Private Health Care Institutions Research Articles

Implementing genetic testing in diabetes: Knowledge, perceptions of healthcare professionals, and barriers in a developing country.

Maturity-Onset Diabetes of the Young (MODY) is an unusual type of diabetes often missed in clinical practice, especially in Africa. Treatment decisions for MODY depend on a precise diagnosis, only made by genetic testing. We aimed to determine MODY knowledge among Nigerian healthcare professionals (HCPs), their perceptions, and barriers to the implementation of genetic testing in diabetes patients. A cross-sectional survey was conducted among doctors and nurses in three levels of public and private healthcare institutions in Ibadan, Nigeria, from December 2018 to June 2019. In all, 70% and 30% of a total 415 participants were recruited from public and private centers, respectively. HCPs were recruited in a 60:40% ratio, respectively. A 51-item instrument was used to assess MODY knowledge, perceptions of HCPs, and barriers to the implementation of genetic testing in diabetes patients. In the survey, 43.4% self-rated their current MODY knowledge to be at least moderate. About 68%, 73% and 86%, respectively, correctly answered 3 of 5 questions on basic genetics' knowledge. However, only 1 of 7 MODY-specific questions was answered correctly by 72.7% of the respondents. The mean basic genetics and MODY-specific knowledge scores were 2.6/5 (SD=1.0) and 1.8/9 (SD=1.3), respectively. Multiple linear regression showed higher mean scores among those aged 30-49 years, those with degrees and fellowships (except PhD), and general practitioners; 360 (80.0%) perceived that genetic testing plays a central role in diabetes care. Barriers to genetic testing were lack of access to testing facilities, guidance on the use of and updates/educational materials on genetic testing (82.7%, 62.1% and 50.3%, respectively). The level of MODY awareness and knowledge among Nigerian HCPs is unacceptably low with a lack of access to genetic testing facilities. These can hinder the implementation of precision diabetes medicine. Increased awareness, provision of decision support aids, and genetic testing facilities are urgently needed.

Skodsborg Badesanatorium: An Adventist Health Resort on the Fringe of Danish Public Healthcare 1898–1992

Summary Today healthcare in Denmark is overwhelmingly public, but around 1900 much was left to religious institutions. One of the largest and most long-lived was Skodsborg Badesanatorium, which survived from 1898 to 1992. Founded on the Seventh-day Adventists’ health principles, the sanatorium introduced therapies and medical ideas, which were frowned upon in Denmark around 1900. The sanatorium had to navigate between alternative and orthodox medicine, constantly defining itself as alternative enough to provide what patients could not get at the public hospitals, but orthodox enough to be scientifically reliable. The article analyses how the therapy at the sanatorium was presented, comparing alternative and orthodox medicine. Likewise, the sanatorium’s relation to public healthcare is analysed from its extensive administrative material. This article sheds light on private healthcare institutions, which are largely neglected in Danish historical health research, and thereby explores the space between public and private healthcare and orthodox and non-orthodox medicine.

The Coproduction of Health Framework: Seeking Instructive Management Models and Theories.

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.

Economic Burden of Accidents and Injuries in India: What Does 75th Round of National Sample Survey Imply?

Accidents and injuries constitute a sizable share of mortality and morbidity in low- and middle-income countries. This affects the most productive age group and increases disability-adjusted life years (DALYs). It results in a substantial financial burden on the households. To explore the economic burden of accidents and Injuries on Indian households and to find how the catastrophic health expenditure (CHE) from accidents and injuries affects the population. Another objective is to explore Catastrophic out-of-pocket expenditures (OOPE) patterns and distressed financing of households in India. The study used data from the 75th round of nationally representative surveys, that is, the National Sample Survey (NSS). Authors have analyzed the data using descriptive binary logistic regression analysis to estimate the rate and average days of hospitalization, average OOPE, and share of the population experiencing the catastrophic impact from the health expenditure separately from the public and private healthcare institutions. The study observed that hospitalization in the private sector imposes 72% of households incur CHE at more than 10% cut-off and 41% at more than 25% cut-off. In comparison, it is less in the public sector, with 22% of households incurring CHE at more than 10% of annual per capita household income and 9% at more than 25%. The increasing incidence of road traffic accidents (RTA) is a concern for the overstretched health system. The government should provide better healthcare facilities and universal health insurance coverage to ensure patients' speedy recovery and financial security.

