Demand For Public Services Research Articles

Dual Clinical Practice (DCP) policy to improve the retention of human resources for health in Rwanda: a mid-term review using a cross-sectional and retrospective study design

BackgroundDespite the high demand for public services globally, ensuring the quality of services provided by public health facilities is challenging. Poor remuneration of public sector health care providers (HCPs) drives their migration to private health facilities. The Dual Clinical Practice (DCP) Policy in Rwanda represents a strategic initiative aimed at retaining healthcare professionals in public health facilities, allowing them to engage in private practice concurrently. This study assesses the implementation challenges and identifies opportunities for potential reformulation of DCP schemes.MethodsThis study employed a mixed methods approach, incorporating both cross-sectional and retrospective designs across six Rwandan public hospitals. Quantitative and qualitative data were collected through key informant interviews (KIIs) and joint interviews (JIs), as well as through the analysis of health facility records obtained from the Health Management Information System (HMIS) and the Electronic Medical Record (EMR). Qualitative data were analyzed using Atlas.ti software, while quantitative data were analyzed using Microsoft Excel.ResultsThe study involved participants from six Rwandan hospitals, including 20 healthcare providers and 32 patients. Qualitative results revealed that a substantial majority of health care providers supported the DCP policy, with a high patient satisfaction rate of 81% regarding DCP services. However, challenges emerged, including limited awareness of the policy and difficulties in tracking DCP engagements. Quantitative data from the HMIS and EMR indicated an increase in patient enrollment across most facilities, with DCP outpatient visits accounting for a significant percentage of total visits in some hospitals. While the DCP contributed positively to hospital revenues, concerns about the sustainability of the scheme and the adequacy of health care remuneration were highlighted, calling for a review of DCP policy involving stakeholders beyond the Ministry of Health.ConclusionThis study found that the DCP policy in Rwanda positively impacted healthcare provider retention, patient satisfaction, and hospital revenues. Providers expressed strong support for the policy, and patient satisfaction was high, with 81% of patients reporting positive experiences with DCP services. The scheme contributed to increased patient enrollment and hospital revenue, particularly in urban facilities. However, challenges, such as limited awareness of the policy among healthcare providers and difficulties in tracking DCP engagements, were noted. Additionally, concerns about the sustainability of the DCP and the adequacy of healthcare remuneration highlighted the need for policy revisions. To address these challenges, a collaborative approach involving stakeholders such as tax authorities, hospital administrations, and health insurance companies is necessary. Additionally, our study highlights the critical role of investments in physical infrastructure to support the long-term success of DCP. Enhancing infrastructure would not only ensure better healthcare quality but also support the retention of providers in both urban and rural settings.

Factors associated with adolescent pregnancy among girls aged between 15 and 19 years in Muhanga district, Rwanda

BackgroundAdolescent pregnancy, also known as teenage pregnancy, is an unwanted pregnancy affecting girls aged 15–19 years. With a global prevalence of 25%, Africa has 18.8% of female adolescents become pregnant, preventing them from a better standard of living, such as good education and parental care, and adolescent pregnancy, which poses health risks, educational and career disruptions, financial strain, and lower academic achievement, while also increasing public costs and social service demand. This study aimed to determine the prevalence and factors associated with adolescent pregnancy among girls aged 15–19 years in Muhanga district, Rwanda.MethodsThe study involved 392 female adolescents aged 15–19 years in Muhanga district, Rwanda. The participants were selected through a multistage sampling method, and the study ensured voluntary participation whereby the assent and consent forms were signed. Data were collected through questionnaires and analyzed via STATA v.18, and statistical analysis, including chi-square tests and multivariate logistic regression, was used to control for confounders. Ethical approval was obtained from Mount Kenya University and Muhanga district administration.ResultsThe study reported an adolescent pregnancy rate of 10.7% (95% CI: 7.7–13.7). Adolescents financially supported by others (not their parents or guardians) had higher odds of having pregnancy (AOR = 3.9, 95% CI: 1.431–10.467, p < 0.01). Those not in school and primary school showed higher odds of having a pregnancy (AOR = 23.76, 95% CI: 6.833–82.630, p < 0.001) and (AOR = 25.60, 95% CI: 7.224–90.741, p < 0.001), respectively, compared to those in secondary school. Receiving SRH education was associated with lower odds of having a pregnancy (AOR = 0.2, 95% CI: 0.80–0.514, p < 0.001). Experiencing peer pressure increased the odds of having a pregnancy (AOR = 4.12, 95% CI: 1.521–11.131, p < 0.01).ConclusionsThis study highlights a significant adolescent pregnancy rate in Muhanga district, emphasizing the need for targeted interventions. Addressing educational gaps, improving financial support systems, and enhancing sexual and reproductive health education are crucial steps. Policymakers should focus on these areas to reduce adolescent pregnancies and improve outcomes for young girls. Future efforts should also include strategies to counteract peer pressure and integrate comprehensive support programs.

