Poor Information Flow Research Articles

Factors influencing the uptake of cervical cancer screening services in Tanzania: A health system perspective from national and district levels.

AimThis study aimed at examining factors influencing uptake of cervical cancer screening services among women in Tanzania.DesignExploratory qualitative study.MethodsIn‐depth interviews were used to obtain information from 10 key Informants. Of these, three were officials (policy makers) from the Reproductive Health‐Cancer Unit of Ministry of Health and Community Development, Gender, Elderly and Children (MoHCDGEC), three were health managers working at Kinondoni Municipal health system reproductive and child health section and four were health workers from the Ocean Road Cancer Institute (ORCI). The study participants were purposively selected since they hold the responsibility of planning, coordinating and implementing the Tanzania cervical cancer prevention strategies at different levels of health system. The qualitative data analysis was done manually using thematic analysis.ResultsThe national health system factors influencing the early uptake of cervical cancer screening services include poor flow of information from national to lower level and inadequate availability of tools and instruments and shortage of skilled and competent staff. The district level health systems factors influencing uptake of cervical cancer screening services include inadequate number of partners, poor flow of information, poor collaboration with the private sector, no adequate provision of cervical cancer screening services due to lack of prioritization, poor creation of awareness and failure to use the health information system effectively.

“99DOTS”techno-supervision for tuberculosis treatment – A boon or a bane? Exploring challenges in its implementation at a tertiary centre in Delhi, India

In India, daily regimen with fixed-dose combination along with 99DOTS adherence tool and one-stop service at Anti-Retroviral Treatment (ART) centres for HIV infected Tuberculosis (TB) patients was launched in 2017. No systematic evaluation of its implementation has been done so far in a tertiary care setting in urban India. A mixed-methods study was conducted at National Institute of Tuberculosis and Respiratory Diseases, Delhi in 2018-19. Missed doses, average adherence and treatment outcomes were compared across 99DOTS dashboard and TB treatment card. In-depth interviews of patients and health care providers were conducted to explore the implementation challenges and benefits. Median of missed doses recorded during intensive and continuation phase were 56 and 68 respectively in 99DOTS as compared to 0 in the TB Treatment card (p<0.0001). Average adherence was observed to be 27% in 99DOTS versus 99% in the TB treatment card (p<0.0001). Technical issues like software malfunction, logistic difficulties such as missing custom envelops and patient's inability to give call were reported. Role clarity among ART and TB program staff was ambiguous, which contributed to poor information flow between them. Patient benefits such as reduced stigma, less travel costs and reduced work absenteeism were reported. Success of 99DOTS program under programmatic condition needs webtool stability, uninterrupted logistic supplies (envelops), training of staff and better coordination between TB and HIV program personnel. Despite the challenges in its implementation, the benefit of this tool in terms of greater convenience and reduced stigma for patients is encouraging.

Research on Agricultural Products Circulation in Fengcheng City Based on E-commerce

The circulation of agricultural products in rural areas of China is still at a low level, and it is difficult to cater to the needs of modern social and economic development and agricultural modernization. In the process of circulation of agricultural products, there are problems such as long circulation time, large loss, poor information flow, and poor circulation channels. This paper takes Frenching as the research object, combines the theory of e-commerce and agricultural product circulation, analyses the current situation of the circulation of agricultural products in Frenching City and the main problems. From the perspective of e-commerce of agricultural products, it integrates the existing domestic typical county development of agricultural products. The successful experience, combined with the objective conditions of Frenching, explored the issues related to the development of e-commerce in Frenching to promote the circulation of agricultural products, and tried to design a network suitable for the e-commerce circulation of agricultural products in Frenching. Finally, some targeted suggestions and countermeasures are given to promote the development of agricultural products e-commerce in Frenching.