Migrants’ access to healthcare services: evidence from fieldwork in Turkey

Abstract This study builds on an analytical framework of access to healthcare and, using notes from interviews conducted with 110 migrants of different categories, it discusses the fit between migrant patients and Turkish health services. There is an overall mediocre fit between migrant patients and the Turkish healthcare system, which varies for different migrant groups, and is influenced by the dimensions of awareness, availability, affordability, and accommodation. Migrants’ social capital and socio-economic statuses affect the degree of fit, while irregularities in their legal statuses do not necessarily create a misfit. The existence of many private healthcare institutions offering various services to patients with different incomes and operating in informal ways has improved accessibility, availability, affordability, and accommodation and thus affects the fit positively. Therefore, the health reforms that paved the way for privatization, marketization, and commodification of health services in Turkey in the early 2000s also help explain the degree of fit. Migrants suffer most from language barriers in the health system, and there is an alarming decline in acceptability especially for Syrian refugees, who have reported facing discrimination while seeking healthcare.

Risk Perception of Healthcare Workers Regarding Polymer Medical Waste Management

Despite the relatively small amounts produced, medical waste is a significant issue for the government and the healthcare industry primarily because it poses threats to persons and the environment. Healthcare wastes pose threats to the environment and public health, but knowledge of these concerns and how they relate to management techniques is still lacking. Evaluating waste management practices and healthcare staff expertise is critical to identify shortcomings and lower risk levels. The study was conducted at three selected private hospitals. These three hospitals contain 462 beds, all together with 184 healthcare workers. The study was designed as a descriptive cross-sectional study, and three private healthcare institutions in the study region were evaluated. These 100 healthcare workers were chosen by purposive sampling. The hospitals under consideration include general surgical, Gynecological, pediatric, and various specialty treatments. Data was gathered for the study utilizing a quantitative questionnaire, which includes closed-ended structured questionnaires. The results showed that most healthcare workers practice waste segregation at source. Chemical cross-linking was very poor. However, waste shredding technology is being used substantially. Risk perception among Healthcare workers regarding polymer help waste management showed more of average to high risk. The study concluded that despite the existence of policies and plans, execution is still subpar at private healthcare institutions. The creation of guidelines for hospital waste management, their distribution to other institutions, and their encouragement to do a critical self-evaluation should all be required by the government.

The practice patterns and perceptions of surgeons in Singapore regarding breast-conserving surgery

Breast-conserving surgery (BCS) is often the preferred treatment in operable breast cancer.1 While tumour biology and systemic therapy are major determinants of disease control, surgical effectiveness remains a key factor in ipsilateral breast tumour recurrence.1 As heterogeneity in surgical approach has been observed, we sought to understand Singaporean surgeons’ practice patterns and perceptions. Breast surgeons from Singapore’s public and private healthcare institutions were invited to participate in a Dillman’s Tailored Design Method online-based survey and their responses are summarised in Table 1. We discuss how surgeons’ perception may influence overall management.

Real World Data on Treatment of Acute Myeloid Leukemia (AML) in a Private Healthcare Institution in Brazil, a Low-Middle Income Country - Importance of Allogeneic Hematopoietic Stem Cell Transplantation (HSCT)

Introduction: Treatment of patients with AML has evolved in the past decade, with development of novel drugs and increased knowledge about the genetic basis of disease. However, results of therapy in AML in LMICs have lagged those seen in more developed countries. A recently published paper highlighted the worse outcome of pts with AML treated in two public healthcare hospitals in Brazil compared with pts treated at an academic center at Oxford, UK, with lower overall survival (OS), lower rates of HSCT and a longer time to HSCT. 1 We hypothesized, however, that better outcomes could be seen in private healthcare institutions in Brazil with a higher rate of HSCT in first remission. Methods: We reviewed medical records of 122 patients with a diagnosis AML treated at Hospital Israelita Albert Einstein in São Paulo, Brazil, from 2010 until 2023. OS was defined as time from diagnosis until death from any cause and estimated by the Kaplan-Meier method. Risk was evaluated by the ELN 2022 risk classification. Results: A total of 122 consecutive patients were included. Median age was 63 years (range 24-91 years), and 45% were female. Per the ELN 2022 risk classification, 17% of patients were low risk, 33% were intermediate risk and 50% were considered high risk cases. Intensive chemotherapy was used in 62.5% of cases, while low-intensity regimens were employed in 37.5% of cases, including venetoclax in 21.4% of patients. After a median follow-up of 36 months, median OS of the whole cohort is 25.2 months (95% CI 19.2-83.8 months), and 3-years OS is 44% (95% CI 34-55%). As expected, patients in the high 2022 ELN risk category had lower 3-years OS probability (15.6% vs. 47.3%/91.6% for intermediate- and low-risk, respectively). Eighty-two patients (67.2% of the cohort) underwent HSCT, and 59% were in MRD-negative complete remission (CR) prior to HSCT. We next analyzed outcomes in patients younger than 60 years of age who received intensive chemotherapy, the subset of patients analyzed by Silveira et al. 1 Results are summarized in Table 1 and figure 1. The outcomes of our patients compare favorable to what has been reported here in Brazil and, like the data from the UK center, has a high rate of HSCT with a low time to transplant. Conclusion: Our results demonstrate that it is feasible to obtain favorable outcomes in patients with AML in a LMIC with a high rate of HSCT in first CR. It is also important to mention that our results also reflect the reality of a private healthcare institution in Brazil. However, even after considering this, our results carry an important message. There is limited availability of clinical trials and novel medications for AML in LMICs compared to the developed world, and options in the salvage setting are usually limited to intensive chemotherapeutic regimes. Allogeneic HSCT is a technique that is readily available in most countries and has the potential to cure AML, particularly when employed in first CR. We believe that physicians and institutions treating patients with AML in a LMIC should primarily focus on strategies that improve access to HSCT in first CR for these patients.

