Healthcare Authorities Research Articles

Impact of Direct Health Facility Financing on Health Insurance Enrollment and Service Quality in Dodoma Region, Tanzania

The National Health Insurance Fund (NHIF) and the Improved Community Health Fund (iCHF) are pre-payment schemes in Tanzania designed to achieve universal health coverage (UHC). Despite these efforts, public health facilities have historically struggled with poor-quality care. In response, the Direct Health Facility Financing (DHFF) mechanism was introduced in 2017, enabling health facilities to procure medicines and equipment directly from approved vendors when out-of-stock notifications are received from the Medical Store Department (MSD). This study evaluates the impact of DHFF on health insurance enrollment and service quality in the Dodoma Region. Utilizing a mixed-methods approach with an explanatory sequential design, a total of 35 respondents were involved in the proposed study, of which 30 were obtained from health insurance beneficiaries and 5 were from key informants. Results revealed increased health insurance enrollment for both NHIF and iCHF from 2018–2019 to 2019–2020, attributed to enhanced medicine availability, community education, and sensitization efforts. Beneficiaries reported significant improvements in health facilities, including better medicine availability, upgraded infrastructure, and improved attitudes from healthcare providers. Healthcare providers and authorities also noted improved service quality since DHFF's introduction. However, challenges remain, particularly with MSD's rigidity in notifying health facilities about out-of-stock items. Recommendations include enhancing the MSD's supply chain management to ensure timely notifications and deliveries. Future research should expand to multiple regions to account for cultural variations and additional factors influencing health insurance participation, enrollment, and service quality.

Civilians under missile attack: post-traumatic stress disorder among the Jewish and Bedouin population of Southern Israel

BackgroundOver the past 20 years, Jewish and Bedouin civilians in southern Israel have faced the ongoing threat of missile attacks from Gaza, with possible mental health consequences. This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) among Jewish and Bedouin adult civilians in southern Israel in a period with few missile attacks from Gaza, and no military operations.MethodsThe study population included 389 participants (246 Jews, 143 Bedouins) living within 40 km/25 mi from Gaza for at least 2 years and interviewed between January and March 2023 (before the ongoing war that started on October 7th, 2023). The PTSD Checklist (PCL-5) was used, with a score of 33 as a cutoff point for the presence of PTSD.ResultsCompared to Jews, a significantly lower proportion of Bedouins reported accessibility to bomb shelters and siren warning systems. Overall, 20.3% of the respondents exhibited PTSD. Multivariate analysis revealed that after adjustment for demographic and household characteristics, Bedouins had a six-fold significantly higher probability of PTSD in comparison to Jews (OR 5.6, 95%CI 2.8–10.8). Compared to participants with high socioeconomic status (SES), participants with low SES had a six-fold significantly higher probability of PTSD (OR 6.0, 95%CI 2.2–16.5). Participants who did not have an alarm system had more than two-fold odds for PTSD (OR 2.3, 95%CI 1.1–5.5). Being single, living in urban areas, or having a disability significantly increased the probability of PTSD.ConclusionsThe findings of this study demonstrate a significantly higher prevalence of PTSD among the Bedouin population of Southern Israel. Several sociodemographic characteristics were associated with the increased prevalence of PTSD, the most prominent of which was low SES. Healthcare professionals and authorities should be proactive in screening for PTSD, and provide tailored treatment and support, taking into account ethnical and cultural background. Authorities should address the disparity in bomb shelter access and siren warning coverage between Bedouin and Jewish communities.

Pandemic Times and Health Care Exclusion: Attitudes Toward Health Care Exclusion of Undocumented Immigrants.

Most of the 11 million undocumented immigrants living in the United States are excluded from government healthcare programs. Yet, healthcare inequities pose significant dangers to all members of society during a pandemic. This project explores to what extent undocumented immigrants, in the context of a pandemic, can be seen as deserving of access to government healthcare programs. The first survey experiment explores whether work ethic can affect perceptions of undocumented immigrants as deserving of government healthcare programs. The second survey experiment tests to what extent appeals to fairness and self-interest, during a pandemic, shape healthcare deservingness attitudes. The results show that respondents view undocumented immigrants as less deserving of healthcare than citizens, even when undocumented immigrants have a solid work history. The second survey experiment, however, shows that appeals to fairness and self-interest trigger substantial increases in support for undocumented immigrants, both among Republicans and Democrats. The results suggest that while undocumented immigrants are seen as less deserving of access, appeals to fairness and self-interest can trigger increased support.

