Financial Challenges Research Articles

Navigating vaccine procurement and financing challenges in Cameroon: Insights and recommendations from a mixed-methods study (2015–2020)

ObjectivesVaccine stockouts at the national level has been recognized as a critical challenge in ensuring sustained and equitable immunization coverage. These stockouts often arise from inherent issues within countries, including delays in government funding, suboptimal forecasting and stock management practices, and inefficiencies in the procurement process amongst others. Understanding the complexities and barriers within vaccine procurement and financing systems is crucial for developing effective strategies to enhance vaccine availability and strengthen immunization programs. This is particularly relevant in the context of reaching zero dose children and transitioning from Gavi. This study aimed to comprehensively assess the vaccine procurement and financing landscape in Cameroon from 2015 to 2020. Study designThis was a descriptive cross-sectional study. MethodsEmploying a mixed-methods approach, we conducted a desk review of pertinent documents and engaged in in-depth interviews with key stakeholders involved in the procurement and funding mobilization processes. Through data collection and analysis using Microsoft Excel 365 and Dedoose software, we delineated the intricacies of the procurement process and pinpointed specific barriers that have contributed to vaccine stockouts. ResultsThe mapping of vaccine procurement processes revealed complexity, protracted timelines, and the involvement of multiple stakeholders. The Expanded Program on Immunization (EPI) faced a USD 4 million funding deficit for vaccine procurement between 2016 and 2019. Consequently, the program experienced delays in acquiring 20 million vaccine doses, leading to 41 months of stockout for at least one antigen. Major bottlenecks identified by key stakeholders in vaccine procurement and financing encompassed delayed fund mobilization, inefficient and lengthy processes for fund mobilization and disbursement, poor data utilization, and discrepancies between forecasted, allocated, and mobilized funds. ConclusionThe findings of this research hold significant implications for many EPIs. By elucidating procurement and financing challenges, we can formulate evidence-based recommendations aimed at optimizing resource allocation, streamlining procurement processes, and bolstering vaccine availability. These insights are essential for fostering collaboration between government agencies, technical partners, and financial partners to achieve sustainable vaccine access in Cameroon. Establishing a joint procurement working group could streamline processes, potentially reducing stockouts and improving vaccine coverage.

Diversity of fish otoliths from the Gulf of Mexico and the Caribbean Sea: Report on the first digital collection of fish otoliths (Actinopterygii) from the Atlantic region of Mexico

The Otolith Collection of Fishes from the Gulf of Mexico and Caribbean Sea was created with the objective to conserve and illustrate the diversity of these structures from species living in the Gulf of Mexico, the Caribbean Sea, and the freshwater and brackish systems of the Yucatan Peninsula, incorporating morphological descriptions and morphometric data. Otoliths, non-skeletal calcareous structures that develop in the inner ear of fish, are essential for balance and hearing. They have become pivotal tools for age and growth determination, population analysis, and ecological, trophic, and archaeological studies due to their resistance to degradation and the extensive information they provide about the environment and physiology of fish. The collection now includes otoliths from 214 species, representing 67 families, obtained through sampling campaigns and collaborations with local fishermen. The otoliths are extracted using techniques that ensure the integrity of the structures for later preservation. High-resolution images were obtained using optical and scanning electron microscopy, and these images are stored in an online database. This database facilitates research and teaching by providing public access to digital specimens and associated data. In addition to fostering academic development, this collection represents a significant step towards the creation of a national platform for otolith data analysis, aligned with international efforts to digitize biological collections. Despite the financial and logistical challenges involved in building and maintaining biological collections, this collection demonstrates its value as an essential resource for taxonomic, systematic, and ecological studies, as well as for biodiversity education and awareness. The online availability of the collection not only facilitates access to data but also promotes innovation and international collaboration in the study of fishes and their habitats.

