Inequality In Distribution Research Articles

The Effects of Corporate Governance Reforms on Distribution Inequality: Micro Evidence from Japan

The Effects of Corporate Governance Reforms on Distribution Inequality: Micro Evidence from Japan

A synergistic study on farmers’ income enhancement and urban-rural financial development under the perspective of common wealth by an intelligent decision support system for land improvement

Abstract This paper proposes the general framework and technical process of the intelligent decision support system for land improvement based on a multi-objective artificial immunity algorithm. Based on the analysis of the current situation of land use structure and spatial layout in County S, three land resource quantity structure optimization schemes are selected, and the improvement of agricultural land use efficiency and agricultural output value in the three schemes are evaluated and analyzed. The mechanisms that affect income distribution in urban-rural financial development and land finance are summarized. The results show that after land improvement, the area of cultivated land and grassland in County S decreased by 1,444 ha, and the area of garden land and forest land increased to the greatest extent in the economically prioritized scenario. The size of towns increased to 541 ha, and the size of villages decreased to different degrees and all three land improvement programs had the combined effect of increasing the gross agricultural product and boosting farmers’ incomes. The development of urban and rural finance is aided by land improvement, but the degree of inequality in income distribution is widened.

Comparison of five equations in describing the variation of leaf area distributions of Alangium chinense (Lour.) Harms.

Previous studies have validated a performance equation (PE) and its generalized version (GPE) in describing the rotated and right-shifted Lorenz curves of organ size (e.g., leaf area and fruit volume) distributions of herbaceous plants. Nevertheless, there are still two questions that have not been adequately addressed by prior work: (i) whether the PE and GPE apply to woody plant species and (ii) how do the PE and GPE perform in comparison with other Lorenz equations when fitting data. To address these deficiencies, we measured the lamina length and width of each leaf on 60 Alangium chinense saplings to compare the performance of the PE and GPE with three other Lorenz equations in quantifying the inequality of leaf area distributions across individual trees. Leaf area is shown to be the product of a proportionality coefficient (k) and leaf length and width. To determine the numerical value of k, we scanned 540 leaves to obtain the leaf area empirically. Using the estimated k, the leaf areas of 60A. chinense saplings were calculated. Using these data, the two performance equations and three other Lorenz equations were then compared and assessed using the root-mean-square error (RMSE) and Akaike information criterion (AIC). The PE and GPE were found to be valid in describing the rotated and right-shifted Lorenz curves of the A. chinense leaf area distributions, and GPE has the lowest RMSE and AIC values. This work validates the GPE as the best model in gauging variations in leaf area of the woody species.

Generalized Pareto distribution and income inequality: an extension of Gibrat's law

<abstract> <p>Motivated by empirical observations, we proposed a possible extension of Gibrat's law. By applying it into the random growth theory of income distribution, we found that the income distribution is described by a generalized Pareto distribution (GPD) with three parameters. We observed that there is a parameter $ \eta $ in the GPD that plays a key role in determining the shape of income distribution. By using the Kolmogorov-Smirnov test, we empirically showed that, for typical market-economy countries, $ \eta $ is significantly close to 0, indicating that the income distribution is characterized by a two-class pattern: The bottom 90% of the population is approximated by an exponential distribution, while the richest 1%~3% is approximated by an asymptotic power law. However, we empirically found that in China during the period of the planned economy and the early stages of market reform (from 1978 to 1990), $ \eta $ deviated significantly from 0, indicating that the bottom of the population no longer conformed to an exponential distribution.</p> </abstract>

New indices to balance α-diversity against tree size inequality

The number and composition of species in a community can be quantified with α-diversity indices, including species richness (R), Simpson’s index (D), and the Shannon–Wiener index (H΄). In forest communities, there are large variations in tree size among species and individuals of the same species, which result in differences in ecological processes and ecosystem functions. However, tree size inequality (TSI) has been largely neglected in studies using the available diversity indices. The TSI in the diameter at breast height (DBH) data for each of 999 20 m × 20 m forest census quadrats was quantified using the Gini index (GI), a measure of the inequality of size distribution. The generalized performance equation was used to describe the rotated and right-shifted Lorenz curve of the cumulative proportion of DBH and the cumulative proportion of number of trees per quadrat. We also examined the relationships of α-diversity indices with the GI using correlation tests. The generalized performance equation effectively described the rotated and right-shifted Lorenz curve of DBH distributions, with most root-mean-square errors (990 out of 999 quadrats) being < 0.0030. There were significant positive correlations between each of three α-diversity indices (i.e., R, D, and H') and the GI. Nevertheless, the total abundance of trees in each quadrat did not significantly influence the GI. This means that the TSI increased with increasing species diversity. Thus, two new indices are proposed that can balance α-diversity against the extent of TSI in the community: (1 − GI) × D, and (1 − GI) × H'. These new indices were significantly correlated with the original D and H΄, and did not increase the extent of variation within each group of indices. This study presents a useful tool for quantifying both species diversity and the variation in tree sizes in forest communities, especially in the face of cumulative species loss under global climate change.