Legal status of the head of the health care institution

The article examines the administrative and legal status of the head of a health care institution. The content of the concept and theoretical provisions of legal status are analyzed, its types are defined.
 It was determined that the legal status of the head of a health care facility can be considered a special legal status, which, on the one hand, means that all heads of health care facilities have this status, and not a specific one. And on the other hand, this means that the special legal status is regulated by the norms of various branches of law, and not just one. However, differences in the legal status of managers of state and communal health care institutions and managers of private institutions lead to the conclusion that their legal status is characterized only by individual features.
 It has been established that the main special acts that determine the legal status of the head of a health care institution include the Fundamentals of Ukrainian legislation on health care, the Resolution of the CMU on approving the Procedure for concluding a contract with the head of a state, communal health care institution and standard contract forms with the head of the state, communal health care institution, as well as the Directory of the qualification characteristics of employees' professions.
 It was concluded that the rights and responsibilities of the head of a state and communal health care institution are characterized by similarity to the powers of an administrative body. The right of managers of such institutions is not exercised in the same way as the right of an individual is exercised, namely, on the basis of freedom of free choice, but on the performance of tasks and functions of the manager. That is, there is less variability in the choice of behavior. With regard to private health care institutions, the absence of a standard contract approved by a government act leads to greater variability in determining both the rights and duties of the manager, as well as the institution's management structure itself.

An Impact of Motivational Factors to Enhance Human Productivity: A Case study of Private Healthcare Institution of Karachi

Worker motivation is a crucial factor for an organization's success, as it affects productivity and helps achieve its vision and objectives. Supervisors at specialized medical care institutions in Karachi face a challenge in achieving ideal motivation for their staff, which would significantly improve hierarchical execution. This study aims to understand the components that impact representative motivation and how it influences worker performance in these institutions. 
 The research used an expressive exploration approach, with workers from Karachi's specialized medical care institutions as the focus. A Non-likelihood judgment analysis was used, and data was collected through Google structures and analyzed using SPSS software. Inferential measurements were used to assess the information. Results showed that worker motivation and the viability of data trade, as well as the nature of the workplace, had the most strong connection for external components, while representative motivation and occupation impact by partners had the least. The relationship between decency of treatment at work and worker motivation was the most strong, while the relationship between input on presentation and strengthening and representative independence and worker motivation was the most precarious. In conclusion, the study reveals significant strengths in the relationship between dependent and autonomous components, the significant impact of external and internal variables on worker motivation, and a basic impact of worker motivation on worker performance.

RESULTS OF CLINICAL AUDITS APPLIED IN UROLOGY PRACTICE: SYSTEMATIC REVIEW FROM 2008 TO 2023

Aim. Identifying and evaluating the possibilities of clinical audit as exemplified by its use in urology.
 Materials and Methods. The study was performed by analyzing clinical audit reports in urology. Information on clinical audit data was obtained from the electronic databases of clinical audits, such as NHS Digital, HQIP, the online library PubMed and the journal "The Online Journal of Clinical Audits". The methods of the system approach, bibliosemantic, content analysis and structural-logical analysis were used in the study.
 Results and Discussion. The reports on the results of the clinical audit concerned various aspects of urology: health care management in urology departments; provision of medical care under inpatient conditions; prostate cancer, etc. Clinical audit was conducted in both public and private health care institutions. Based on the results of clinical audits, existing and potential problems and shortcomings were identified, on the basis of which specific recommendations were formulated. During the analyzed period, repeated clinical audits took place, the purpose of which was to monitor the effectiveness of implementations. A key feature that unites the analyzed clinical audit reports is the identification of needs and potential opportunities for improvement.
 Conclusions. Based on the conducted systematic review, it was established that clinical audit is an effective tool for improving the quality of medical care, in particular, for urological patients. Therefore, it is likely to be applied in other areas of health care for effective management of clinical practice. Its use in private health care institutions will contribute to the improvement of patient care services, and its implementation in the public sector and at the national level of health care will ensure qualitative changes in the medical field.