Exploring physicians\u2019 decision-making in hospital readmission processes - a comparative case study

BackgroundHospital readmissions is an increasingly serious international problem, associated with higher risks of adverse events, especially in elderly patients. There can be many causes and influential factors leading to hospital readmissions, but they are often closely related, making hospital readmissions an overall complex area. In addition, a comprehensive coordination reform was introduced into the Norwegian healthcare system in 2012. The reform changed the premises for readmissions with economic incentives enhancing early transfer from secondary to primary care, making research on readmissions in the municipalities more urgent than ever. General practitioners (GPs) and nursing home physicians, have traditionally held a gatekeepers function in hospital readmissions from the municipal healthcare service, as they are the main decision-makers in questions of hospital readmissions. Still, the GPs’ gatekeeper function is an under-investigated area in hospital readmission research. The aim of the study was to increase knowledge about factors that lead to hospital readmissions among elderly in municipal healthcare, with special attention to GPs’ and nursing home physicians’ decision making.MethodThe study was conducted as a comparative case study. Two municipalities affiliated with the same hospital, but with different readmission rates were recruited. Twenty GPs and nursing home physicians from each municipality were recruited and interviewed. Forty hours of observation were conducted during the huddles in one long-term and one short-term nursing home in each municipality.ResultsSeven themes describing how different factors influence physicians’ decision-making in the hospital readmission process in two municipalities were identified. Poor communication, continuity and information flow account for hospital readmissions in both municipalities. Several factors, including nurse staffing and competence, patients and their families, time constraints and experience affected physicians’ decision-making.ConclusionCommunication, continuity and information flow contributed to hospital readmissions in both municipalities. The cross-case analysis revealed slight differences between municipalities. More research focusing on GPs’ and nursing home physicians’ decision-making, nursing home nurses and home care nurses’ experience of hospital readmissions and discharges is needed.

Resource Complementarity for Social Service Delivery: A Case of Corporates and Local Government Authorities in Morogoro, Tanzania

Employing a case study design, this paper examined corporates’ resource complementarity to Local Government Authorities in Morogoro region. The findings revealed that as much as corporates such as Kilombero and Mtibwa Sugar Companies comit significant amount of resources through CSR to offer social services, which could otherwise be offered by the LGAs; the LGAs are less informed of the actual contribution made by corporates in terms of the actual budgets spent to complement social services in their areas of jurisdiction. The findings further revealed that poor flow of information from Villages and Wards levels to the District Council has accounted for this challenge, which has resulted into LGAs failing to acknowledge contribution made by the corporates. Failure of LGAs to acknowledge the contribution of Corporates has far reaching impact on the reputation of the corporates and the motivation of corporates to sustain resource complementarity to LGAs. This paper recommends that, there is a need to improve information system within LGAs on the resources complemented by corporates and other stakeholders for social services delivery. Such improvement should encompass production and submission of reports on resources and social services provided through CSRs by development stakeholders to the District Councils.

Differentiation of access management services at seaport terminals: Facilitating potential improvements for road hauliers

Plagued by congestion and long turnaround times, road hauliers' access to seaport terminals suffers from inefficient seaport terminal and haulier operations, poor information flows between hauliers and seaport terminals and a lack of high-quality, real-time data. To address hauliers' poor access management at seaport terminals, five access management services provided by different seaport terminals worldwide were identified as part of an ongoing conversation about such services. This paper offers new insights to both scholars and practitioners by differentiating the services according to the elements of turnaround time, access reliability, access precision and access flexibility, characteristics of which were identified during a review of relevant literature. The potential impacts of the elements for each access management service were investigated during empirical studies involving six semi-structured interviews and two workshops with participants (i.e. two hauliers and a seaport terminal). The chief finding is that access management services able to exchange information in real time have greater potential to improve access management for road hauliers.