Evaluation of Change Management Innovation Training Based on Participant Perception

This research was conducted to find out how effective Management of Change and Innovation, CMI training is in increasing participants' understanding of the CMI concept. Organizational change is triggered by changes such as dynamic regulations, societal demands for better public services, and technological advances. Public organizations must change, make continuous improvements, and move towards High Performance Public Organizations to achieve their best performance. In the three groups of participants in this study, there was an average increase of 52,23% from pre-test to post-test. Cohort IV showed the greatest improvement, while participant satisfaction levels varied, with Cohort V showing higher levels of satisfaction than Cohorts IV and VI. According to the evaluation of the implementation of innovation proposals, more than 65,47% of participants successfully implemented innovative proposals in their workplace. This shows that participants are very interested in innovation. The evaluation results stated that the CMI training was successful in increasing participants' understanding, but variations in participant satisfaction needed further attention. Evaluation and in-depth study of participant feedback is the key to improving the quality of CMI training services. A further training evaluation of the variables that influence the level of participants' understanding and the effectiveness of the training is needed, as well as the importance of planning improvements based on the evaluation results so that the training program can continue to develop and provide maximum benefits for participants in the future.

Approach Towards the Development of Digital Twin for Structural Health Monitoring of Civil Infrastructure: A Comprehensive Review

Civil infrastructure assets’ contribution to countries’ economic growth is significantly increasing due to the rapid population growth and demands for public services. These civil infrastructures, including roads, bridges, railways, tunnels, dams, residential complexes, and commercial buildings, experience significant deterioration from the surrounding harsh environment. Traditional methods of visual inspection and non-destructive tests are generally undertaken to monitor and evaluate the structural health of the infrastructure. However, these methods lack reliability due to the need for instrumentation calibration and reliance on subjective visual judgments. Digital twin (DT) technology digitally replicates existing infrastructure, offering significant potential for real-time intelligent monitoring and assessment of structural health. This study reviews the existing applications of DTs across various sectors. It proposes an approach for developing DT applications in civil infrastructure, including using the Internet of Things, data acquisition, and modelling, together with the platform requirements and challenges that may be confronted during DT development. This comprehensive review is a state-of-the-art review of advancements and challenges in DT technology for intelligent monitoring and maintenance of civil infrastructure.

Digital Transformation in Civil Service Management: Implementing the SmartASN Platform

Digital transformation is a critical need for modern governments to address the growing demands for fast, transparent, and efficient public services. This study examines the implementation of the SmartASN platform in driving the digital transformation of State Civil Apparatus (ASN) management. Employing a qualitative research approach with a narrative review methodology, the study systematically reviews and synthesizes secondary data collected from 2016 to 2022 on the digital transformation of ASN management. The Agile Governance theory guides the analysis. It focuses on three key aspects: 1) SmartASN Platform Governance, 2) Systematic and Adaptive Approaches in ASN Management, and 3) ASN Management in the Digital Age. The findings demonstrate that the SmartASN platform is instrumental in advancing ASN’s digital transformation, supporting Indonesia’s broader goals of creating a world-class bureaucracy. This is evidenced by Indonesia’s significant improvement in the E-Government Development Index (EGDI), which rose from 116 in 2016 to 77 in 2022. The study contributes to the academic understanding of digital governance by providing actionable recommendations to optimize the SmartASN platform and develop policies that support agile digital transformation. These insights highlight the potential of digital platforms in fostering innovation and enhancing adaptability in the public sector.