Assessing contextual factors influencing scale-up: a interactive approach involving stakeholders

Abstract Issue Pilot interventions are not always put into practice at scale. When they are, effectiveness is often highly reduced in the field due to contextual factors. To effectively implement a scale-up, stakeholders’ involvement is crucial. Curema is an international research evaluating an intervention aiming to reduce malaria transmission by distributing RDTs and treatments in mobile hard-to-reach populations. This intervention might be scaled-up in Brazil, Suriname, and French Guiana as a tool of national malaria programs for specific areas and populations. Description of the problem An interactive pre-planning assessment was conducted involving key stakeholders -implementers, decision-makers, and researchers - in working sessions, semi-structured interviews, and formal meetings. Mendelow’s Power/Interest Matrix was used to map stakeholders and a SWOT analysis was conducted using ExpandNet/WHO Framework to evaluate contextual factors and identify levers and obstacles influencing the scale-up. Results A total of 23 participants were involved. Health authorities had high power and generally high interest, while implementers and recipients had lower power and different interest levels. National engagement for WHO E2025 or E2030 enhanced scalability and represented a main opportunity in the three countries. Nevertheless, several regulatory and administrative aspects were identified as potential obstacles to be addressed to make scale-up realistic. Funding was also a major concern for sustainability. The need for regional cooperation was emphasized to achieve malaria elimination. Lessons Despite financial and regulatory challenges, a window of opportunity is open to scale-up Curema. Identifying and involving stakeholders in a pre-planning assessment and advocating for foster regional cooperation are crucial steps to support the scale-up. Stakeholder analysis should be refined during the scaling-up to capture further changes in factors that might influence the process. Key messages • Engagements with WHO represent windows of opportunity to enhance Curema scale-up. • Stakeholder involvement and regional cooperation are crucial for scaling up Curema in Brazil, French Guiana and Suriname.

Living with Dementia: exploring the challenges and needs of informal Dementia caregivers in Portugal

Abstract Background Dementia profoundly impacts not only those diagnosed but also their informal caregivers. The Nova Center for Global Health at NOVA-IMS, in collaboration with the Alzheimer Portugal Association, embarked on a comprehensive study to explore the various aspects of daily life that affect informal caregivers of people with dementia in Portugal. Understanding these impacts is important for developing targeted interventions that address the caregivers’ needs effectively, particularly given the current lack of research on informal dementia caregivers. Methods The study utilized a crafted survey developed through initial scripting on key topics identified by informal caregivers and validated by experts on dementia. This phase was followed by a series of in-depth interviews with professionals in neurology, psychology, and social work, as well as with the caregivers themselves. The final survey was distributed among members of the Alzheimer Portugal Association and other volunteers, resulting in 305 valid responses. Results Preliminary findings reveal significant emotional, physical, and financial challenges faced by caregivers, underlining the diverse needs across 14 key areas of their lives. The study highlights specific areas where support is lacking, providing a grounded basis for developing more effective support mechanisms. Conclusions The ‘Living with Dementia’ project underscores the complex reality faced by informal caregivers. It calls for innovative, practical solutions that can alleviate the burden on these caregivers and improve their quality of life. By addressing the specific needs identified through this research, policy-makers and support organizations can better tailor their interventions to help those at the front lines of caregiving in dementia. Key messages • Informal caregivers of people with dementia face challenges that necessitate a comprehensive understanding to tailor effective support systems. • Interventions are needed that address the emotional, physical, and financial hardships caregivers face, improving their overall well-being and capacity to care.

A Critical Study of Psychology of Retail Investors

This research critically examines the psychology of retail investors, focusing on the behavioural finance approach to investment decision-making. Behavioral finance challenges the traditional assumption that investors are always rational, proposing instead that psychological, social, and cultural factors influence financial behaviours. The study aims to explore how demographic factors such as gender, age, and investment experience, along with macroeconomic conditions like interest rates and inflation, shape retail investors' decision-making processes. By analysing both quantitative and qualitative data from surveys and questionnaires, the study seeks to uncover patterns in how emotions, cognitive biases, and social networks affect investment choices across different groups. The scope of this research extends to identifying significant variations in investment behaviour based on demographics and cultural influences. Moreover, the study will test hypotheses related to gender differences in the influence of peers and interest rate changes on investment decisions. Through a mixed-methods approach, this research aspires to provide valuable insights for financial institutions and individual investors, enhancing their understanding of the psychological drivers behind market behaviour and investment strategies.

