to take counter measures in spite of the attempts of Greek Cypriots and Greece to take over the whole island. One of these measures is the military alliance agreement to be signed by Turkey, who for the time being possesses one of the most powerful armies of the region, and Turkish Republic Northern Cyprus (TRNC) allowing building a military air and naval base with in their territories. This article has been prepared for the purpose of better investigation and evaluation of this subject. The conclusion of this article puts forward the everlasting will of Greek Cypriots to get hold of the Cyprus island and government in full, The Turkish Cypriots and Turkey’s deliberate opposition to this will and their efforts to block it, the international political crisis originated from the hydrocarbon resources in the Eastern Mediterranean, and the strategies of USA, EU and Russia to have some legal rights directly or indirectly on the regional energy resources.

BackgroundMaintaining sufficient health care workforce is a global priority to achieve universal health coverage. Therefore this study addresses the availability of physiotherapists in Brazil.ObjectiveTo describe secular trends of the physiotherapy workforce-to-population ratio in the Unified Health System, considering public and private sector and care level (primary, secondary, tertiary) in Brazil and its regions.MethodDescriptive exploratory quantitative study based on secondary sources. All data related to the distribution of physiotherapists between August 2007 and September 2016 regarding facilities types, location and public and private sectors was obtained from the Brazilian National Registry of Health Care Facilities. Data related to the population of Brazil was extracted from Brazilian Institute of Geography and Statistics. The physiotherapy workforce-to-population ratio was calculated by the number of physiotherapists per 1000 population (public and private sector and care level) by ANOVA test. The distribution trends are represented on maps. Annual growth rates were estimated with Prais–Winsten linear regression models, with a significance level of 0.05, autocorrelation was checked by the Durbin–Watson test.ResultsThe physiotherapists ratio in Brazil was 0.22/1000 population in 2007 and 0.41 in 2016, showing growth of 86%, with an increasing trend of 0.5% on an annual average. The public sector had the biggest physiotherapy workforce in the country in 2007 and 2016. The primary health care had the smallest physiotherapy workforce-to-population ratio (2007: p > 0.001 and 2016: p = 0.003), even though it had the largest growth trend in annual average (0.9% p > 0.001), followed by public and private tertiary health care sectors (0.8% p > 0.001). The workforce in secondary health care was bigger in the private sector than in the public sector (0.6% p > 0.001 vs. 0.2% p = 0.004). Overall, all regions had greater growth of physiotherapy workforce-to-population ratio in public primary and tertiary health care sectors, and private secondary health care sector, mainly the Southeast, South and Central-West regions.ConclusionAlthough the physiotherapy workforce in Brazil is relatively small, there was a trend towards growth with differences among care levels, and public and private sectors. The physiotherapy workforce-to-population ratio is bigger in the private secondary health care sector, followed by public tertiary, secondary and primary health care sectors. Sub-national regions show similar trends to the national estimates, with minor variations by region.