Impact of privatization on social welfare in the service supply chain

Emerging economies have developed different service supply chain configurations due to government divestment. Despite high demand for public services, governments typically lack capital to invest. Consequently, public services quality can decline, thereby affecting social welfare overall. Therefore, public firms partner with private firms to offer public services. Additionally, the private sector offers services to the public and maximizes profits. Therefore, any private sector involvement in public services should be carefully evaluated. Hence, it is important to understand how public and private entities have different objectives that affect SW and CS in terms of social welfare. This study uses the healthcare sector as a motivational example and develops and solves three models that consider different decisions: (1) All public firms provide services; (2) All private firms provide services; and (3) Public and private partners provide services. Additionally, social welfare maximization has been considered in a competitive environment. The results show that consumer surplus and welfare are higher when public firms only offer services. Private-public partnerships result in lower SW and CS. The CS and SW are higher under competition and lower without. Furthermore, another interesting result is that profit, CS, and SW are the same for Model AB and Model BA. Finally, we guide managers on privatizing service supply chains.

Personality Type, Financial Rewards, and Prestige: Factors Influencing Students' Interest in Public Accounting Careers

The increasing number of companies listed on the IDX signifies a growing demand for public accounting services. Despite this, the number of public accountants in Indonesia remains relatively low. This research utilizes the Theory of Planned Behavior and the Big Five Personality Theory to empirically test how personality types, financial rewards, and professional prestige influence students' interest in pursuing a career as public accountants. The study was conducted by the PSSA class of 2020 at Udayana University, using a questionnaire as the research instrument. The sample consisted of 169 respondents, and the data analysis technique employed was Multiple Linear Regression. The findings reveal that personality types, financial rewards, and prestige significantly and positively influence students' interest in a public accounting career. The theoretical implications of this research offer detailed insights into the Theory of Planned Behavior and the Big Five Personality Theory.

Exploring food insecurity and sustainable food in rural India: collaborative learning through student mobility programme

Four main NCDs identified in India (cardiovascular diseases (CVDs), cancers, chronic respiratory diseases (CRDs) and diabetes) are closely related to behavioural risk factors - unhealthy diet, lack of physical activity, and use of tobacco and alcohol(1). South India (Tamil Nadu state) where the research was conducted faces challenges like the rich-poor gap in access to health, the persistence of high levels of malnutrition, anaemia, and the ever-increasing expectation and demands for public health services from the public(2). Variation and inequality in nutrient intake showed a declining trend(3) due to factors such as expenditure on food, household size, and literacy and poverty especially in rural area(4). There is need to determine the food insecurity situation comprehensively in India and plan appropriate policy actions to address it effectively, to attain the key Sustainable Development Goals (SDGs)(5). This pilot study investigated food insecurity and related health behaviours in a rural village in Tamil Nadu. Additionally, collaborative learning (peer learning) was implemented, as both UK and local Indian students conducted this research - UK students travelled to India using the Turing Funding Scheme.This is qualitative research, whereby researchers from two universities (UK and India) obtained perspectives of the rural communities. Data was collected in two stages: observation of health behaviours (for each family on three different days in a week), where pictures were taken with permission, and followed by face-to-face interviews (with 6 heads of households). A total of three male and three female adults (aged between 28–68 years old, all married and living in an intergenerational family setting) were interviewed for approximately 30-40 minutes and analysed thematically using the Braun &amp; Clarke approach(6). Consensus coding was used to determine invariant constituents, while reliability and validity were achieved through intercoder agreement, audio recording, triangulation, and member checking.A total of five themes were identified: Accessibility to food, Influences of culture, Health behaviour and barriers, and Vision for a healthier community. It was apparent that their food consumption was affected by their economic background, but it was thought-provoking to discover that they were focusing on more sustainable and traditional ways to address food insecurity, such as consuming different millets rather than rice (which were cheaper, sustainable, and nutrient-rich), vegetables and fruits sourced locally, milk, and eggs. Limited consumption of meat and fish, processed food, and snacking was rare. Deficiencies and malnutrition were self-reported during the interview (such as iron and calcium). Limited motorized vehicles were used, and they walked a lot, there was no exercise routine practiced. Social media plays a significant role in influencing their health behaviour.There is a need for more awareness of nutrition and health through the right channels- social and digital media.