Beyond the Ire of Flames: Work Experiences of Bureau of Fire Protection (BFP) Station Chiefs

Fire occurrences have significantly risen in recent years. These fires endanger lives, cause economic damage, and harm the environment. Uncontrolled fires are a major reason for building collapses and injuries. Building fires cause trauma due to the loss of belongings and the building itself. Existing fire safety systems are failing due to unaddressed factors causing building fires (Rathnayake et al., 2020). This study explored the experiences of the station chiefs of the Bureau of Fire Protection in Iloilo Province, Philippines, through a qualitative research method. The participants of this study were the selected ten (10) BFP station chiefs. All participants were subjected to an individual in-depth interview. The findings of this study are described in emergent themes. Six (6) emergent themes described the positive and negative experiences of the informants in the performance of their duties. For the positive experiences, two (2) emergent themes were developed, namely Personal Satisfaction Through Job Fulfillment and Workplace Camaraderie and Support. For the negative experiences, four (4) emergent themes were also developed, namely: Inadequate Resources and Financial Challenges, Complexity of Leadership and Personnel Management, Bombarded with Public Dissatisfaction, and Operational Delays and Equipment Failures. Meanwhile, three (3) emergent themes were formulated to explain how the participants address the challenges encountered in the performance of their duties, namely: Empowering Collaboration and Support Networks, Bolstering Preventive Measures and Education, and Embodying Resilience and Adaptability. Finally, three (3) emergent themes were created to express the aspirations of participants to improve the quality of their services, namely Continuous Training and Professional Development, Adequate Fiscal Allocation and Service Facilities, and Improvement of Personnel and Staffing Issues. Based on the emergent themes identified, it is recommended that the fire station chiefs be enhanced by providing them with specialized training and career development programs. This can be accomplished by the successful integration of the latest firefighting technologies in the specialized training to enhance the response effectiveness of their station.

Empowering marginalised communities: Leveraging indigenous knowledge for sustainable energy development in South Africa

AbstractAmidst South Africa's volatile energy landscape—characterised by political turbulence, economic instability and Eskom's chronic financial and operational challenges—the imperative for transformative reform is both urgent and indispensable. Municipalities are confronted with deteriorating infrastructure, recurrent power disruptions and widespread electricity theft, which collectively exacerbate the national energy crisis. This paper investigates the integration of indigenous knowledge systems within the country's energy sector as a strategic response to these persistent challenges, promoting the empowerment of marginalised communities and advancing environmental sustainability. Anchored in the theoretical frameworks of environmental justice and indigenous rights, the paper advocates for Afrocentric paradigms such as traditional resource governance and community‐driven energy solutions. Employing thematic analysis of secondary data, it evaluates the viability and prospective benefits of this paradigm shift. The paper posits that the inclusion of indigenous knowledge in energy practices not only presents tangible solutions to the energy crisis but also cultivates socio‐economic empowerment and reinforces environmental stewardship.

Significant challenges facing small institutions in America

AbstractThe landscape of higher education in the United States currently comprises 5918 institutions serving approximately 18.1 million students. Among them, 1833 are small institutions with full‐time equivalent enrollments of 3000 or less. In this article, the authors examine financial and enrollment challenges facing small institutions and the potential impact of these challenges.

The Effect of Financial Education on the FinancialLiteracy of the Millennial Generation

This study aims to analyze the influence of financial education on the financial literacy of the millennial generation. Millennials face increasingly complex financial challenges as access to digital financial products and consumptive lifestyles increases. Good financial literacy is needed so that they are able to make wise financial decisions, save, and invest for the future. This study uses a quantitative approach by collecting data through a survey involving 121 millennial respondents who have participated in financial education programs. Data analysis was carried out using SPSS version 25 software and linear regression methods to test the relationship between financial education and financial literacy levels. The results of the study show that financial education has a significant positive influence on millennial financial literacy. These findings underscore the importance of financial education programs in improving the financial understanding of millennials so that they are better prepared to face complex financial decisions. This research is expected to be a reference for policymakers and educational institutions in designing more effective financial literacy programs to support the financial well-being of the millennial generation.

An examination of caregiver burden and contributing factors in cases of congenital microtia deformity.