Influence of Medical Mistrust on Prevention Behavior and Decision-Making Among Minoritized Youth and Young Adults During the COVID-19 Pandemic.

Medical mistrust (MM) is seen as a barrier to assessing healthcare needs and addressing health disparities; however, limited literature has focused on assessing MM for vulnerable populations, especially racial/ethnic minority and sexual/gender minority youth and young adults (YYA). Between February 2021 and March 2022, we conducted the Youth and Young Adults COVID-19 Study, a prospective cohort of minoritized YYA aged 14 to 24years (n = 1027), within the United States and its territories. Participants were recruited through a combination of paid social media ads, outreach with organizations serving marginalized youth, and an existing registry, targeting racial and ethnic minority and LGBTQ + youth for a study on COVID-19 health behaviors. Multiple multinomial logistic regression models were developed to examine associations between demographics and three dimensions of MM including healthcare experience, government information, and scientific information. Most participants were between the ages of 18 and 21years (48.3%), identified as Hispanic (33.3%) or white (22.5%), and bisexual or pansexual (34.3%). Queer YYA had higher odds of reporting worse personal healthcare experiences than their straight peers. The odds of gay/lesbian YYA that reported somewhat or extreme trust in doctor's sources were two times higher than their straight peers. Except for those who identified as Asian, racial/ethnic minority YYA were less likely to report somewhat or extreme trust in the CDC's general information or its COVID-19 data than white YYA. Transgender and gender diverse YYA were more than twice as likely to report being very or extremely influenced by statistics of the dangers of COVID-19 than cisgender YYA. Our study indicated the importance of incorporating marginalized identities into the assessment of medical mistrust to better understand YYA's health prevention and treatment behaviors and to develop public health prevention and treatment strategies, especially for minoritized communities.

Towards performance governance in healthcare: An analysis of Italian local health units.

Bouckaert and Halligan (2008) proposed four ideal types of performance management systems, ranging from a disconnected and input-led approach (performance administration) to a model in which performance management is fully integrated with both the internal and external context of an organisation (performance governance). This article empirically analyzes performance plans issued by Italian Local Health Units (LHUs) to provide a first nationwide snapshot of the different ideal-types of performance management that each (LHUs) have reached, in a 'performance governance'-oriented perspective. This paper employs a qualitative methodology based on document analysis. The model orienting the analysis features six dimensions capturing the ideal-types characteristics and what the Italian performance regulations prescribe. Data was derived from the performance plans adopted by the Italian LHUs on the condition that they made the documentation necessary for the analysis public on their institutional website. For a 'performance governance' oriented approach, two elements are considered relevant: familiarity with the analysis of stakeholders and context. In our sample, consisting of 63 performance plans out of 99 Italian LHUs, it was challenging to identify specific territorial clusters, due tosignificant heterogeneity. The role of strategic objectives, integration between cycles, and context analysis seems to positively influence the orientation towards a 'performance governance' approach. The application of Bouckaert and Halligan's ideal-types has only been episodically investigated in the healthcare sector, mainly at the individual health unit or Region level. This article's innovative contribution consists of conducting a qualitative analysis based on a replicable taxonomy that enables further national comparisons. Furthermore, it highlights the need for public healthcare systems to engage more with external stakeholders to improve the quality of their performance governance.

Cost-utility Analysis of Navigate, a Treatment Decision Aid for Men with Prostate Cancer and Their Partners, in Comparison to Usual Care