OPTIMIZATION ALGORITHM OF PUBLIC SERVICE FACILITIES LAYOUT IN EARTHQUAKE-STRICKEN AREAS BASED ON SA ALGORITHM

The environment in earthquake-stricken areas is complex and changeable. The optimization of public service facility layout usually involves multiple objectives, such as maximizing coverage, minimizing service distance, optimizing resource allocation, etc. The coupling conflict between these objectives weakens the functions of public service facilities in earthquake-stricken areas. To improve the emergency response speed of the earthquake-stricken regions and reduce disaster losses, a simulated annealing (SA) based optimization algorithm for the layout of public service facilities in earthquake-stricken areas is proposed. Considering the public service demand in different stages of the earthquake-stricken area, set the minimum maximum weighted distance, the minimum number of facility points, and the minimum total weighted distance of the service demand point area within the service area of the public service facility point as the objective function, and set constraints such as each demand point is covered by at least one facility point, and the minimum number of public service facility points, build a multi-objective optimization model of public service facilities layout to avoid coupling conflicts between multiple objectives. The SA algorithm is used to solve the multi-objective optimization model of public service facility layout. SA algorithm adopts temperature update function and sets heuristic cooling criteria. Combining the success-failure method and the variable scale method, a new solution is generated using the effective offset. The improved Metropolis algorithm is used to set the acceptance criteria for the solution to obtain the optimal layout result for public service facilities in earthquake-stricken areas. The experimental results show that the algorithm can effectively optimize the layout of public service facilities in earthquake-stricken areas, and improve facility coverage and resource utilization.

Seeing the Forest for the Trees: The role of Growth-Oriented Leadership in Shaping Public Servants’ Work Experiences in the Post-NPM Environment

In recent years, growth-oriented leadership (GOL) has come to the fore as a salient predictor of positive employee outcomes in public sector contexts. This empirical paper examines the role of GOL in shaping perceptions of quantitative demands as a product of an evolved New Public Management (NPM) context and the subsequent impact on stress and well-being for 419 local government employees working in Western Australia. While latent in previous GOL-oriented studies, this paper is the first to explore the intersection of GOL and quantitative demands, noting that the former has an established positive effect on employee wellbeing, and the opposite case for the latter. Drawing on the challenge-hindrance framework, this article argues that GOL helps to shape employees’ primary appraisals of demands as challenges, rather than hindrances, in the post-NPM environment. The results indicate strong, direct negative relationships linking GOL with quantitative demands and stress, and a strong positive relationship between GOL and well-being. This study establishes GOL as a relevant capability for public leaders in supporting employees to deal effectively with public service demands and subsequently grow. Understanding how leadership capability, and particularly GOL, can shape the employee experience is important in ensuring the effective delivery of public services.

APPLICATION OF A LOGIT MODEL TO IDENTIFY SOCIODEMOGRAPHIC FACTORS INFLUENCING THE CHOICE OF PUBLIC TRANSPORT FOR DAILY TRIPS – A CASE STUDY BASED ON THE EXAMPLE OF THE GÓRNOŚLĄSKA-ZAGŁĘBIOWSKA METROPOLIS (POLAND)

The attractiveness of an offer is the main factor in determining the demand for public transport services, which goes beyond just the transportation itself and includes various accompanying aspects. Before starting their journey, many people confront the dilemma of choosing a mode of transportation. Often, this choice depends on individual habits. Individuals who possess a passenger vehicle cannot justify the advisability of using it instead of bike or public transportation. The primary objective of the present article was to determine the factors that impact the utilization of public transportation services while traveling. The research used data from surveys conducted among the inhabitants of the Górnośląska-Zagłębiowska Metropolis. During the modeling process, the authors used logit models, which have been used in different countries globally to show the behavior of public transport users, as shown in the literature review. However, the factors that impact the decision to use public transportation by the residents of the GórnośląskoZagłębiowska Metropolis remain unexamined. The current results suggest that the choice of a hypothetical travel scenario is mainly influenced by age, education, and employment status. However, no correlation with the gender of potential public transport users was found. Other variables not considered in this study may also impact public transport usage. Nevertheless, the findings lay the groundwork for more extensive, in-depth analyses incorporating a broader range of independent variables that could influence public transport use. The research results, when combined with the application of mobility management tools, could serve as a means to better shape the transport offerings. By enhancing the attractiveness of public transport, ticket revenue would likely increase, leading to an improved financial situation for the communes within the GórnośląskaZagłębiowska Metropolis. This would also align with the principles of sustainable transport development policy.

