Benefit Package Research Articles

Cervical cancer screening program in Indonesia: is it time for HPV-DNA tests? Results of a qualitative study exploring the stakeholders’ perspectives

ObjectivesCervical cancer is a significant public health concern in Indonesia, and effective screening methods are necessary to improve the detection and reduce mortality. This study aimed to explore the perspectives of high-level stakeholders involved in cervical cancer screening in Indonesia and whether the use of human papillomavirus-deoxyribonucleic acid (HPV-DNA) methods for cervical cancer screening is acceptable in Indonesian settings.MethodsA qualitative research approach guided by realist evaluation was applied using focus group discussions (FGDs) between December 2021 and February 2022, conducted with stakeholders involved in cervical cancer screening in Indonesia. They were representatives of practitioners and policymakers involved in the screening, and were recruited through purposive recruitment. The data were analysed using inductive approach of thematic analysis.ResultsThe analysis of two FGDs with 29 participants identified four main themes: (i) Visual inspection with acetic acid (VIA) method as the most common modality used for cervical cancer screening, (ii) the applied screening programs in the community, (iii) the perceived challenges on the screening program, such as limitations of the National Health Insurance benefits package and a lack of regulations regarding screening procedures, and (iv) the possibilities of HPV-DNA testing as another modality for cervical cancer screening. Incorporating HPV-DNA testing also needs to ensure the capacity of the workers and the readiness of healthcare facilities.ConclusionAlthough HPV-DNA testing is a promising modality, challenges on the cervical cancer screening in Indonesia remain on the coverage, accessibility of the tools in practice and the women’s awareness towards the screening. Ultimately, the findings of this study would help inform policies to improve cervical cancer screening programs in Indonesia.

Citizen engagement in national health insurance in rural western Kenya.

Effective citizen engagement is crucial for the success of social health insurance, yet little is known about the mechanisms used to involve citizens in low- and middle-income countries. This paper explores citizen engagement efforts by the National Health Insurance Fund (NHIF) and their impact on health insurance coverage within rural informal worker households in western Kenya. Our study employed a mixed methods design, including a cross-sectional household survey (n = 1773), in-depth household interviews (n = 36), six focus group discussions with community stakeholders and key informant interviews (n = 11) with policymakers. The findings reveal that NHIF is widely recognized, but knowledge of its services, feedback mechanisms and accountability systems is limited. NHIF enrolment among respondents is low (11%). The majority (63%) are aware of NHIF, but only 32% know about the benefit package. There was higher awareness of the benefit package (60%) among those with NHIF compared to those without (28%). Satisfaction with the NHIF benefit package was expressed by only 48% of the insured. Nearly all respondents (93%) are unaware of mechanisms to provide feedback or raise complaints with NHIF. Of those who are aware, the majority (57%) mention visiting NHIF offices for assistance. Most respondents (97%) lack awareness of NHIF's performance reporting mechanisms and express a desire to learn. Negative media reports about NHIF's performance erode trust, contributing to low enrolment and member attrition. Our study underscores the urgency of prioritizing citizen engagement to address low enrolment and attrition rates. We recommend evaluating current citizen engagement procedures to enhance citizen accountability and incorporate their voices. Equally important is the need to build the capacity of health facility staff handling NHIF clients in providing information and addressing complaints. Transparency and information accessibility, including the sharing of performance reports, will foster trust in the insurer. Lastly, standardizing messaging and translations for diverse audiences, particularly rural informal workers, is crucial.

Adjustments in purchasing arrangements to support the COVID-19 health sector response: evidence from eight middle-income countries.