Background and objectiveEvidence on the cost effectiveness of decision aids to guide management decisions for men with prostate cancer is limited. We examined the cost utility of the Navigate online decision aid for men with prostate cancer in comparison to usual care (no decision aid). MethodsA Markov model with a 10-yr time horizon was constructed from a government health care perspective. Data from the Navigate trial (n = 302) and relevant published studies were used for model inputs. Incremental costs and quality-adjusted life-years (QALYs) were calculated for the two strategies. One-way and probabilistic sensitivity analyses were undertaken to address model uncertainty. Key findings and limitationsOn average, the Navigate strategy was estimated to cost AU$8899 (95% uncertainty interval [UI] AU$7509–AU$10438) and produce 7.08 QALYs (95% UI 6.73–7.36) in comparison to AU$9559 (95% UI AU$8177–AU$11017) and 7.03 QALYs (95% UI 6.67–7.31) or usual care. The Navigate strategy dominated usual care as it produced cost-savings and higher QALYs, although differences for both outcomes were small over 10 yr. The likelihood of Navigate being cost effective at a conventionally acceptable threshold of AU$50000 per QALY gained was 99.7%. This study is limited by the availability, quality, and choice of the data used in the model. Conclusions and clinical implicationsUse of an online decision aid for men with prostate cancer appears to be cost effective relative to usual care in Australia, driven by the higher acceptance and uptake of active surveillance. Wider implementation of decision aids may better inform men diagnosed with prostate cancer about their management options. Patient summaryWe looked at the cost effectiveness of an online decision aid for guiding Australian men with prostate cancer in choosing a management option. We found that this decision aid was cost effective, mainly because more men chose active surveillance. Decision aids that inform patients about their management options should be more widely used in health care.

Smart Tender Management System Using Blockchain in Python

-Blockchain technology has been adopted by a number of industries, including government agencies, financial services, healthcare, and agriculture, to improve their operations in the quickly changing modern world. But the industry for tenders hasn't yet completely realized all of its advantages. Due to problems including bias, bad record- keeping, lack of transparency, vulnerability to hackers, and data tampering, inadequate tender management procedures can cause large losses. We suggest using blockchain technology to ensure improved security and effectiveness in tender management as a solution to these problems. We can create a secure transaction management system that protects important documents and transactions related to the tendering process by utilizing encryption and the immutable nature of blockchain. By safely storing bid proposals, firm profiles, historical data, tender documents, and other information, this system fosters transparency and integrity. The Admin and Company modules are the two main components of the Smart Tender Management System. Administrators can oversee applications, handle tenders, and keep an eye on transaction logs with the help of the admin module. Companies can register, submit proposals, and monitor the status of their applications using the Company module. The solution improves security, lowers expenses, and simplifies tender processing by doing away with intermediaries and utilizing strong encryption techniques. This fosters an easy- to-use and effective experience for all parties involved KeyWords: Block chain Technology, Encryption, Smart Contracts, Tender Management.

Healthcare Diseases Classification Based on Machine Leaning Algorithms: A Review

Researchers have increasingly focused on applying machine learning algorithms to enhance healthcare operations in the past few years. Machine learning has become increasingly popular and has shown to be a viable strategy for raising the standard of healthcare, preventing disease transmission and early disease detection, reducing hospital operational expenses, aiding government healthcare programs, and enhancing healthcare efficiency. This review offers a succinct and well-structured summary of machine learning research that has been done in the field of healthcare. Specifically, the emphasis is placed on the examination of non-communicable illnesses, which pose a significant risk to public health and rank among the primary contributors to global mortality. Moreover, the COVID-19 pandemic, which is among the world's deadliest illnesses and has recently been formally declared a public health emergency, is included. This study aims to assist health sector researchers in choosing appropriate algorithms. After conducting a comprehensive investigation, it was shown that the Decision Tree (DT), Gaussian Naive Bayes (GNB), and Random Forest (RF), algorithms had the highest performance in healthcare classification, achieving a remarkable accuracy rate of 100%. In most tests, the Random Forest (RF) and Support Vector Machine (SVM) demonstrated consistently better performance

Unveiling the heart of disaster nursing: A qualitative study on motivations, challenges, and lessons from the devastating 2023 Turkey earthquakes.