Peningkatan Performa Pelayanan Publik Melalui Penerapan Core Values BerAKHLAK di Kota Singkawang Tahun 2022-2023

In the midst of increasingly high public demands for quality public services, the government through service officers must be able to serve professionally. Implementation and apllication of the core values of BerAKHLAK is one of the main keys to realizing excellent public services. This study aims to examine the process of internalization and application of the core values of BerAKHLAK carried out in Singkawang City in the implementation of public services and their contribution to improving the performance of quality public services for the community. The research method used is a descriptive research type and qualitative approach. Informants were selected through purposive and snowball sampling techniques. Data analysis techniques included data reduction, data presentation, and conclusion/verification sourced from observation, interviews and documentation. The results showed that the internalization of the core values of BerAKHLAK in Singkawang City has been running well and has had a positive impact on improving public service performance. This is evidenced by the increasing value of the public service index in Singkawang City by the Ministry of PAN-RB with a score of 4.22 in 2022 from previously in 2021 getting a score of 3.57. In addition, public satisfaction with public services in Singkawang City has also increased as seen from the value of the public satisfaction index, and the commitment of UPP in Singkawang City to improving the quality of public services. However, there are still weaknesses in several aspects of service. Therefore, The Singkawang City Government must continue to make sustainable efforts to improve the quality of public services in Singkawang City.

Development and validation of a rating scale for barriers to and facilitators of nurses’ participation intentions in “Internet + Nursing Service”

BackgroundGiven increases in China’s aging population, the growing demand for public health services and the shortage of human resources among nurses have become more prominent. Under such a background, “Internet + Nursing Services” have received more attention. Thus, exploring the barriers to and facilitators of nurses’ willingness to participate in “Internet + Nursing Services” and utilizing internet technology to increase the supply of nursing services has become a key issue.ObjectiveThis study aimed to develop a scale for assessing the barriers to and facilitators of nurses’ willingness to participate in “Internet + Nursing Services” and to test the validity and reliability of the scale.MethodsA preliminary scale was developed based on a literature review, theoretical research, semistructured qualitative interviews, and two rounds of Delphi expert inquiry. A convenient sampling method was used for the questionnaire survey. A 5-point Likert scale was used to evaluate the importance of the items. The survey data of 659 clinical nurses obtained from February to March 2023 were used for item analysis, exploratory factor analysis (EFA), and reliability and validity tests of the scale. The survey data of 538 clinical nurses obtained in April 2023 were used for confirmatory factor analysis (CFA) of the final scale.ResultsThe final scale consists of 25 items and 4 dimensions (performance expectations, perceived risk, need for professional knowledge training, and nonprofessional knowledge training). The scale showed good structural validity and content validity: the Cronbach’s α coefficient of the scale was 0.955, the split-half reliability was 0.778, the test-retest reliability was 0.944, the kaiser-meyer-olkin(KMO) value was 0.960, and the cumulative variance contribution rate of the 4 common factors was 83.147%. The scale content validity index(S-CVI) was 0.914. The confirmatory factor analysis model had favorable fit indices: χ2/df = 4.234, RMSEA = 0.078, NFI = 0.940, IFI = 0.953, TLI = 0.947, and CFI = 0.953.ConclusionThe scale for assessing the barriers to and facilitators of nurses’ willingness to participate in “Internet + Nursing Services” has good reliability and validity, and provides a reference for evaluating nurses’ willingness to participate in “Internet + Nursing Services”.

Assessing The Relationship Between Demand And Accessibility For Pediatric Ophthalmology Services By State In The United States.