The COVID-19 pandemic has triggered several changes in countries' health purchasing arrangements to accompany the adjustments in service delivery in order to meet the urgent and additional demands for COVID-19-related services. However, evidence on how these adjustments have played out in low- and middle-income countries is scarce. This paper provides a synthesis of a multi-country study of the adjustments in purchasing arrangements for the COVID-19 health sector response in eight middle-income countries (Armenia, Cameroon, Ghana, Kenya, Nigeria, Philippines, Romania and Ukraine). We use secondary data assembled by country teams, as well as applied thematic analysis to examine the adjustments made to funding arrangements, benefits packages, provider payments, contracting, information management systems and governance arrangements as well as related implementation challenges. Our findings show that all countries in the study adjusted their health purchasing arrangements to varying degrees. While the majority of countries expanded their benefit packages and several adjusted payment methods to provide selected COVID-19 services, only half could provide these services free of charge. Many countries also streamlined their processes for contracting and accrediting health providers, thereby reducing administrative hurdles. In conclusion, it was important for the countries to adjust their health purchasing arrangements so that they could adequately respond to the COVID-19 pandemic, but in some countries financing challenges resulted in issues with equity and access. However, it is uncertain whether these adjustments can and will be sustained over time, even where they have potential to contribute to making purchasing more strategic to improve efficiency, quality and equitable access in the long run.

Willingness to pay for Social Health Insurance and associated factors among Public Civil Servants in Ethiopia: A systematic review and meta-analysis.

The provision of equitable and accessible healthcare is one of the goals of universal health coverage. However, due to high out-of-pocket payments, people in the world lack sufficient health services, especially in developing countries. Thus, many low and middle-income countries introduced different prepayment mechanisms to reduce large out-of-pocket payments and overcome financial barriers to accessing health care. Though many studies were conducted on willingness to pay for social health insurance in Ethiopia, there is no aggregated data at the national level. Therefore, this systematic review and meta-analysis aimed to estimate the pooled magnitude of willingness to pay for social health insurance and its associated factors among public servants in Ethiopia. Studies conducted before June 1, 2022, were retrieved from electronic databases (PubMed/Medline, Science Direct, African Journals Online, Google Scholar, and Web of Science) as well as from Universities' digital repositories. Data were extracted using a data extraction format prepared in Microsoft Excel and the analysis was performed using STATA 16 statistical software. The quality of the included studies was assessed using the Newcastle-Ottawa Scale for cross-sectional studies. To evaluate publication bias, a funnel plot, and Egger's regression test were utilized. The study's heterogeneity was determined using Cochrane Q test statistics and the I2 test. To determine the pooled effect size, odds ratio, and 95% confidence intervals across studies, the DerSimonian and Laird random-effects model was used. Subgroup analysis was conducted by region, sample size, and publication year. The influence of a single study on the whole estimate was determined via sensitivity analysis. To estimate the pooled magnitude of willingness to pay for the Social Health insurance scheme in Ethiopia, twenty articles with a total of 8744 participants were included in the review. The pooled magnitude of willingness to pay for Social Health Insurance in Ethiopia was 49.62% (95% CI: 36.41-62.82). Monthly salary (OR = 6.52; 95% CI:3.67,11.58), having the degree and above educational status (OR = 5.52; 95%CI:4.42,7.17), large family size(OR = 3.69; 95% CI:1.10,12.36), having the difficulty of paying the bill(OR = 3.24; 95%CI: 1.51, 6.96), good quality of services(OR = 4.20; 95%CI:1.97, 8.95), having favourable attitude (OR = 5.28; 95%CI:1.45, 19.18) and awareness of social health insurance scheme (OR = 3.09;95% CI:2.12,4.48) were statistically associated with willingness to pay for Social health insurance scheme. In this review, the magnitude of willingness to pay for Social Health insurance was low among public Civil servants in Ethiopia. Willingness to pay for Social Health Insurance was significantly associated with monthly salary, educational status, family size, the difficulty of paying medical bills, quality of healthcare services, awareness, and attitude towards the Social Health Insurance program. Hence, it's recommended to conduct awareness creation through on-the-job training about Social Health Insurance benefit packages and principles to improve the willingness to pay among public servants.