Purpose : Strategic performance measurement and management (SPMM) as a subject has come over increased research radar over the last four or so decades. The so-called “performance measurement revolution” of the 1980s to 1990s concentrated on the private sector. “Business managerialism” and “accountingisation” kicked-in into the public sector with transplanting of hitherto private sector management techniques under New Public Management (NPM) and other administrative reform programmes by various governments internationally. Specifically, the 1990s saw the implementation of modern multi-dimensional SPMM systems originally in the private sector. Considering the nuanced nature of the public sector, the transfer of SPMM systems from the private to the public sector has not been straightforward due to technical, conceptual and behavioral factors. This paper contrasts the features of the private and public sectors and investigates the implication of the distinctive nature of the public sector on the application of SPMM in the public sector. This will augment our perceptions and comprehension of existing public sector SPMM theory and practice. Design/Methodology/Approach: The study adopted a systematic literature review (SLR), a mode of research which has been widely adopted and strongly justified for adoption in business and management research since the turn of the 21st century. The study conducted a content and thematic analysis on the commonalities and differences between private and public sectors and implication of the differences on public sector strategic performance measurement and management. The study itself covered 233 published and unpublished documents covering the seven decades to 2023 which to our knowledge constitutes the most comprehensive update on the public-private debate trends to date. Findings: The study thoroughly interrogated the literature perspectives or models on the commonalities and differences between the public and private sectors. The study then deep-dived into the underlying characteristics which differentiate the public and private sectors producing one of the most detailed side-by-side analyses of public-private differentiation based on organisational characteristics, dimension, or concept of all time. The systematic review further identified and derived several thematic areas related to public-private differences and went on to establish the implications of the public-private divergences from an SPMM perspective especially as it relates to the derivation and application of public sector performance measures. These findings are critical for both practitioners and academics as they explore the subject of transplanting private sector SPMM practices into the public sector which is another overripe area for research. The findings provide public managers with a comprehensive and critical cog in their management toolbox as they navigate the practical realities and difficulties of implementing SPMM in the public sector’s unique and complex environment. Research Limitations: The main challenge with conducting a comprehensive research of this magnitude relates mainly to the broad range of literature covered, the unwieldy and onerous analysis and lots of judgement calls which could impact bias and replicability. Practical Implications - This paper conducts a comparative analysis of the key features of the private and public sectors found in the literature and evaluates how they drive attendant management practices in the two sectors and specifically how the public sector’s distinctive nature impacts on the measures of performance. Originality/value - Studying the differences and how they impact the choice of public sector KPIs is crucial in attempting to address the myriad of challenges and potential hindrances to future institutionalisation of SPMM in contemporary PSOs. Exploring and understanding the differences and similarities between public and private sectors is a beneficial springboard to cultivate erudition, cross-pollination and facilitation of knowledge transfer between the two sectors of the contemporary global political economy. Keywords: Strategic, performance management, performance measurement, performance measures, key performance indicators, public-private differences DOI: 10.7176/PPAR/13-2-03 Publication date: March 31 st 2023

What Really Matters for Cancer Care – Health Systems Strengthening or Technological Innovation?

South Africa rolls out pilot health insurance scheme

Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON

In Venezuela, two public-health systems grow apart

How did Sierra Leone provide free health care?

BackgroundLittle is known about the contributions of faith-based organisations (FBOs) to health systems in Africa. In the specialist area of eye health, international and domestic Christian FBOs have been important contributors as service providers and donors, but they are also commonly critiqued as having developed eye health systems parallel to government structures which are unsustainable.MethodsIn this study, we use a health systems approach (quarterly interviews, a participatory sustainability analysis exercise and a social network analysis) to describe the strategies used by eye care practitioners in four hospitals of north-west Tanzania to navigate the government, church mission and donor rules that govern eye services delivery there.ResultsPractitioners in this region felt eye care was systemically neglected by government and therefore was ‘all under the NGOs’, but support from international donors was also precarious. Practitioners therefore adopted four main strategies to improve the sustainability of their services: (1) maintain ‘sustainability funds’ to retain financial autonomy over income; (2) avoid granting government user fee exemptions to elderly patients who are the majority of service users; (3) expand or contract outreach services as financial circumstances change; and (4) access peer support for problem-solving and advocacy. Mission-based eye teams had greater freedom to increase their income from user fees by not implementing government policies for ‘free care’. Teams in all hospitals, however, found similar strategies to manage their programmes even when their management structures were unique, suggesting the importance of informal rules shared through a peer network in governing eye care in this pluralistic health system.ConclusionsHealth systems research can generate new evidence on the social dynamics that cross public and private sectors within a local health system. In this area of Tanzania, Christian FBOs’ investments are important, not only in terms of the population health outcomes achieved by teams they support, but also in the diversity of organisational models they contribute to in the wider eye health system, which facilitates innovation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12961-016-0137-9) contains supplementary material, which is available to authorized users.