This study aimed to assess the burden and influencing factors among primary caregivers of children with congenital microtia. A total of 153 primary caregivers of children with congenital microtia who underwent auricular reconstruction surgery at a tertiary A-grade hospital in Xi'an between October 2019 and August 2022, were recruited using convenience sampling. The Zarit Caregiver Burden Interview (ZBI) was employed to evaluate caregiver burden. While convenience sampling allowed for the practical recruitment of participants, its limitations include potential selection bias, which may affect the generalizability of the results. The mean total ZBI score was 30.07 ± 12.29. Among the participants, 26 caregivers (17.0%) reported no burden, 102 caregivers (66.7%) reported mild burden, 22 caregivers (14.4%) reported moderate burden, and 3 caregivers (2.0%) reported severe burden. Multivariate regression analysis identified several significant factors influencing caregiver burden, including the location and severity of the lesion, educational level, method of medical payment, monthly household income, communication with others about the child's condition, caregiver self-blame or guilt, and family support (all P < .05). Primary caregivers of children with congenital microtia face substantial burdens, emphasizing the need for targeted healthcare interventions. Strategic approaches are essential to address the psychological, social, and financial challenges they encounter. Future research should focus on longitudinal studies and interventions to enhance caregiver well-being and patient outcomes. However, caution is advised when generalizing these findings due to the sampling limitations.

Factors influencing the adoption of extended reality (XR) applications in libraries for sustainable innovative services: a systematic literature review (SLR)

Purpose This study aims to identify the factors influencing the adoption of extended reality (XR) applications in libraries for sustainable innovative services and reveal the challenges of adopting XR technology in libraries. Design/methodology/approach A systematic literature review was applied to address the study’s objectives. The 26 most relevant seminal studies published in peer-reviewed journals were selected to conduct the study. Findings The findings showed that access to digital collections, skill development, marketing, innovation and sustainable development factors influence the adoption of extended reality applications in libraries. The study illustrated that technical challenges, financial challenges, the unavailability of staff expertise and lack of institutional support caused barriers to the adoption of XR in libraries. Originality/value The study has added valuable literature to the existing body of knowledge. It has provided a framework to efficiently adopt extended reality in libraries for the delivery of sustainable, innovative services to library patrons.

EMD combined with ensemble of machine learning predictors for foreign exchange rate forecasting

Forecasting foreign exchange rates is a critical financial challenge. In this paper, we build on recent trends and address the limitations of prior research by proposing a novel approach. Our method combines empirical mode decomposition (EMD) with ensemble of machine learning predictors in foreign exchange rate forecasting. To demonstrate that our proposed method (called EMD-ML) is effective, we used the new approach to forecast six foreign exchange rate time series at a specific time. The first experiment was implemented to compare the proposed forecasting model EMD–LSTM, which combines empirical mode decomposition (EMD) with ensemble of Long Short-Term Memory (LSTM) models, and the single LSTM model. The results indicate that the proposed EMD–LSTM model is more effective than the single LSTM. Besides, to aim at comparing deep-learning models against shallow machine learning models in combination with the EMD decomposition, the second experiment compared EMD-LSTM with the approach which combines EMD with an ensemble of k-nearest neighbors’ predictors (called EMD-KNN method) and the results of the second experiment show that EMD-LSTM cannot outperform EMD-KNN in foreign exchange rates forecasting.

Strategic Navigation of Firm-Specific Risks: A Comprehensive Analysis of Corporate Finance Challenges and Solutions

Abstract: This paper delves into the multifaceted nature of firm-specific risks (FSRs) within corporate finance, highlighting operational, financial, and strategic risks as pivotal challenges confronting companies across industries. Through detailed examinations of scenarios ranging from regulatory hurdles in the pharmaceutical industry to cyber threats in retail and currency fluctuations impacting multinational corporations, this study elucidates the intricate web of internal and external factors contributing to FSR. Furthermore, it explores the critical role of corporate governance, emphasizing board structure, transparency in financial reporting, and robust internal controls in effectively managing these risks. By integrating advanced data analytics and risk modeling with comprehensive risk management frameworks, the paper showcases strategies for identifying, assessing, and mitigating FSRs, thereby enhancing corporate resilience and strategic agility. This analysis not only contributes to the academic discourse on risk management but also offers practical insights for practitioners aiming to fortify their organizations against the unpredictability of the business landscape.