Evaluation of employee turnover among public secondary teachers in Kisii Central District, Kisii County, Kenya

Knowledge and expertise have become essential components of wealth growth and development that organizations continue to foster employee retention. Statistics show that over 800 teachers quit to pursue other opportunities, making delivering services in Kenyan schools hard. The study aimed to identify factors that influenced turnover among secondary school teachers. The Study's survey research design was cross-sectional. Three hundred seventy-six teachers from 47 public secondary schools attended. A sample of 188 teachers was recruited using a planned stratified random sample of 47 principals and 141 teachers. A self-administered questionnaire was used. The Chi-square test determined the impact the characteristics had on the turnover of trained teachers. The findings established that coming up with a professional path, developing attractive compensation, inspiring teachers to stick to their positions at work, boosting teacher evaluations, and finding ways to communicate, have a significant positive effect, for they helped reduce labour turnover. The study recommends that managers strengthen professional development programs, salary and benefits packages, a positive work environment, performance evaluations that work, communication channels, and leadership possibilities. The study is novel in identifying specific geographical dynamics important in turnover mitigation. It also analyzes interconnected elements contributing to labour turnover and suggests complicated mitigation approaches to assist policy development and resources

Scoping Review of International Experience of a Dedicated Fund to Support Patient Access to Cancer Drugs: Policy Implications for Thailand

Background: Access to high-cost cancer drugs is an unsolved problem globally. The dedicated drugs fund is attractive and feasible. This study reviewed currently implemented dedicated drugs fund worldwide to inform policy implications for Thailand. Methods: A scoping review was conducted to identify countries currently implementing dedicated funds for cancer drugs. We searched electronic databases, PubMed and Embase, from 2010 to May 2021, Google and Google Scholar in August 2021, and government websites up to April 2022. The structure, management, cost containment strategies, and impact of dedicated funds were summarized and compared across the identified countries and Thailand. Results: Out of 218 nations, Hong Kong, England, and Italy have established dedicated cancer drugs fund, primarily funded by their governments. Funds in England and Italy operate within annual budget limits. Hong Kong relies on an endowment fund. In England and Italy, pharmaceutical companies contribute proportionally to cover overspending as per risk-sharing agreements, while cost-sharing is not required. Hong Kong implements cost-sharing based on a patient's family income. England and Italy employ a parallel pathway, utilizing the same drug selection committee to determine whether innovative drugs belong in the regular pharmaceutical benefits package or the dedicated drugs fund. Hong Kong follows a sequential pathway, allowing drugs to be considered for the dedicated funds after a negative decision. These countries use the fund for 5-11 years, making administrative adjustments to ensure sustainability. Conclusion: The dedicated drugs fund is an effective strategy to improve access to non-reimbursable high-cost drugs in Thailand. Robust evaluation of the fund itself and funded drugs are recommended for policymakers’ better decision-making. Learning from other countries can offer promising solutions. Health insurers need to balance providing cancer treatments with overall system preparedness.

Managed competition in Colombia: convergence of public and private insurance and delivery.

The Colombian health system has made a deep transition into managed competition since a major reform in 1993. A market for insurers was created, the consumer has free choice of insurer and a national-level equalisation fund distributes revenues via a per-capita payment. Fully subsidised insurance for the poor and informal, and a comprehensive standardised benefit package for subsidised and contributory schemes (both schemes covering 98 per cent of the population), has led to a low level of out-of-pocket expenses and high financial protection, as well as to reduced gaps in equity in access. The preconditions for managed competition are largely met, but improving health care providers' organisation towards integrated care, to enable them to deliver more value, is a necessary step to achieve the expected results of managed competition in terms of efficiency and quality. Although the current system is likely to be reformed in the coming months, the nature and extent of those reforms are not defined yet, so our analysis is based on the current system.

The impact of an ‘evergreening’ strategy nearing patent expiration on the uptake of biosimilars and public healthcare costs: a case study on the introduction of a second administration form of trastuzumab in The Netherlands

In this paper, we explore dynamic market share and public healthcare costs of trastuzumab’s evergreening (subcutaneous) variant during introduction of trastuzumab’s competitive biosimilar variants in the Netherlands. We used a time series design to assess dynamic market share of trastuzumab’s evergreening variant after introducing trastuzumab’s biosimilar variants, focusing on the number of treatments and patients. The public healthcare costs of this evergreening strategy were estimated using administrative claims data. Our results show that the original trastuzumab was completely replaced by the subcutaneous and biosimilar variants. The uptake of the subcutaneous form peaked at 50% market share but after the introduction of biosimilars progressively reduced to a market share of 20%, resulting in a more competitive market structure. The public healthcare costs for trastuzumab significantly decreased after the introduction of the biosimilars. After the introduction of the biosimilars, a substantial price drop is visible, with the subcutaneous version, still under patent, also falling sharply in price but less strongly than the iv/biosimilar version. As the costs are publicly funded, we recommend a more explicit societal debate to consider if the potential benefits of subcutaneous Herceptin® (and other similar medicines) are worth the additional costs, and at which price it should be reimbursed as the part of the benefit package.