POVERTY IN BULGARIA: A GENERAL CHALLENGE

The current article is not committed to the complex task of providing solutions to the deepening unfavorable economic situation in the country, but rather to put an emphasis on one of the most pressing problems for society in Bulgaria - poverty. European statistics report that our country faces the highest risk of poverty compared to other members of the European Union. Among those most at risk are some of the working people - the so-called working poor, children and persons over 65 years of age. Bulgaria is the EU-27 country with the highest inequality in income distribution and a low poverty threshold. The research has an empirical and analytical focus, considering indicators that have a direct relationship to the high proportion of the poor population in our country.

Towards a Greener and Fairer Transportation System: A Survey of Route Recommendation Techniques

In recent years, ride-hailing services have emerged as a popular means of transportation for the residents of urban areas. There is an inequality in the spatio-temporal distribution of demand and supply, which requires the proper recommendation of routes to drivers in order to guide them towards riders optimally. This paper provides a review of different route recommendation strategies that have been applied in ride-hailing platforms with the main focus on fairness, and environmental issues. It is important to consider the environmental aspects of route recommendation systems as the transportation sector is one of the major sources of air pollution and has reduced the life expectancy of people around the globe. Moreover, there is an unfair distribution of resources and opportunities among the drivers and riders of the platform which has affected their long-term sustainability in the market. In this paper, we highlight the critical challenges and opportunities inherent in the design of green and fair route recommendation systems and indicate some possible directions for future research.

AUGUST: An Interpretable, Resolution-based Two-sample Test

Two-sample testing is a fundamental problem in statistics. While many powerful nonparametric methods exist for both the univariate and multivariate context, it is comparatively less common to see a framework for determining which data features lead to rejection of the null. In this paper, we propose a new nonparametric two-sample test named AUGUST, which incorporates a framework for interpretation while maintaining power comparable to existing methods. AUGUST tests for inequality in distribution up to a predetermined resolution using symmetry statistics from binary expansion. Designed for univariate and low to moderate-dimensional multivariate data, this construction allows us to understand distributional differences as a combination of fundamental orthogonal signals. Asymptotic theory for the test statistic facilitates p-value computation and power analysis, and an efficient algorithm enables computation on large data sets. In empirical studies, we show that our test has power comparable to that of popular existing methods, as well as greater power in some circumstances. We illustrate the interpretability of our method using NBA shooting data.

Aiming at low nitrogen leaching diets based on nitrogen fertilizer regulatory policy: A regional bio-economic assessment of the Zayandeh-Rud river basin-Iran

Negative environmental impacts of nitrogen (N) intensive diets have triggered global debates on sustainable nitrogen management. Solutions such as dietary transitions, cropland reallocation and N Regulatory Policy (NRP) have been proposed to mitigate the adverse environmental impacts of N use in food production. However, there is still insufficient understanding of how NRPs could be designed to minimize negative environmental impact across diverse agro-ecological zones without sacrificing human dietary requirements. To increase this understanding, we evaluated the consequences of three NRP scenarios (low, moderate, and high N fertilizer rates) on the amount of livestock and non-livestock diet components as well as the associated N leaching and farmers' Gross Margin (GM) by optimizing the allocation of cropland between food and feed crops. We developed a bio-economic Interval Fuzzy Multi-Objective Programming (bio-economic IFMOP) model for the Zayandeh-Rud river basin, Iran, and a procedure that accounts for annual average availability of calories per capita, calorie sources from livestock and non-livestock components of three dietary preferences, and inequality in calorie distribution. The interaction among soil, climate and weather variability and NRPs across nine sub-regions of the case study region was handled by crop yield simulation using the DSSAT software. The solution of farmers' GM, derived from the optimization problem across possibilities of water fluctuations, was assessed to determine the uncertainty in GM. We also introduced an N leaching per Block of Distributed Calories (BDC) criterion based on solutions of supplied calories and associated N leaching. The upper bound of the moderate NRP scenario resulted in the smallest N leaching per BDC. This corresponded to ∼0.34, ∼0.34, ∼3.77 and 19.00 million BDC of meat, dairy, wheat and potato, respectively. Also, the upper bound of this scenario satisfied the lowest instability in farmers’ GM against water fluctuation compared with low and high NRP scenarios. The affordable volume of N leaching per BDC varied across sub-regions between [1.53,3.49], [1.52,3.33], [0.76,0.99] and [0.05,0.08] kg for meat, dairy, wheat and potato, respectively. Our results highlighted both optimistic and pessimistic prospects of producing low N leaching diets. The approach of this study could also be applied to other regions and countries.