Research on the Risk Management of International Engineering Project Financing

Abstract: Against the backdrop of the "Going Global" strategy's continuous advancement and the rapid integration of the international economy, China's development prospects in the realm of international engineering contracting and investment appear highly promising. Currently, in the implementation of international engineering projects, construction contracting enterprises regularly participate in project financing to alleviate funding challenges faced by project owners. Within the context of international engineering project financing, an array of risks is inevitably encountered. Among these, the most prominent risks include political, legal, market, performance, economic, construction, and operational risks, among others. Through the analysis of various risk factors presented in this paper, the aim is to enhance the understanding of international engineering contractors regarding the intricacies of these multifaceted risk elements. Subsequently, corresponding mitigation strategies are proposed to empower project operators in effectively managing and guarding against these multifaceted risks.

Current Situation of Digital Inclusive Finance in China

Inclusive finance is not only an innovation in financial service concepts but also an institutional arrangement to address the imbalance in social and economic development. Therefore, it is particularly necessary to study the current development status, development level, and challenges of inclusive finance and to conduct research on these issues. Overall, inclusive finance has demonstrated a positive momentum of development, but improvements are still needed in terms of market players, products and services, and the external ecosystem. China’s inclusive finance is still in its infancy, making it essential to accelerate its development and promote inclusive finance in the country.

An ecosystem of interconnected technologies to increase efficiencies in blood establishments: The example of the Blood and Tissue Bank of Aragón, Spain.

Blood establishments face environmental, financial, demographic and societal challenges that may impair sustainable blood supply to patients. This study presents the technologies (devices and software) assembled in a global ecosystem implemented by the Blood and Tissue Bank of Aragón (BTBA), Spain, over the last decade to overcome these challenges. Descriptive yearly activity data (2013-2023) of BTBA were retrospectively collected to evaluate the impact of different technologies on blood processing efficiency, focusing on the production of blood components (red blood cell concentrates [RCCs], platelet concentrates [PCs]) and plasma. Operator satisfaction about the technologies introduced in daily routine work was also monitored. Between 2013 and 2023, the annual production decreased by 16.0% for RCCs and increased by 13.3% for PCs. From 2020, all PCs were treated with pathogen reduction technology, and no inventory stock-out was reported. The lowest PC expiry rate (0.2%) was observed after the implementation of the software for blood processing and PC stock management. The deployment of this software also improved plasma recovery: on average, an extra plasma volume of 9 mL was collected per donation in 2023 compared to 2015. A survey confirmed staff satisfaction. The progressive implementation of automated and software-based solutions was key to increasing efficiencies in BTBA. This enabled the optimization of blood processing by maximizing productivity, enhancing traceability, reducing overproduction and wastage and increasing the yield of recovered plasma, while ensuring blood product safety and staff satisfaction.

Peer support groups and care burden in hemodialysis caregivers: a RCT in an Iranian healthcare setting

BackgroundChronic renal failure poses a significant global health challenge, exerting a substantial burden on both patients and their caregivers. Hemodialysis, a common treatment for end-stage renal disease, imposes extensive physical, emotional, and financial pressures on caregivers, often leading to a high care burden. This study uniquely examines the impact of peer support groups on reducing the care burden among caregivers of patients receiving hemodialysis in an Iranian healthcare setting, an aspect that has not been extensively explored before.MethodsA parallel-controlled clinical trial was conducted involving 60 caregivers, divided into intervention and control groups. The intervention group participated in an 8-session peer support program tailored to their identified needs, including coping with stress, social isolation, and financial challenges. The Zarit Care Burden Interview Scale was used to measure care burden before and after the intervention.ResultsThe study revealed statistically significant reductions in care burden, particularly in physical, social, and emotional dimensions, among caregivers in the intervention group compared to the control group. The total care burden score showed a marked decrease, indicating the effectiveness of the peer support intervention. While economic challenges remained a concern, the intervention had a limited impact in this domain.ConclusionThis study demonstrates that peer support groups significantly alleviate the care burden experienced by caregivers of patients receiving hemodialysis, improving their well-being across several dimensions. The findings highlight the importance of integrating peer support strategies into healthcare programs for chronic disease management and underscore the need for supplementary economic support measures to comprehensively address caregivers’ needs. Future research should explore the scalability and long-term sustainability of such interventions and address the unique economic challenges faced by these caregivers.Trial registrationThis study was registered in the Iranian Registry of Clinical Trials (IRCT) under the registration number IRCT20220724055540N1 on 11/08/2022.