Determinants of community-based health insurance membership renewal decision among rural households in Kellem Wollega zone, Oromia regional state, Ethiopia: a community-based cross-sectional study.

Despite the fact that community-based health insurance (CBHI) is a promising program to achieve the goal of universal health coverage (UHC), it faces challenges that are not only due to low enrollment but also due to membership renewal decision that impact its sustainability. Hence, the study aimed to identify the determinants of CBHI membership renewal decision among rural households in Kellem Wollega zone, Ethiopia. The study was conducted in Kellem Wollega, Ethiopia, among rural households from March 30-April 30, 2022, using a community-based cross-sectional study design. An interviewer-administered structured questionnaire through face-to-face interviews was used. Using a systematic random sampling method, 551 households were selected making 540 (98%) response rates. The data was entered into EPI Data 3.1 and analyzed using SPSS 25 software. Descriptive statistics, binary, and multiple logistic regressions were performed. Using multiple logistic regressions, a significant association between the CBHI membership renewal decision and independent variables was identified, declaring the statistical significance level using a 95% confidence interval (CI) at p < 0.05. The overall rate of CBHI membership renewal decision among households was estimated to be 365 (67.6%, 95% CI = 63.7-71.5%). The factors that significantly influenced the households' membership renewal decision were family size (AOR = 0.46, 95% CI = 0.25-0.86), low literacy status (AOR = 0.28 95% CI = 0.12-0.64), lower than middle-level of wealth index (AOR = 9.80, 95% CI = 2.75-34.92), premium affordability (AOR = 4.34, 95% CI = 2.08-9.04), unavailability of services (AOR = 0.26, 95% CI = 0.12-0.55), trusting in health facilities (AOR = 5.81, 95% CI = 2.82-11.94), favorable providers' attitude toward members (AOR = 8.23, 95% CI = 3.96-19.64), good quality of service (AOR = 4.47, 95% CI = 2.28-8.85) and health care seeking behavior (AOR =3.25, 95% CI = 1.32-7.98). The overall CBHI membership dropout decision rate among rural households was high, which could affect health service provision and utilization. Therefore, the insurance scheme and contracted health facilities should consider and work on family size and wealth status when membership premiums are calculated, the education level of households when creating awareness about the scheme, building trust in the contracted health facilities by providing all promised benefit packages of health services with good quality, and improving the attitude of health care providers towards the scheme members.

Why Was the Policy Idea on the Health Benefits Package Advisory Panel Gazetted in Kenya? A Retrospective Policy Analysis.

In 2018, Kenya's Ministry of Health (MoH) gazetted the Health Benefits Package Advisory Panel (HBPAP) to develop a benefits package for its universal health coverage (UHC) programme. In this study, we examine the political process that led to the gazettement of the HBPAP. We conducted a case study based on semi-structured interviews with 20 national-level participants and, reviews of documents such as organizational and media reports. We analyzed data from the interviews and documents thematically using the Braun and Clarke's six step approach. We identified codes and themes deductively using Kingdon's Multiple Streams Theory which postulates that the successful emergence of a policy follows coupling of three streams: the problem, policy, and politics streams. We found that the problem stream was characterized by fragmented and implicit healthcare priority-setting processes that led to unaffordable, unsustainable, and wasteful benefits packages. A potential policy solution for these problems was the creation of an independent expert panel that would use an explicit and evidence-based healthcare priority-setting process to develop an affordable and sustainable benefits package. The political stream was characterized by the re-election of the government and the appointment of a new Cabinet Secretary for Health. Coupling of the problem, policy, and political streams occurred during a policy window that was created by the political prioritization of UHC by the newly re-elected government. Policy entrepreneurs who included health economists, health financing experts, health policy analysts, and health systems experts leveraged this policy window to push for the establishment of an independent expert panel as a solution for the issues identified in the problem stream. They employed strategies such as forming networks, framing, marshalling evidence, and utilizing political connections. Applying Kingdon's theory in this study was valuable in explaining why the HBPAP policy idea was gazetted. It demonstrated the crucial role of policy entrepreneurs and the strategies they employed to couple the three streams during a favourable policy window. This study contributes to the body of literature on healthcare priority-setting processes with an unusual analysis focused on a key procedural policy for such processes.