Turkey has faced a notable escalation in earthquake disasters in the last two decades. Despite initiating a health and disaster management system, nurses' pivotal roles and experiences in handling such crises have been disregarded. This qualitative study analyzed nurses' experiences before, during, and after deployment in response to the 2023 Turkey earthquakes to enhance disaster-response efforts. This descriptive qualitative study was conducted between March and May 2023 using semistructured interviews with 15 nurses purposively sampled among those who volunteered to work in the earthquake zone. The MIRACLE and COREQ guidelines were followed for reporting qualitative research. The analysis exposed five main themes for pre-tasking: moral obligation, motivation, insufficient experience, balancing responsibilities, and preparation challenges. The peri-task themes include responsibilities, skills, bravery and characteristics, workload management, teamwork, and outcomes. Post-tasking has three themes: competence assessment, career goals and aspirations, and support. Training and coping with anxiety and stress are common themes for all phases. Disaster relief requires a comprehensive and coordinated response from healthcare organizations, government agencies, and support systems. Providing adequate training, ensuring safety protocols, offering mental health support, and fostering a fair and supportive work environment are crucial steps in mitigating the adverse effects on nurses and, by extension, the patient care process in earthquake-affected areas. Nurse training in disaster preparedness should cover various response methods and involve multiple disciplines. Managers can help by arranging drills, simulations, online courses, and workshops and promoting partnerships for improved collaboration. Psychological support should be included to address emotional challenges. Regularly updating response policies based on past experiences is crucial for preparedness and efficiency.

Physical inactivity and its associated factors among pre-retirement government healthcare workers in Kuala Lumpur, Malaysia

IntroductionThe rising worldwide concern of Non-Communicable Diseases (NCD) is alarming as it is associated with 80% of annual global mortality. NCD threat is rising due to, among others, the increasing ageing population, thus putting the efforts to promote health ageing at the forefront of many countries’ health agenda. Physical activity has been recognised as one of the significant factors in the pursuit of healthy ageing. Nevertheless, approximately one third of individuals in Malaysia are physically inactive. The aim of this study is to determine the prevalence of physical inactivity and its associated factors among pre-retirement government healthcare workers.MethodsThis cross-sectional study was conducted from May to June 2023 among pre-retirement government healthcare workers in Kuala Lumpur, Malaysia. The sample size required was 233 and proportionate random sampling was used to recruit potential respondents who answered self-administered online questionnaires. Global Physical Activity Questionnaire (GPAQ) was used to measure the level of physical activity and data analysis was performed using SPSS version 29.ResultsA total of 214 complete responses were received from the 233 questionnaires distributed, giving a response rate of 91.8%. The prevalence of physical inactivity among pre-retirement healthcare workers was 39.7% as compare only 29.9% in general population. Significant predictors for physical inactivity included higher education levels (SPM, STPM, or certificate holders) (AOR = 13.4, 95% CI: 2.47–72.65), non-Malay ethinicity (AOR = 4.7, 95% CI: 1.23–18.38), personal barriers (AOR = 1.6, 95% CI:1.35–1.79), social barriers (AOR = 1.21, 95% CI: 1.06–1.39), and physical environment barriers (AOR = 1.468, 95% CI: 1.221–1.765).ConclusionThis study shows a worrying prevalence of physical inactivity among pre-retirement healthcare workers that is even higher than the general population in Malaysia. The findings highlight the importance of focusing the preventive strategies among non-Malay workers and those with lower education levels. It is also vital to address all the physical, social, and environmental barriers towards physical inactivity. By prioritising these factors, employers and stakeholders will be able to establish better workplace health promotion and address the issue of physical inactivity more efficiently.

Knowledge, attitude, and perception towards COVID-19 vaccinations among the adults in Rwanda: a cross-sectional study