Exploring the risks of fragmentation in health care markets – An analysis of inpatient care in Georgia

Private providers play an important role in health systems in low-and middle-income countries. In many such contexts, markets are characterized by a high number of relatively small private facilities. The potential risks from highly concentrated healthcare markets are well-researched, and feature in the “Theories of Harm” investigated by competition regulators. However, there is limited evidence on markets that exhibit substantial harms as a result of very low concentration. This paper explores the risks associated with such market fragmentation, drawing on the example of Georgia, which has a largely privatized provider network.We used a mixed-method study design to analyze the inpatient market in Georgia. Market structure was described using administrative data on bed capacity and discharge numbers and geo-location data on travel time between facilities. The implications of the market structure were explored through in-depth interviews (n = 35) with policymakers, healthcare managers, and local experts and an anonymous online survey of similar groups (n = 97).Georgia's inpatient sector is characterized by a high number of small hospitals in terms of bed numbers and inpatient volumes, mitigated to a limited degree by the presence of provider networks. Travel time to the 3rd nearest competitor was extremely short, ranging from 3 to 5 min in big cities to 10 min in small towns and 33 min in remote locations. The fragmented nature of the market, together with inadequate regulatory and purchasing mechanisms, was argued to exacerbate challenges in the availability and competence of clinical staff, while the financial challenges caused by intense competition encouraged wasteful marketing, harmful cost-cutting measures, and demand inducement.We present “Theories of Harm” from market fragmentation, and argue that an effective policy response requires market-shaping activities using regulatory, financing, and purchasing mechanisms to encourage appropriate levels of market consolidation and so enhance quality, efficiency, and effective governance.

The cost of COVID-19 vaccine delivery in Bangladesh

ABSTRACT COVID-19 vaccination has been instrumental in fighting the pandemic, but evidence on the actual costs associated with delivering these vaccines in resource-constrained settings has been limited. We estimated the cost of delivering COVID-19 vaccines in Bangladesh through five delivery strategies in 2021 and 2022, including Ministry of Health (MOH) hospitals, non-MOH government hospitals, outreach at Expanded Program on Immunization (EPI) centers, mass campaigns, and schools. This was a bottom-up costing study, estimating costs from a payer and beneficiary perspective. We also mapped the funding flows for COVID-19 vaccination activities and analyzed programmatic and financial challenges. The economic cost incurred by the health system to deliver COVID-19 vaccines was $1.05 per dose, excluding vaccine costs. This was made up of a financial cost of $0.29 per dose and an opportunity cost of $0.75 per dose. School-based delivery incurred the lowest financial cost of $0.27, while outreach at EPI centers incurred the highest at $0.44 per dose. The low financial cost per dose is attributed to the high daily volumes delivered at sampled sites, minimal additional resources provided to sites to implement the COVID-19 vaccination program, and a reliance on the existing workforce. Beneficiaries spent an average of $1.63 to receive a single dose of COVID-19 vaccination at fixed sites, with transport representing the largest cost driver ($0.75 per dose). The economic cost to receive one dose of the COVID-19 vaccine was $4.78. Findings can support the Government of Bangladesh to make efficient and equitable resource allocation decisions for vaccination programs.

The Role of Technology in Promoting Green Finance: A Systematic Literature Survey and the Development of a Framework

Green finance, defined as channeling money into sustainable development activities, is still far lower than needed to achieve net-zero emissions objectives. In this paper, we discuss the role of technologies in developing green finance. We identify that green finance faces three major challenges, including the risk management of green projects, the scarcity of innovative green financing products, and compliance with the regulations. Then, in the context of the existing literature, we explore recent technologies, including blockchain, artificial intelligence (AI), machine learning (ML), data analytics, Internet of Things (IoT), and robotics that are helping to deal with the challenges in green finance. We show that data-driven approaches utilizing AI and ML help in the risk assessment of green projects; FinTech-based crowdfunding platforms provide innovative green financial products and regulatory technologies (RegTech) support in compliance with regulations. We also identify that the environmental footprint of cryptocurrencies is an emerging area in the technologies and green finance domain. Our framework could be helpful to further extend the debate on the role of technology in green finance.