Cost-utility analysis of proton beam therapy for locally advanced esophageal cancer in Japan.

Proton beam therapy (PBT) has recently been included in Japan's health insurance benefit package for certain cancer types. This study aimed to determine the cost-effectiveness of PBT as a replacement for conventional three-dimensional conformal radiotherapy (3D-CRT) for locally advanced esophageal cancer (LAEC) that is not covered by social insurance. We estimated the incremental cost-effectiveness ratio (ICER) of PBT as a replacement for 3D-CRT, using clinical evidence from the literature and expert opinions. We used an economic model, decision tree, and Markov model to illustrate the courses followed by patients with LAEC. Effectiveness was estimated as quality-adjusted life years (QALY) using utility weights for the health state. Social insurance fees were calculated as costs. We assumed two base cases depending on the two existing levels of fees for PBT in social insurance: 2,735,000 Japanese yen (US$20,652) or 1,600,000 yen (US$13,913). The stability of the ICER against these assumptions was appraised using sensitivity analysis. The effectiveness of PBT and 3D-CRT was 2.62 and 2.51 QALY, respectively. The estimated ICER was 14,025,268 yen (US$121,958) per QALY for the higher fee level and 7,026,402 yen (US$61,099) for the lower fee level. According to the Japanese threshold for cost-effectiveness of anticancer therapy of 7,500,000 yen (US$65,217) per QALY gain, the inclusion of PBT for LAEC in the benefit package of social insurance is cost-effective if a lower fee is applied. PBT is a cost-effective alternative to 3D-CRT for LAEC and making it available to patients under social insurance could be justifiable.

Leviathan

Would you want to live forever? In this work of philosophical short story fiction, the narrator works at a technology company that has created Leviathan, a technology system that allows people, when they die, to have their mind uploaded to a virtual space for a fee. In this virtual space they continue to live their lives as 0’s and 1’s. They watch TV, shop, work, and continue forever. The narrator’s job is to check in on the customers, and make sure they aren’t unhappy, or otherwise breaking their environment by killing their pets, or burning down their own house on purpose. His coworker doesn’t believe in the company’s mission, but works there because it pays better than her last job. Her opinion falters when she is diagnosed with cancer. One day she doesn’t come to work and the narrator is left to wonder if she accepted the employee uploaded benefits package that each of them are offered.

Strengthening Public Financing of Primary Healthcare in India: A Perspective.

Resilient and high-performing health systems that can respond to the global polycrisis hinge upon the effectiveness of their primary healthcare (PHC) system. This requires adequate and sustainable financing for PHC, which should be predominantly government financed. The recent Ayushman Bharat health reforms in India aim to ensure comprehensive PHC services and enhance financial risk protection through increased government financing. The government has augmented investments to fortify the PHC system by establishing Health and Wellness Centers (HWCs), equipped with an expanded benefit package for PHC services & human resource capacity. Aligned with the National Health Mission's targeted and flexible financial mechanisms, this offers States the opportunity to contextualize solutions and offer incentives to healthcare workers. However, aligning public financing arrangements to service delivery complexities and health outcomes pose intricate challenges in shaping the required reforms. The economic growth and room for increased taxation on health products provide an avenue for increased funding. Smart and efficient payment mechanism with improved accountability should complement increased investment.

Fostering Flexibility: How Medicare Advantage Potentially Accelerated Telehealth Benefits.