A Comparative Analysis of Household Incomes of People with Different Levels of Education in Poland and the USA

Abstract Research background Household income is one of the most important economic categories depending on various factors, in particular on the level of education of the head of the household. Salaries are treated as the market valuation of graduates made by employers. Hence, the question arises of how the education system affects the distribution of household income, in particular in the group of people with higher education. Purpose The aim of the paper is to apply the Singh-Maddala model to describe the income distribution of people with primary, secondary and higher education in Poland and the USA. On the basis of numerical characteristics and measures of income inequality, the situation of education, in particular higher education, and its impact on household income in the analyzed countries were assessed. Research methodology The study used data from the Luxembourg Income Study Database (LIS) from 2020. All analyzes were based on the Singh-Maddala model. The maximum likelihood method was used to estimate the model parameters. Results The analysis showed that the higher the level of education, the better the income situation of the household. In Poland, salaries in the group of people with higher education are the most unequal, while in the USA the greatest income inequalities occur in the group of people with primary education. Novelty The paper describes the issue of household income distribution and income inequality, which is an important and current socio-economic problem. To describe and analyze the economic situation of the household incomes of people with different levels of education in Poland and the USA statistical data from the Luxembourg Income Study Database (LIS) was used. Empirical studies conducted for different samples add significantly to existing knowledge on the topic.

Livelihood strategies, baobab income and income inequality: Evidence from Kordofan and Blue Nile, Sudan

This paper analyses the relationship between livelihood strategies, baobab income, and income inequality in rural Sudan. Baobab is an emerging commercial crop with emerging specialised value chains in Kenya and Malawi. In Sudan, baobab traditionally has been used with limited research on evolving business opportunities and associated implications for rural development. The study utilizes survey data from 374 randomly sampled households from two states in Sudan (Kordofan and Blue Nile) and examines livelihood strategies, income inequalities and the role of baobab income for rural households. We use principal component analysis (PCA) and hierarchical cluster analysis to identify three household clusters in each region based on the income sources. In Kordofan, the identified strategies were ‘livestock and baobab-based’, ‘livestock and crop-based’, and ‘business-based’. In Blue Nile, they were ‘mixed’, ‘business-based’, and ‘crop-based’. The clusters exhibited variations in asset endowments and wealth, with differences in access to land, savings, credit, and technology. Households classified under the livestock-baobab strategy (Kordofan) and the mixed strategy (Blue Nile) had the highest degree of poverty, lowest per capita income, and baobab contributed 33% and 26% of total income, respectively, underscoring the importance of baobab income to the livelihood security of poorer households. To analyse inequality in distribution of income Gini coefficients are estimated for regions and livelihood strategy categories. Baobab income contributes to reducing income inequality: 10% increase in baobab income reduces inequality by 6.5% and 11% in Kordofan and Blue Niles, respectively, but shows also in Kordofan better off households generate higher incomes from baobab.