Public Sector Provision of Free Agricultural Inputs in Uganda: The Rationale and Challenges of Operation Wealth Creation Programme

The paper analyses the rationale and challenges of public sector provision of free agricultural inputs in Uganda focusing on Operation Wealth Creation (OWC) programme. The programme officially started in 2014 and targets subsistence farmers in the country. OWC aims at commercialization of agriculture thus creating wealth and reducing poverty. It uses the military (Uganda Peoples Defence forces) to distribute and supervise delivery of inputs on the assumption that the army is efficient, organized and disciplined. The study was conducted in the new district of Sheema using purely a qualitative approach. We interviewed farmers, local leaders, opinion leaders and central government officials (key stakeholders) and conducted two Focus Group Discussions. Observation was also used to see how input distribution was being done. Our findings revealed that although OWC is well intended (creation of wealth and reduction of poverty at household level), it faces numerous challenges that hamper smooth implementation. The most common identified challenges were: small quantities of inputs supplied due to limited budget, poor quality inputs, elite capture and stringent entry requirements. Others are fear of the military by farmers, late deliveries of inputs and poor information flow between suppliers, district leadership and farmers. We recommend that government should increase agriculture sector budget, improve on quality of inputs and information flow between suppliers, district leaders and farmers but also fully involve the district leadership in programme implementation.

Factors affecting the delivery of healthcare on a humanitarian operation in West Africa: A qualitative study

IntroductionMedical personnel in the UK Armed Forces are highly trained to deploy in support of military operations that assist humanitarian, peacekeeping, counter-terrorism and environmental catastrophes anywhere in the world. Such environments are often austere and successful outcomes demand an individual is highly resilient and able to adapt quickly to any situation. This qualitative study aimed to determine the factors that affect healthcare delivery on such missions by capturing the personal experiences of the first military personnel deployed on a humanitarian operation in support of the Ebola outbreak in West Africa between October 2014 and January 2015. MethodsA grounded theory methodology was utilised to probe the personal accounts of these experiences. Semi-structured interviews were conducted on 14 multi-disciplinary personnel 3–6 months following their return to the UK and were transcribed verbatim. Data were analysed and a framework generated that had been further refined by discussion with military personnel independent of the study but with the contextual understanding and experience of this particular deployment. FindingsThe resultant theoretical framework was underpinned by participants framing their experience by “just getting on with it”. Stressors such as a poor flow of information, a fear of the unknown, strict patient admission criteria, environmental constraints and transcultural boundaries to care were mitigated by strong leadership, teamwork, peer support and the positive impact of having made a difference. ConclusionCollective pre-deployment training generated competence, confidence and team cohesiveness providing a firm foundation for coping with the challenges of this humanitarian mission, which continued to be strengthened throughout the deployment. These factors helped to build personnel's resilience to the stressors associated with the mission and may help to protect their mental health outcomes in the longer-term.

Participatory evaluation of delivery of animal health care services by community animal health workers in Karamoja region of Uganda.

AimAn evaluation exercise was carried out to assess the performance of Community Animal Health Workers (CAHWs) in the delivery of animal health care services in Karamoja region, identify capacity gaps and recommend remedial measures.Materials & methodsParticipatory methods were used to design data collection tools. Questionnaires were administered to 204 CAHWs, 215 farmers and 7 District Veterinary Officers (DVOs) to collect quantitative data. Seven DVOs and 1 Non Government Organization (NGO) representative were interviewed as key informants and one focus group discussion was conducted with a farmer group in Nakapiripirit to collect qualitative data. Questionnaire data was analyzed using SPSS version 19. Key messages from interviews and the focus group discussion were recorded in a notebook and reported verbatim.Results70% of the farmers revealed that CAHWs are the most readily available animal health care service providers in their respective villages. CAHWs were instrumental in treatment of sick animals, disease surveillance, control of external parasites, animal production, vaccination, reporting, animal identification, and performing minor surgeries. Regarding their overall performance 88.8%(191/215) of the farmers said they were impressed. The main challenges faced by the CAHWs were inadequate facilitation, lack of tools and equipments, unwillingness of government to integrate them into the formal extension system, poor information flow, limited technical capacity to diagnose diseases, unwillingness of farmers to pay for services and sustainability issues.Conclusions and recommendationsCAHWs remain the main source of animal health care services in Karamoja region and their services are largely satisfactory. The technical deficits identified require continuous capacity building programs, close supervision and technical backstopping. For sustainability of animal health care services in the region continuous training and strategic deployment of paraprofessionals that are formally recognised by the traditional civil service to gradually replace CAHWs is recommended.