In 2018, the US Congress enacted a policy permitting Medicare Advantage (MA) plans to cover telehealth services in a beneficiary's home and through audio-only means as part of the basic benefit package of services, where prior to the policy change such benefits were only allowed to be covered as a supplemental benefit. MA plans were afforded 2 years of lead time for strategizing, negotiating, and capital investment prior to the start date (January 1, 2020) of the new coverage option. Our data analysis found basic benefit telehealth was offered by plans comprising 71% of enrollment in 2020 and increased to 95% in 2021. At the same time, remote access telehealth was offered as a supplemental benefit for 69% of enrollees in 2020, a decrease of 23% compared to 2019. These efforts by MA plans may have enabled traditional Medicare (TM) to leverage an existing telehealth infrastructure as a solution to the access issues created by public health policies requiring sheltering in place and social distancing during the COVID-19 pandemic. The success of this MA policy prompts consideration of additional flexibility beyond the standard basic benefit package, and whether such benefits reduce costs while improving access and/or outcomes in the context of a managed care environment like MA. Subject to oversight, such flexibility could potentially improve value in MA, and facilitate future changes in TM, as appropriate.

Establishing a Health Technology Assessment Evidence Ecosystem in India’s Pradhan Mantri Jan Arogya Yojana

ABSTRACT The introduction of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) scheme in India was a significant step toward universal health coverage. The PM-JAY scheme has made notable progress since its inception, including increasing the number of people covered and expanding the range of services provided under the health benefit package (HBP). The creation of the Health Financing and Technology Assessment (HeFTA) unit within the National Health Authority (NHA) further enhanced evidence-based decision-making processes. We outline the journey of HeFTA and highlight significant cost savings to the PM-JAY as a result of health technology assessment (HTA). Our paper also discusses the application of HTA evidence for decisions related to inclusions or exclusions in HBP, framing standard treatment guidelines as well as other policies. We recommend that future financing reforms for strategic purchasing should strengthen strategic purchasing arrangements and adopt value-based pricing (VBP). Integrating HTA and VBP is a progressive approach toward health care financing reforms for large government-funded schemes like the PM-JAY.

The Evolution of Health Benefits Packages in Colombia: Thirty Years of Successes and Failures

ABSTRACT Health benefits packages in Colombia—what is covered, by whom, and at what cost—have evolved over the past thirty years. Coverage changed from two explicit health benefits packages (with benefits linked to ability to contribute) to an implicit approach that covers, in theory, everything for everyone, excluding a narrow negative list of services and health technologies. This article explores the evolution of priority setting in Colombia during two periods of major reform. Each period had its own advantages and disadvantages associated with different institutional arrangements, processes, and methodologies. Colombia’s evolution provides several lessons for other low- and middle-income countries interested in institutionalizing evidence-based priority-setting.

Влияние компенсационной политики на удержание персонала

Retention is one of the key fundamentals that are necessary for organizational success. In a globalized environment, retention and engagement of high prospective employees are a huge challenge to International corporations. In many cases, even engaged employees are sometimes dissatisfied with the outcomes of organizational performance which may lead them to look elsewhere. Due to these reasons, this paper investigates compensation factors and policies that influence employee retention and examines their impacts on both International Corporations and employees. For the purpose of this study primary data was used. The ex-post facto method was employed. The population consists of the members of staff of Guinness International PLC Plant, Lagos Nigeria. Yamane formula was adopted to determine the sample size. The data was analyzed using manual and electronic based methods through the data preparation grid and statistical package for the social sciences (SPSS). Linear regression analysis method which also makes use of ANOVA was employed to test the hypothesis. The study found out that salary in compensation policy have effect on employee job security and also allowance affect job satisfaction Thus, the study recommends that International Corporations should identify those benefits which have more influence on employee retention. Furthermore, International Corporations need to revisit their present benefits package to identify those benefits which are not useful in order to replace them.