A study of agro-economic development and its impact on socio-economic inequality in Ukraine

In today’s world, the problem of inequality is gaining global significance, and numerous international institutions set among their main tasks the fight against its manifestations – economic, social, etc. The study of economic inequality during martial law is extremely relevant, as it primarily negatively affects people’s lives and well-being, provokes crises and additional social tensions, and, as a result, destabilizes the state system and the national economy, which are already in a state of crisis due to military operations. The purpose of this paper is to analyse the causes of social and financial stratification of Ukrainian society in the context of agro-economic development. The dynamics of salary in Ukraine, in particular, in the agricultural sector, was studied using the method of statistical analysis, and the index of general economic stratification was calculated using the Gini coefficient method. Statistical data on the development of the agricultural land market was analysed, starting from the end of the moratorium in July 2021 and until June 2023. As a result, the current key indicators of the land market in Ukraine, and information on salary in various sectors of the economy in the period from 2014 to 2022 were obtained, and the incomes of agricultural employees were analysed, which turned out to be below average. For a more objective assessment, statistics on the largest agricultural countries of the European Union were used and compared with their inequality indicators. The calculation of the Gini coefficient showed a 10% increase in the inequality of income distribution of Ukrainian households between 2014 and 2022, but it was still lower than the current indicators of such European countries as Germany, Sweden, and Poland. The practical significance of the work lies in the development of recommendations for reducing the gap between rich and poor in Ukraine, in particular in the agricultural sector, which can be used by the relevant authorities to redistribute the agricultural market and optimize tax legislation

Has the digital economy improved the consumption of poor and subsistence households?

Using Chinese Family Panel Studies (CFPS) database from 2012 to 2018, this paper examines the impacts and transmission mechanisms of the digital economic growth on the consumption of the poor and subsistence households. The results show that the digital economy negatively affects the consumption of the poor and subsistence households, with a more prominent effect on the poor families. Mechanism analysis indicates that digital economic development reduces the consumption of poor and subsistence households mainly by exacerbating the uncertainties they face in labor market (higher unemployment risk and expected income uncertainty) and the inequality of wealth distribution (higher deprivation of income and wealth). Further analyses reveal that the digital economy has greater negative impacts on households with less material, human and social capital endowments, and leads no significant improvements in the consumption environment for the disadvantaged households.

The water–energy–food (WEF) nexus as a tool to develop climate change adaptation strategies: a case study of the Buffalo River catchment, South Africa

Abstract The Buffalo River catchment in KwaZulu-Natal, South Africa, has limited water resource infrastructure development, and climate change is predicted to increase its water supply deficits by exacerbating water distribution inequalities. This study evaluates and optimises current climate change policy plans on the Buffalo River catchments water system to aid in assessing the sustainability of policies that address the aforementioned challenges. The water–energy–food (WEF) nexus approach, which encourages system thinking by considering interconnections among water, energy, and food resources when developing integrated natural resource management strategies, was used to perform the evaluation. The water system's reliability in meeting projected domestic, agricultural, and energy water demands under climate change conditions was used for gauging the sustainability of the development plans. Findings projected the existing water policy plans to increase the domestic water provision by &amp;gt;70% under climate change; however, the &amp;lt;3% increase in irrigation and energy generation water demand coverage yielded a significant contrast in reliability between densely populated areas and regions with extensive agricultural activities. The optimised policy plans, which improved water provision for all considered sectors increased by &amp;gt;20% under climate change, are thus recommended for future water resource management research and dialogue in the Buffalo River catchment.

Determinants of differences in RT-PCR testing rates among Southeast Asian countries during the first six months of the COVID-19 pandemic.

A positive correlation has been demonstrated between gross domestic product (GDP) per capita and COVID-19 tests per 1000 people. Although frequently used as an indicator of economic performance, GDP per capita does not directly reflect income distribution inequalities and imposed health costs. In this longitudinal ecological study, we aimed to determine if, besides GDP per capita, indicators relating to governance, public health measures enforcement, and health and research investment explain differences in RT-PCR testing rates among countries in Southeast Asia (SEA) during the first six months of the COVID-19 pandemic. Using open-access COVID-19 panel data, we estimated the effect of various indicators (GDP per capita, health expenditure per capita, number of researchers per one million population, corruption perceptions index, stringency index, regional authority index) on daily COVID-19 testing by performing fixed-effects negative binomial regression. After accounting for all indicators, the number of daily confirmed COVID-19 cases, and population density, the model provided a 2019 GDP per capita coefficient of 0.0046330 (95% CI: 0.0040171, 0.0052488; p <0.001), indicating that a rise in 2019 GDP per capita by 100 international dollars is associated with a 46.33% increase in the number of daily tests performed. Additionally, all indicators were significantly associated with the daily number of RT-PCR testing on multivariable analysis. In conclusion, we identified different country-level indicators significantly associated with differences in COVID-19 testing rates among SEA countries. Due to the study's ecological design, we caution on applying our results to the individual level given potential for systematic differences between the included countries. Additional investigation is likewise needed to understand how government expenditure on healthcare may have impacted COVID-19 testing capacity during the initial stages of the pandemic.