BackgroundMultiple vaccinations have received approval for the prevention of the coronavirus illness. Nevertheless, the sluggish vaccination rate is mostly attributed to the general population’s limited understanding and unwillingness to accept the use of vaccinations. Thus, it is important to investigate the Rwandan population’s knowledge, attitudes, and perceptions toward COVID-19 vaccines.MethodsA cross-sectional survey was conducted among 370 participants from 11th to 17th February 2023. Demographic information was gathered, and knowledge, attitudes, and perceptions of COVID-19 vaccinations were assessed. A binary logistic regression analysis was undertaken to determine the parameters that determine the perception of COVID-19 vaccinations.ResultsThis study included 370 participants. Among them, 85% had good knowledge about COVID-19 vaccines, and 84% had a positive attitude towards them. Additionally, the study had a diverse group, with half of the participants being female and nearly half falling between the ages of 30 and 39. Several key findings emerged through logistic regression analysis. Those aged 30–39 had 1.39 times higher odds of positive perception than 18–28 (OR = 1.39, 95% CI = 1.08–3.24). Participants with a university education were twice as likely to have a positive perception compared to those without an education level (OR = 2.43, 95% CI = 1.30–6.20). Additionally, single individuals were three times more likely to have a positive perception than their married counterparts (OR = 3.39, 95% CI = 1.28–9.09). Vaccinated individuals had twice the odds of positive perception than non-vaccinated individuals (OR = 2.89, 95% CI = 1.01–8.89). Those receiving information from government health institutions were three times more likely to have a positive perception than those who received the information from friends (OR = 3.19, 95% CI = 1.02–12.7). Moreover, employed participants were four times more likely to have a positive perception non-employed individuals (OR = 4.21, 95% CI = 1.48–13.6). Besides, gender and COVID-19 diagnosis did not significantly correlate with positive COVID-19 vaccine perception.ConclusionThe results indicate that the general public in Rwanda has good knowledge, positive attitudes, and a positive perception toward the COVID-19 vaccination, however, some of the participants had some misconceptions towards COVID-19. The findings of this study will be valuable for policymakers and healthcare authorities working to improve vaccination rates.

Prevalence of Iron Deficiency Anaemia Among Pregnant Women Attending Primary Health Care Center Malala Dukku Local Government Area of Gombe State, Nigeria

Iron deficiency anaemia in pregnancy is an important health issue resulting in high maternal morbidity and mortality. The purpose of the current study was to identify the prevalence of iron deficiency anaemia among pregnant women attending primary healthcare center malaladukku local government of Gombe state, the researcher pick interest on the topic as a result of high rate of anaemia in pregnancy in the research setting primary healthcare center malala, a cross sectional descriptive non-experimental design was adopted by the researcher. Questionnaire was used as a tool for data collection various literature were review which include conceptual review, theoretical review, and empirical review of prevalence, causes and preventive measures. The study assesses the prevalence iron deficiency anaemia among pregnant women, causes of iron deficiency anaemia, and the preventive measures of the condition. The result of the study shows that the prevalence of iron deficiency was high at (74.9%) many factors were considered responsible with the condition as revealed by the research work which includes previous history of the condition, imbalanced nutrition 66.6% () and malaria in pregnancy. Supplementary iron therapy during pregnancy 83.3% (), antenatal services as soon as pregnancy is confirmed, sleeping under mosquito treated net (58.3%) s and chief alternative of healthy diet (46.6%) are the preventive measures of iron deficiency anaemia as revealed by the study. There is also need for further studies on ways of preventing and reducing the rate of iron deficiency anaemia. The research work will help in enlightening the midwives, healthcare providers on the disease and its preventive measures wsith regards to clinical practice and it will also add to the body of knowledge in the medical field and the researcher’s knowledge on the condition.

The Role of Virtue Ethics in Modern Moral Dilemmas

Purpose: The study sought to investigate how virtue ethics can be applied to contemporary ethical issues and comparing its implementation across different cultural contexts. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to the role of virtue ethics in modern moral dilemmas. Preliminary empirical review revealed that virtue ethics provided a robust framework for addressing modern moral dilemmas by focusing on the development of moral character and the habitual practice of virtues like honesty, courage, and compassion. It emphasized that virtues guide not only actions but also motivations, enabling consistent ethical behavior. The study highlighted the importance of community and social context in nurturing virtues, suggesting that supportive environments are crucial for ethical decision-making in various settings, such as healthcare and corporate governance. Ultimately, virtue ethics was found to promote ethical resilience and adaptability, making it a valuable approach for resolving contemporary ethical challenges and fostering a more just and sustainable world. Unique Contribution to Theory, Practice and Policy: Aristotle's Virtue Ethics, Alasdair MacIntyre's Neo-Aristotelian Virtue Ethics and Philippa Foot's Natural Goodness may be used to anchor future studies on virtue ethics and modern moral dilemmas. The study recommended expanding the theoretical foundations of virtue ethics to include contemporary issues, integrating virtue ethics into professional and personal domains, and incorporating it into public policy frameworks. It emphasized the need for educational institutions to promote character development and suggested community programs to nurture virtues. Additionally, the study highlighted the importance of continuous research and interdisciplinary dialogue to keep virtue ethics relevant in addressing modern moral dilemmas. These recommendations aimed to enhance theoretical insights, improve practical applications, and create policies that foster an ethically conscious society.