Revitalizing community forestry in the Amhara Region of Ethiopia: A property right perspective

Severe deforestation, land degradation, and the lack of forest products in Ethiopia have necessitated the implementation of a community forestry program since the 1980s by mobilizing the local communities. However, there have been incidents indicating that many of the community forests are either degrading or remaining unproductive. While community forests are, in principle, the collective property of the local community, empirical evidence concerning how property rights impact their management and their role in enhancing rural livelihoods and environmental rehabilitation is lacking. This study aims to investigate the performance of community forestry through the lens of property rights and tenure security, in order to uncover the challenges impeding community forestry in Ethiopia, with a focus on community forests in the Amhara Region. The study gathered primary data on community forest management from two community forests located in East Gojam and North Wollo, using questionnaires, focus group discussions, key informant interviews, and field observations. Additionally, secondary data on legal frameworks were collected from institutions involved in community forestry. The data analysis employed descriptive statistics and thematic analysis. The findings of the study revealed that a majority of respondents (91%) lacked clarity regarding the objectives of establishing community forests, and about 95% claimed that community forests belong to the state. These incidents have led to diminished interest in continuing the program. The study highlighted that the community forestry program suffers from inadequate policy and legal provisions, chronic institutional instability, overlapping mandates, and limited community engagement. These factors have weakened property rights, which are reflected in tenure insecurity and the absence of individual household benefit packages. Consequently, it can be concluded that community forest interventions have been promoted based on general belief in the importance of trees for rural livelihoods and ecosystem rehabilitation, rather than as part of a deliberate and directed policy and strategy. In summary, revitalizing community forestry in Ethiopia necessitates a thorough understanding of property rights and tenure security issues. In this regard, it is imperative for government agencies to enact a clear national strategy for community forestry development and adopt a supportive role to enable communities to establish robust community forestry institutions to safeguard their rights while fostering community forestry and environmental protection activities.

VIRTUAL COMPREHENSIVE GERIATRIC ASSESSMENT FOR VETERANS: AN INTERDISCIPLINARY QUALITY IMPROVEMENT PILOT PROJECT

Abstract The Veterans Millennium Health Care and Benefits Act requires comprehensive geriatric assessments (CGA) to be provided to all older Veterans as part of the Veterans Medical Benefits Package. Access to a CGA may be difficult for Veterans with limited ability to travel. Currently, in the North Florida/South Georgia (NFSG) Veterans Health System, approximately 11,500 older Veterans are recognized to be at high risk for hospitalization or placement in a long-term care facility, yet only 0.09% of them have received a CGA. NFSG Geriatrics and Extended Care (GEC) developed a standardized virtual CGA process to increase access to geriatric specialty care utilizing VA Video Connect (VVC). The project design and implementation included: the development of a standard operating procedure using evidence-based screening tools, templates, clinic grids and flowcharts, communication channels, and the development of a dashboard for data collection. In addition, the VHA National CGA Template was piloted. This novel Tele-Geriatrics virtual interdisciplinary project allows older Veterans and/or caregivers to remain at their homes for all telehealth/virtual sessions completed by the CGA interdisciplinary team, including pharmacy, nursing, social work, occupational therapy, and geriatric providers. The project demonstrates increased access to comprehensive assessments, consequently closing the gap between current practice and the Veterans Millennium Health Care and Benefits Act requirements. The pilot also decreased the health disparities of rural Veterans. Furthermore, this project helped to increase Veteran knowledge of geriatric syndromes, VA resources, participation in telehealth, and access to durable medical equipment (DME) to help Veterans age in place.

Impact of Pay Satisfaction on Employee Engagement and Employee Intention to Turnover

Purpose: The purpose of this research paper was to investigate the impact of pay satisfaction on employee engagement and employee intention to turnover. &#x0D; With the current tight labor market, competition for top talent is fierce. Organizations that can offer competitive pay and benefits packages are more likely to attract and retain the best employees. High turnover rates can be costly for organizations, both in terms of the direct costs of recruiting and training new employees, as well as the indirect costs of lost productivity and customer service. By offering competitive pay, organizations can reduce turnover rates and keep their best employees. Employee engagement is crucial for organizational success. Pay satisfaction is one of the key drivers of employee engagement, so organizations that can offer competitive pay and benefits are more likely to have engaged employees who are more productive and provide higher quality customer service. Design/Methodology/Approach: This study is exploratory study and was conducted on the employees of the five private banks in Mumbai. A sample of 200 employees was randomly selected to study their pay satisfaction, employee engagement and turnover intention. Originality/value The study surveyed impact of pay satisfaction on employee engagement and turnover intentions of employees.