Kernel Estimation of the Quintile Share Ratio index of Inequality for Heavy-tailed Income distributions

Evidence from micro-data shows that capital incomes are exceedingly volatile, which makes up a disproportionately high contribution to the overall inequality in populations with the heavy-tailed nature on the income distributions for many countries. The quintile share ratio (QSR) is a recently introduced measure of income inequality, also forming part of the European Laeken indicators and which cover four important dimensions of social inclusion (health, education, employment and financial poverty). In 2001, the European Council decided that income inequality in the European Union member states should be described using a number of indicators including the QSR. Non-parametric estimation has been developed on the QSR index for heavy-tailed capital incomes distributions. However, this method of estimation does not give satisfactory statistical performances, since it suffers badly from under coverage, and so we cannot rely on the non-parametric estimator. Hence, we need another estimator in the case of heavy tailed populations. This is the reason why we introduce, in this paper, a class of semi-parametric estimators of theQSR index of economic inequality for heavy-tailed income distributions. Our methodology is basedon the extreme value theory, which offers adequate statistical results for such distributions. Weestablish their asymptotic distribution, and through a simulation study, we illustrate their behaviorin terms of the absolute bias and the median squared error. The simulation results clearly showthat our estimators work well.

Analysis of MSME Capital Using Sharia Fintech Peer to Peer Lending

As one of the pillars of the economy in Indonesia, it is proven that MSMEs are able to survive the Covid-19 pandemic with various innovations they have implemented, but there are still several obstacles in the development of MSMEs themselves. MSMEs, especially for the micro business scale in Indonesia, are still classified into segments that have limited access to formal financial institutions (unbankable population). The results of the PWC survey in 2019 The biggest problem of MSMEs is the problem of capital, and in an effort to obtain additional capital, around 74% of the micro segment cannot access financing from the formal financial sector. Increasing access to finance itself is one of the strategies to achieve Sustainable Development Goals (SDGs). Based on previous research, Islamic fintech has a role in driving SDGs targets, especially the targets to (1) eradicate poverty and (2) hunger, and (3) reduce inequality in wealth distribution. In this study we conducted indepth interviews with several MSME players and Islamic fintech companies. The lack of literacy related to fintech with the sharia peer to peer lending scheme makes MSMEs afraid to do business financing with this scheme, even though this scheme is very suitable for the unbankable population because the financing requirements are easy and fast in the disbursement process.

Measuring the relationship between income distribution inequality and life expectancy at birth in OECD countries with Hellinger correlation analysis

Bu çalışma, “doğumda yaşam beklentisi” ve “gelir dağılımı adaletsizliği” arasındaki ilişkinin Hellinger korelasyon analizi ile ölçülmesini konu almaktadır. Analizler 2019 yılı verileri üzerinden 29 OECD ülkesi için gerçekleştirilmiştir. Gelir dağılımı adaletsizliğini temsilen, Gini katsayısı ve Palma oranı kullanılmıştır. Çalışmanın birincil amacı, klasik Pearson korelasyon analizi ile anlamlı sonuç vermeyen “doğumda yaşam beklentisi” ile “gelir dağılımı adaletsizliği” arasındaki ilişkinin, Hellinger korelasyon analizi uygulandığında anlamlı olup olmadığını araştırmaktır. Çalışmanın bir diğer amacı ise, gelir dağılımı adaletsizliğinin doğumda yaşam beklentisi üzerindeki etkisinin, cinsiyetlere göre farklılık gösterip göstermediğini ortaya koymaktır. Bu nedenle, doğumda yaşam beklentisi değişkeni; toplam nüfusun doğumda yaşam beklentisi, kadınlar için doğumda yaşam beklentisi ve erkekler için doğumda yaşam beklentisi şeklinde üç ayrı kategoride ele alınmıştır. RStudio 4.0.5. HellCor paketi kullanılarak gerçekleştirilen uygulamalar sonucunda; klasik Pearson korelasyon analizi ile ölçülen ilişkilerin tamamı istatistiksel olarak anlamsız bulunurken, doğumda yaşam beklentisi ile Gini katsayısı arasındaki tüm Hellinger korelasyon katsayıları 1’e yakın, çok yüksek ilişkili bulunmuştur. Fakat aynı durum Palma oranı için geçerli değildir. Doğumda yaşam beklentisi ile Palma oranı arasındaki tüm Hellinger korelasyon katsayıları düşük bulunmuştur. Bu durumun, Gini katsayısı ile Palma oranının hesaplanma yöntemlerinin farklı olmasından kaynaklandığı düşünülmektedir. Çalışmada ayrıca, gelir dağılımı adaletsizliğinin, hem kadınların hem de erkeklerin doğumda yaşam beklentileri ile ilişkisinin benzer olduğu; gelir dağılımı adaletsizliğinin, cinsiyetlerden bağımsız olarak, tüm toplumun yaşam beklentisi ile yüksek ilişkili olduğu sonucuna varılmıştır.