To investigate the relationship between public demand for pediatric ophthalmology services and the accessibility of such services on a statewide basis in the United States, focusing on strabismus care. Using Google Trends data, search volumes for "strabismus" were analyzed from January 2014 to December 2023. Pediatric ophthalmologist availability was assessed via the American Academy of Ophthalmology directory, normalized for state population size to create a relative demand index. Additional metrics from the United States Census Bureau and Centers for Disease Control and Prevention provided socioeconomic and health data. Correlation coefficients were used to explore relationships between search volumes, specialist availability, vision screening, socioeconomics, and demographic factors. The data revealed variability in public interest in pediatric ophthalmology across states, with Alaska showing the highest relative search volume for strabismus. The data also indicated notable disparities in pediatric ophthalmologist density, with North Dakota, Vermont, and Wyoming having no pediatric ophthalmologists. A significant correlation was identified between pediatric ophthalmologist availability and vision screening (R = 0.486, p < 0.001). Negative correlations were observed between the relative demand index and urbanization (R = -0.388, p = 0.007), as well as the strabismus prevalence (R = -0.455, p = 0.001), indicating that urbanization and specialist distribution influence eyecare demand and access. The findings highlight disparities in accessibility and demand for pediatric ophthalmology services across the US, influenced by urbanization and distribution of healthcare professionals. The study underscores the need for targeted interventions to improve access to care and bridge gaps in pediatric ophthalmology service provision.

Civilian Agency and Service Provision Under Rebel Rule: Evidence from Côte d'Ivoire

In rebel-held territories, public services often continue to be delivered, although rebels rarely have the administrative capacities to provide them. Although the literature on rebel governance has emphasised rebel-led institution building, many rebel groups rely on existing institutions or establish collaborative arrangements with civilian actors, who often play a key role in revitalising public services. Drawing from extensive research in formerly rebel-held Côte d'Ivoire, I argue that the availability of services provided by pre-existing institutions, the strength of civilian demands for public services and the strategic interests and ideological orientation of the rebels contribute to explain variations in how services are provided. While direct rebel rule in Côte d'Ivoire was infrequent, rebels often supported and facilitated civilian-led initiatives. The case of Côte d’Ivoire highlights the importance of revising the concept of rebel governance and broadening the understanding of civilian agency in war beyond cooperation or non-cooperation with armed groups.

Inefficient urban-rural resource allocation and reduced tuition benefits for preschool education: an example from a Chinese county

PurposeTaking urban-rural disparity into account, this research examines the current service provision of preschool education at the local level in China.Design/methodology/approachFollowing a qualitative design, the research is based on a case study on the preschool service provision in Luochuan County in China, with data collected from semi-structured interviews with grassroots officials and residents from the county’s rural and urban regions.FindingsThis research finds that preschool services are inefficiently delivered between the county’s rural and urban areas. While services are oversupplied in rural regions, the popular demand for urban kindergartens is inadequately addressed. Moreover, the tuition subsidy offered by the local government has drastically decreased in recent years.Research limitations/implicationsThis research is confined to a single-case study, so its findings are not necessarily applicable to all Chinese localities. Nevertheless, it proves that these problems in preschool service provision can be a result of the central authority’s tight control.Social implicationsGiven China’s rapid urbanization and fertility decline, this research argues that overinvestment in rural kindergartens can be a widespread phenomenon throughout China. It also suggests a decreasing popular demand for other public services, such as childcare, in Chinese rural regions. This research calls for special attention to the persistent regional discrepancy in preschool service standards and the welfare cuts after the revenue centralization reform.Originality/valueThis research contributes to a clearer picture of the current preschool service delivery by Chinese local governments, which remains largely underexplored by far. It also provides updates on the country’s long-existing urban-rural discrepancy in preschool services.

STIGMA AGAINST PEOPLE LIVING WITH HIV/AIDS: Qualitative analysis of the stigma index brazil

Stigma negatively impacts the quality of life of people living with HIV/AIDS, but there are few national studies dedicated to understanding the subjective dimension of this experience. Based on an unfolding of the Stigma Index 2.0 in Brazil, we aimed to qualitatively analyze the experiences of stigma narrated from the perspective of people living with HIV/AIDS. Of the 618 respondents from seven Brazilian capitals, 538 described in detail situations of stigma suffered by people with HIV/AIDS. A thematic analysis was performed, identifying that 76.4% of the reports had a negative content and 13.4% had an ambivalent content. The main characteristics of the stigma suffered were taboos, myths, ignorance or misinformation (22.4%); breach of confidentiality/exposure of serology (21.5%); the withdrawal or rupture of affective relationships/refusal of relationships (18.2%); and discrimination, neglect or violence by health professionals (16.6%). The context of health services was the main place of exposure (28.4%), with 13.9% of the reports verbalizing demands for public policies and support services. We discussed the implications of the results based on national and international studies, highlighting stigma as a creator of barriers in facing the HIV/AIDS epidemic.