Unique Educational Opportunities for PCPs and Specialists Arising From Electronic Consultation Services

Health care reform should be driven by the goals of better patient experience, improved population health, lower per capita costs, and improved provider satisfaction. Electronic consultation (eConsult) services have been adopted by several jurisdictions in the United States, Canada, and Europe to improve access to specialists by primary care providers (PCPs) and are being heralded as a key component for delivery of coordinated care. The primary intent of an eConsult service is to provide PCPs with efficient, timely, direct access to specialist expertise to help guide the management of their patients, reduce the need for unnecessary face-to-face specialty consultations, and improve the quality of the initial face-to-face consultation when needed, through the preconsultative communication.In addition to improving access to care, eConsult services have been praised by PCPs and specialists for their educational value, in particular their ability to enrich practice-based learning. Less recognized, but equally important from the educational perspective, include the abilities of eConsult programs to promote reflection by PCPs and specialists, improve collegiality and professionalism between primary and specialist care, inform continuing professional development activities and maintenance of certification, and enhance training programs' teaching of effective communication and care coordination.As eConsult services become increasingly available, the medical community must leverage the educational opportunities inherent in eConsult programs to further improve the delivery of coordinated specialty care. The educational role of eConsults should be considered as a priority outcome in their evaluation and must be highlighted and optimized in next iterations of eConsult systems design.

English

Uganda acceded to the International Treaty for Plant Genetic Resources for Food and Agriculture (ITPGTFA) in the year 2003. Despite this, there are still gaps in implementation of the treaty in the country. The article provides insights into the systemic interactions and coalitions among actors in the implementation of the treaty and subsequent barriers to the implementation of the ITPGRFA. Using social network analysis, the interactions of 26 key policy actors are mapped for 4 main expertise networks that are important for implementation of the treaty; that is, the policy direction networks; scientific expertise; financial expertise; and legal networks in order to identify gaps for further action. Findings indicate that the linkages between actors are poor especially in the legal expertise and policy direction networks where the competent authority for the treaty does not have efficient connections with critical and non-critical actors. Many key actors are also excluded from the network leading poor information and resource flows among stakeholders implementing the treaty. In the interim, a memorandum of understanding has been signed by three major institutions that are key to establish clear processes for implementation of the treaty and establishing clear guidelines for access and benefit sharing and clear roles of institutions involved in the policy development and implementation. Key lessons learned from this research are that networks and coalitions are important for fostering information and exchange of expertise to enable effective implementation or domestication of the international treaty (IT). The structured engagement of other non-governmental stakeholders such as non-governmental organisations (NGOs) and international organizations that provide financial and technical support for various aspects of policy implementation is also important. Key words: Policy implementation, policy networks, international treaty for plant genetic resources for food and agriculture (ITPGRFA), Uganda.

Human Trafficking in Malaysia

Recent studies have suggested that migrants are highly vulnerable to being trafficked. Malaysia, with its large number of migrants is vulnerable and is struggling to implement its Anti-Trafficking in Persons and Anti-Smuggling of Migrants Act 2007. There is also little information on implementation experience so far. Through in-depth interviews with government bureaucrats and other stakeholders, this study seeks to gain some insight into Malaysia’s policy implementation experience. It finds inadequate coordination, limited resources, poor information flow, enforcement approach, hierarchical control structure, and need for change as the major factors constraining effective policy implementation.