Impact of Nutrition on Life Expectancy in Russian Regions

The paper studies the impact of nutrition on the life expectancy (LE) of men, as well as women in Russian regions. The empirical analysis is based on data from the Federal State Statistics Service. The panel data includes 1694 observations (77 regions of the Russian Federation in 2000–2021). The authors suggest a summary indicator of regional nutrition patterns based on the nutrition norms developed for 10 food groups by the Ministry of Health of the Russian Federation. The study was run using fixed effect models while controlling for indicators of the socio-economic development of regions.Econometric analysis shows that LE of men and LE of women increases with the decrease in the number of deviations from the regional nutrition norms. Alcohol consumption also reduces the LE of men and women, but the effect on men's life expectancy is more pronounced. As expected, the regional GRP per capita increases life expectancy, while inequality in income distribution leads to the LE decrease. The most important factor that positively affects LE of men, as well as LE of women is the proportion of urban citizens. In addition, LE is also affected by regional healthcare design: the number of doctors per 1000 people increases the LE of women; the number of hospital beds per 10 thousand people is associated with both the LE of men and LE of women. COVID-19 significantly contributed to the decrease in LE of men and especially of women. Its negative impact was already noticeable in 2020 but became particularly pronounced in 2021.The study draws attention to a significant regional variation in the LE of men and LE of women related, among other things, to deviations from the food consumption patterns. The findings may be of interest to regional authorities responsible for developing healthy nutrition policies in Russian regions and increasing the LE of men and women.

Fifty years of hemodialysis in Ghana—current status, utilization and cost of dialysis services

BackgroundKidney failure is common in Ghana. Haemodialysis (HD) is the most common treatment modality for survival. Although, HD has been available in Ghana for 50 years, the majority of patients who develop kidney failure cannot access it. We describe the state of HD, dialysis prevalence, its utilization and cost of HD after fifty years of dialysis initiation in Ghana.MethodsA situational assessment of HDs centres in Ghana was conducted by surveying nephrologists, doctors, nurses and other health care professionals in HD centres from August to October 2022. We assessed the density of HD centres, number of HD machines, prevalence of nephrologists, number of patients receiving HD treatment and the cost of dialysis in private and government facilities in Ghana.ResultsThere are 51 HD centres located in 9 of the 16 regions of Ghana. Of these, only 40 centres are functioning, as 11 had shut down or are yet to operate. Of the functioning centres most (n = 26, 65%) are in the Greater Accra region serving 17.7% of the population and 7(17.5%) in the Ashanti region serving 17.5% of the population in Ghana. The rest of the seven regions have one centre each. The private sector has twice as many HD centers (n = 27, 67.5%) as the public sector (n = 13,32.5%). There are 299 HD machines yielding 9.7 HD machines per million population (pmp) with a median of 6 (IQR 4–10) machines per centre. Ghana has 0.44 nephrologists pmp. Currently, 1195 patients receive HD, giving a prevalence of 38.8 patients pmp with 609(50.9%) in the private sector. The mean cost of HD session is US $53.9 ± 8.8 in Ghana.ConclusionThere are gross inequities in the regional distribution of HD centres in Ghana, with a low HD prevalence and nephrology workforce despite a high burden of CKD. The cost of haemodialysis remains prohibitive and mainly paid out-of-pocket limiting its utilization.