Veteran's Health Administration HIV Care Continuum: 2019 vs 2022.

The diagnosis-based Human Immunodeficiency Virus (HIV) Care Continuum offers a well-established framework for measuring HIV care quality. It is used by the government agencies, community organizations, and health care institutions to "guide the nation's response to HIV" and assesses HIV care from the time of HIV diagnosis through viral suppression. Our objective is to present the Veteran Health Administration's (VHA) HIV Care Continuum, assess postpandemic versus prepandemic performance, and compare VHA performance to Centers for Disease Control and Prevention-published data. We conducted a nationwide retrospective cohort analysis examining the care continuum for people with HIV (PWH) in VHA care in 2019 versus 2022. Measurements included linkage to care, receipt of care, retention in care, and viral suppression. We used multivariable logistic regression of virological suppression to identify factors associated with viral suppression. In VHA in 2019, 83% of individuals newly diagnosed with HIV were linked to care, 84% of PWH received care, 76% were retained in care, and viral suppression was 76% among those with HIV and 93% of those with viral load (VL) results. In 2022, 74% were linked to care, 79% received care, 67% were retained in care, and viral suppression was 70% among those with HIV and 94% of those with a VL result. VHA has achieved >90% viral suppression among those with a VL result. Among all PWH, viral suppression decreased an absolute 5.2% between 2019 and 2022. VHA's performance on the HIV Care Continuum exceeds the national HIV Care Continuum reported by the Centers for Disease Control and Prevention.

Comprehensive Child Welfare Information System (CCWIS)

Child welfare encompasses a broad spectrum of factors crucial for the overall well-being of children, including their physical, emotional, and social health, as well as ensuring their safety and protection from harm. This abstract delves into the multifaceted nature of child welfare and advocates for a holistic approach to address the complex challenges faced by vulnerable children . An effective strategy for child welfare should emphasize prevention and early intervention, aiming to mitigate risks and foster healthy development from infancy through adolescence. This entails establishing supportive environments within families, communities, and institutions that empower caregivers and offer necessary resources to cater to the diverse needs of children. Moreover, a comprehensive approach to child welfare necessitates collaboration among various stakeholders, including government agencies, non-profit organizations, educational institutions, healthcare providers, and community members. Through coordinated efforts and partnerships, services can be streamlined, gaps in care can be identified and addressed, and the impact of interventions can be maximized. Furthermore, it is imperative to tackle systemic issues such as poverty, discrimination, and insufficient access to healthcare and education to enhance child welfare outcomes. Policies and programs must be crafted with a lens of equity and inclusivity, ensuring that all children, irrespective of their backgrounds or circumstances, have equitable opportunities to thrive and succeed..

Social prescribing for and beyond health: hyper-solutionism in health policy

ABSTRACT Social prescribing is a primary care approach that enables healthcare professionals to refer patients to social activities and services. While social prescribing has gained currency across the Global North, there has been little critical engagement with this health policy from a social science perspective. In this article, drawing on the case of Austria as an example, I present the results of a discourse analysis on social prescribing and show how in related policy documents social prescribing is constructed as a solution for multiple problems: Social prescribing is presented as a solution for addressing the social determinants of health and as a fix for the overburdening of the healthcare system. At the same time, through supposedly fostering social inclusion and cohesion, social prescribing is also portrayed as ‘improving’ society more generally. I argue that the depiction of social prescribing as – what I call – a hyper-solution is connected to the pervasive logic of austerity and resource efficiency in the governance of health and healthcare, as social prescribing redefines and expands the notion of what constitutes a healthcare resource, who is responsible for health but also the domain that healthcare is responsible for.