Model to estimate urban public services demand, by zone, using geographic information systems

Para el diseño y operación de cualquier servicio público, un elemento básico es determinar el número de personas a quienes se les prestará el servicio, no importando si es agua potable, drenajes, transporte o electricidad. Sin embargo, cuando los conglomerados urbanos son grandes o tienen ciudades dormitorio, la estimación de la población a servir se vuelve compleja, sobre todo porque los censos poblacionales por lo regular solo consideran la población residente en un territorio. Así, un distrito comercial o financiero puede tener una población residente relativamente pequeña, pero una población flotante considerable que, aunque solo trabaje, estudie o visite la zona, requiere los servicios básicos (agua, drenaje, etc.). Las mediciones de tráfico dan un valor global de cuántas personas ingresan a un municipio o territorio, pero difícilmente determinan cómo se distribuyen en las zonas urbanas. El modelo propuesto aprovecha las ventajas de los sistemas de información geográfica (SIG) para ubicar la demanda, calculando un estimado de la población a servir, en función de los metros cuadrados construidos y tipo de uso; esto permite no sólo determinar la población residente y flotante de una región, sino también sectorizar y delimitar áreas específicas para obtener los datos de población a servir en un sector, definiendo volúmenes de agua, redes, plantas potabilizadoras, tamaño de drenajes y descargas sanitarias, así como dimensionar plantas de tratamiento de aguas residuales (PTAR), o necesidades de transporte y servicio eléctrico. El modelo se aplicó en la zona urbana del municipio de Guatemala, Guatemala, ubicado en América Central, obteniéndose la población residente y flotante por cada una de las zonas. El modelo permite definir la población flotante, estimarla a futuro con base en las proyecciones de área construida y ajustarlo conforme ocurran los cambios.

Health care workers' qualitative descriptions of ethically challenging situations evoking moral distress during Covid-19.

The high public demand for healthcare services during the COVID-19 pandemic and strict infection control measures, coupled with threat of severe illness and death, and limited resources, led to many healthcare workers (HCWs) experiencing ethically challenging situations (ECSs). To systematically explore first-hand accounts of ECS-evoking moral distress among HCWs during this public health emergency. This was an open cohort study. All participants were asked whether they had been in ECS-evoking moral distress during the pandemic. Those who had were asked to describe these situations. Answers were systematically analyzed according to three levels of root causes for ECSs, using thematic analysis. In January 2022, 977 HCWs from four Norwegian university hospitals participated. The study received ethical approval from the Norwegian Ethical Review Authority (No. 130944). In total, 508 participants (52%) reported that they had experienced ECS-evoking moral distress during the pandemic, whereof 323 provided a qualitative description. We found that while a few reported ECSs caused at the patient level, and some described situations at the unit/team level, the vast majority reported situations caused at the system level, predominantly related to resource scarcity, particularly poor staffing. Our findings strongly indicate that efforts to mitigate moral distress among HCWs should be targeted at the system level. More specifically, the study findings highlight resource limitations, particularly poor staffing, as a major cause of moral distress during the pandemic.

Desempenho da atenção primária à saúde no estado de São Paulo, Brasil, no período de 2010-2019

Abstract This article presents the results of an analysis of the performance of primary health care in São Paulo state over the last decade against a backdrop of financial crisis and health funding cuts. We conducted a time series analysis (2010-2019) of performance indicators across the following dimensions based on an adapted conceptual framework: health service performance, health system, and determinants of health. Annual percentage change was calculated for each indicator using a log-linear model. Performance across the indicators was generally positive; however, there was a decline in performance across indicators of quality of care (congenital syphilis, cesarean section rate and cervical cancer screening). The findings also show a potential rise in demand for public services (due to population aging and a reduction in the percentage of the population with private health insurance) and increase in health expenditure against a backdrop of falling GDP per capita.