Analysis of the Supply Chain and Logistics Practices of Warqe Food Products in Ethiopia

Warqe (Enset) is a multipurpose perennial plant, domesticated and grown as a food crop only in Ethiopia. Kocho, bulla, and amicho are food products of warqe. This study analysed the supply chain and logistics practices of warqe foods. Supply chain management concept was used to analyse the warqe-based food chain. Eight supply chain actors were identified. It was observed that the supply chain of warqe foods and the relationship between chain actors was very complex, long and overlapping. The major constraints identified in the chain were poor information flow, poor transportation system, using perishable packaging, lack of cooperation between actors, a poor infrastructure such as road and warehouse services, and poor policies concerning the warqe market. There is a need for cooperation and coordination between the chain actors to create an effective information sharing system. Shared warehouses need to be built near producers and market places. Transportation, packaging and handling need to be improved. Research is required to develop an integrated, efficient and effective logistics for warqe supply and marketing chain.

Analyzing Design Workflow: An Agent-based Modeling Approach

Variability embedded in the architecture, engineering, and construction industry often results from inefficient planning strategies, sub-optimal levels of coordination, and poor flow of information and resources. This inherent variability disrupts workflow in design, results in longer cycle times, increased costs, and rework; thus undermining design, as well as, construction performance. This paper addresses design workflow at the intersection of the social and process aspects of the design phase. These aspects have been studied separately in previous research works, which prevented capturing a comprehensive and realistic understanding of the design process. Accordingly, this study develops a new approach to qualitatively and quantitatively model the exchange of information between design players and pave the way to assessing the impacts of Building Information Modeling and new project procurement strategies on improving design workflow. Agent-based modeling is used to dynamically represent the relationship between social interactions and the diffusion of information between individuals and teams. The study presents a novel design workflow management approach that bridges the gaps in previous studies as it focuses on team structures, interaction dynamics, and information diffusion.

Model reševanja konfliktov - primer lesnega podjetja na Hrvaškem

In business, as well as in all other relationships, there are different opinions and conflicts. Dealing with conflicts is one of the most important tasks of management which has a great influence on efficiency and success of a company. In the research, which was a subject of this article, we were studying the phenomena of conflict in a big wood industry company in Croatia. Data were collected by structured questionnaire survey. We were trying to establish characteristics of an existing model of dealing with conflicts in this particular company. We were more focused on relationship between employees, how often conflicts occur and how persons involved in conflict respond to it. Since in this particular company the model for dealing with conflicts formally does not exist, based on the research we were able to identify the model and prove its characteristics. Results showed that relationship between employees in researched company were good and that responses to conflicts were positive. The most frequent cause for conflicts is a poor information flow between employees, which showed the existing need for improving communication channels, especially by conversations and different meetings. Therefore, communication channels are one of the most important elements of the new model for solving conflict situations in this particular company.

Identification and Elimination of Gaps for Inclusion of Smallholders in Horticulture Value Chain

The agriculture environment is changing in terms of trade practices, business opportunities and availability of technology. There is also pressure on the farmers to generate more income from reduced landholdings. Alternately, there are opportunities offered through emergence of new integrated high value agricultural commodity chains. Diversification towards higher value crops like fruits and vegetables and rising prices has emerged as dominant sources of growth in agriculture during 1990 (1). However, the participation of farmers is observed to be restricted by limitations likeaccess to market, access to training, poor vertical and horizontal linkages and access to finance (2). Poor information flow along the chain, have also been identified as a vital constraint (5). It is thus important to understand the constraints and find out their probable remedies. The value chain approach generating insight into the limitations and opportunities of the chain (1), may help in suggesting solutions to the constraints limiting farmers ’access to markets and help them integrate with high value chains. With this background, the paper attempts to identify the various components to be covered under the value chain approach for horticultural crops and to identify the constraints faced by formers in integrating with the higher value horticulture value chains and realize better income from same level of land resource. The paper also attempts to provide suitable suggestions to eliminate the gaps identified for enhancing the participation of farmers in the high value chain.