A Systematic Approach for Evaluating and Selecting Healthcare Waste Treatment Devices using OWCM-CODAS and Triangular Neutrosophic Sets

Healthcare is a fundamental aspect of human life, impacting individuals, communities, and societies. Investing in healthcare infrastructure, services, and education is essential for fostering a healthy, thriving population. Healthcare waste management is a critical aspect of public health, and it requires a concerted effort from healthcare facilities, governments, and communities to ensure that waste is managed in a way that minimizes risks to human health and the environment. This paper proposes a hybrid methodology combining the Opinion Weight Criteria Method (OWCM) and the Combinative Distance-Based Assessment (CODAS) within the framework of Triangular Neutrosophic Sets (TNS) to evaluate and select the optimal healthcare waste treatment devices. The proposed methodology balances various conflicting criteria and incorporates uncertainty in expert assessments to ensure a robust decision-making process. The paper also provides a comprehensive review of healthcare waste management devices and highlights the need for a comprehensive approach to healthcare waste management. The proposed methodology is applied to a case study involving evaluating healthcare waste treatment devices based on different factors such as economic, environmental, technological, and social aspects. The results show that the OWCM-CODAS methodology, integrated with TNS, effectively evaluates and ranks healthcare waste treatment devices based on multiple criteria. The sensitivity analysis demonstrates the robustness of the proposed model, and the results indicate that the model's performance and the relative ranking of the alternatives are not sensitive to changes in the threshold parameter τ within the tested range.

The metamorphoses of denationalization of 1993. Report-I. The market fight for medications import

In the history of the Russian pharmaceutical market the year of 1993 became the year of formation of rules of market relations and changing under them of market landscape. The significant segment of state-centralized purchases moved under responsibility of regional authorities and their health care authorities. At that, powers of three former state organizations being occupied with purchases of imported medications were distributed between new state companies of Ministry of Health and commercial organizations and firms that entered pharmaceutical market. This diversity rather soon gave rise to competitive fight for budget funds and experiments of Government with market regulation. The traces of these clashes and attempts to make market regulated can be found in Ministry of Health archives and journal publications. The Report I reveals circumstances of entrance of Ministry of Health into market relationships and its acquisition of market player identity.

Health system performance assessment and reforms, Oman.

To prioritize key areas of action and investment for the next strategic cycle of national development plans (2026-2031) in Oman, we needed a holistic view of the country's health system and its main deficiencies and inefficiencies. Informed by the World Health Organization framework, our team of seven national health ministry staff and two international experts conducted a rapid health system performance assessment. We used already available data to identify system bottlenecks and their potential root causes, verifying our findings with key informant interviews. Oman's 4.9 million population is relatively young (average age 28years) but ageing, with a mounting burden of chronic diseases. While health-care services are free for Omani nationals, more than 1.5 million expatriates rely on out-of-pocket payments for health-care services. Strengthening primary health care, improving the quality of care, providing financial protection, and ensuring that public and private health-care providers operate within the same legal and procedural framework are recognized as key national priorities. Our assessment highlighted the need to extend health service coverage to the whole population, strengthen private health-care sector governance, improve health education, increase financial investment, and expand the country's capacity for data collection and analysis. The assessment framework allowed us to identify areas where information is lacking and use already available data to analyse multiple health outcomes. As well as identifying issues that need to be addressed during the next policy development cycle, our findings have contributed towards the preparation of a more extensive assessment.

Trust: How It Affects the Use of Telemedicine in Improving Access to Assistive Technology to Enhance Healthcare Services.

Modern telemedicine (TM) technologies play a crucial role in enhancing access to Assistive Technology in healthcare services. However, the full benefits of this technology will not be realized unless it is widely accepted among service users (patients). This study aimed to investigate the impact of patient trust and perceived risk on the acceptance of TM for Assistive Technology in healthcare. A comprehensive survey instrument was developed and refined through expert feedback and a pilot study, leading to data collection from 917 participants. The theoretical framework guiding this research was based on the Trust factors in TM, which helped in conceptualizing the factors influencing patient acceptance of TM. The study revealed a significant gap in patient trust in TM and highlighted the multifaceted nature of perceived risk, emphasizing the need to consider individual risk factors separately. Results also indicated that trust in technological reliability and the perceived effectiveness of TM were critical factors influencing its adoption. The findings underscore the importance of building trust among service users and promoting the reliability of TM for achieving desirable medical outcomes. In conclusion, to facilitate widespread acceptance of TM for Assistive Technology, a multi-faceted approach involving healthcare providers, organizations, and governments is essential to address patient concerns, enhance trust, and promote the benefits of this technology.