Raspberry Pi and Sensor Networking for African Health Supply Chains

Many medicines in Sub-Saharan Africa lose their effectiveness along the supply chain. Some of the reasons are poor information flows, lack of temperature control systems as well as missing standardized processes including the measurement through performance indicators. Studies from the World Health Organization – executed in 70 countries – report that only 29% of these countries meet the minimum recommended standards for temperature control and levels. In order to meet these challenges, efficient and effective ways need to be found. Frequent power outages, low level of education of personnel and a high rate of warehouses without any ITinfrastructure need to be taken into account. This paper focuses on the usage of Raspberry Pis and Arduino (small, simple and low priced computers) in combination with sensor networking. An in-depth literature analysis as well as an onlocation inspection in Cameroon helped to detect the challenges African health supply chain managers face. The study of the possibilities of a Raspberry Pi in combination with Arduino and sensor networking is currently conducted in order to see if these hardware components could help to improve the cold chain challenges of high priced medicines (e.g. vaccines) in developing countries, e.g. in Sub-Saharan Africa. The objective of our research is to identify a fast, low-cost temperature control system in warehouses in developing countries and health supply chains which is easy to implement, to use, to maintain and works effectively (e.g. fast and reliable).

PRICE TRANSMISSION IN SELECTED MALAYSIAN FRUITS MARKETS

The market for fresh produce such as fruits in Malaysia is alleged to be inefficient due to poor flow of information between market levels and uncompetitive market particularly at the wholesale and retail levels. Due to these structural problems, pricing efficiency is questionable, in that they are not integrated. This study intends to examine the cointegration and causality relationships between the farm and retail prices in the Malaysian market of fruits. To that end, the bivariate cointegration approach, using Granger causality tests, is applied. The study uses monthly data from January 2000 through December 2010. The results show that there is evidence of long run bidirectional causal relationship between farm and retail prices for banana and watermelon. However, the analysis revealed a long run unidirectional relationship from farm prices to retail prices with no evidence of reverse or feedback causality running from farm price to retail prices for jackfruit and durian.

Reverse Consideration about Construction Enterprises’ Ignoring Information Resource

Through doing investigation and research of several construction enterprises in local city, the author realized the weak areas of engineering management for the construction industry. Therefore, the paper gave such a result that management status for the industry lacks process control, which seriously influences management efficiency and economic benefit of the enterprises. At present, process control of construction enterprises has such problems as the shortage of development and utilization of information resources and poor information flow process. For management and control of the process, most managers of construction enterprises do not use the scientific method and have few of concepts of scientific decision. In view of the construction project schedule, this paper discusses the influence of the information technology on process control, expounds function of the process control for improving enterprise management efficiency and analyzes utilization of information technology and information resource for improving project management. It is aimed at achieving target for strengthening management efficiency.

The failure of foresight in crisis management: A secondary analysis of the Mari disaster

Foresight the ability to plan and think systematically about future scenarios in order to inform decision-making in the present has been applied extensively by corporations and governments alike in crisis management. Foresight can be complicated because dispersed groups have diverse, non-overlapping pieces of information that affects an organization's ability to detect, mitigate, and recover from failures. This paper explores the failure of foresight in crisis management by drawing on data on events that preceded and followed the Mari disaster in a naval base in Cyprus in July 2011, where a large explosion killed 13 people and injured 62 others, while completely destroying the major power plant of the island. The paper examines how foresight into crisis management decisions was compromised because of a conscious effort by high ranking decision-makers to minimize emergent danger and avoid responsibility for the crisis, in joint with red tape, bureaucracy, and poor coordination and information flows. The paper explores the notion of operational and political responsibility of individual decision-makers and discusses an alternative approach to foresight in crisis management, one that is built on multiple layers of decision-making.