The Impact of Compensation, Organizational Commitment, and Job Satisfaction on Turnover Intention among Young Female Employees

This study meticulously examined the impact of compensation and organizational commitment on turnover intentions among young female employees, with job satisfaction as a mediating factor. The study's subject pool comprises young female employees aged between 19 and 25 in private healthcare institutions. Data collation entailed employing a Likert scale questionnaire, while the ensuing analysis adopted the Partial Least Squares Structural Equation Modelling (PLS-SEM) approach. The conclusions study proffered that compensation exerted a non-significant negative impact on turnover intentions, concurrently exerting a significant positive influence on job satisfaction. Organizational commitment yielded a notable and negative impact on turnover intentions, simultaneously engendering a marked positive impact on job satisfaction. Curiously, job satisfaction evinced a non-significant negative impact on turnover intentions. Further nuanced analyses revealed that compensation yielded a non-significant negative impact on turnover intentions via the intermediary of job satisfaction. Similarly, organizational commitment's influence on turnover intentions was insignificant when mediated through job satisfaction. This study's seminal contribution discovered that contrary to prevalent assumptions, especially for young female employees, when compensation could provide job satisfaction and is combined with organizational commitment, it will not affect turnover intentions directly or indirectly.

Investigating the relationship between health service quality and patient satisfaction: A case study of Lima East clinics in the midst of the COVID-19 pandemic

Quality assessment has emerged as a recurring consideration in individuals' preferences for healthcare services. As a result, many private healthcare institutions recognize their obligation to improve the services they provide, especially in response to the prevailing demand for care. This study seeks to elucidate the intricate relationship between service quality and patient satisfaction in the clinics of Lima East in the challenging context of the COVID-19 pandemic in 2022. The research results show a remarkable mutual compatibility score and a substantial correlation coefficient of 0.696, indicating the concurrent validity of both variables. In conclusion, this study underscores its paramount importance by shedding light on the critical factors that clinics must prioritize in these challenging times. This illumination enables healthcare institutions to make informed decisions regarding service improvements, while at the same time shedding light on the relationship between service quality and patient satisfaction.

Experience of surgical treatment of hemangioma of the spleen. A clinical case

Focal mass lesions of the spleen are considered rare. The mass lesions of the spleen usually include malignant and benign tumors, true, false, and parasitic cysts, abscesses, hematomas, and spleen infarctions. Hemangiomas are considered the most common benign neoplasms. Abscesses or spleen infarctions have severe symptoms, pronounced laboratory test changes, disturb the patient and force him to seek help. In contrast, small benign and sometimes malignant neoplasms are asymptomatic for a long time and often are incidental findings. A 38-year-old patient with splenomegaly was admitted to the thoracic surgery center of the Private healthcare institution, Central Clinical Hospital "RZD-Medicine". Abdominal computed tomography showed an enlarged spleen. The blood tests were within the reference values. Given the large size of the spleen, the need to exclude marginal zone lymphoma, clinical presentation, and the risk of spleen rupture, a splenectomy was performed.

PHARMACOTHERAPY OF CARDIOVASCULAR DISEASES IN LOCOMOTIVE CREW WORKERS

Cardiovascular pathology is considered one of the leading reasons for the professional unfitness of locomotive crew workers (LCW). Cardiac arrhythmias and elevated blood pressure numbers create prerequisites for the occurrence of cardiovascular catastrophes. Therefore, it seems relevant to investigate the structure of cardiovascular pathology and its pharmacotherapy in LCW from the standpoint of the safety of the use of various drugs among this group of patients. In the course of the study, a retrospective analysis of 100 medical records (machinists and their assistant) of the cardiology department of the Private healthcare institution Clinical Hospital "Russian Railways-medicine" Voronezh" was carried out. The results obtained indicate that various specified rhythm disturbances (41%) and hypertension (30%) in LCW. Holter ECG monitoring detects various types of rhythm and conduction disturbances in almost all the examined patients (supraventricular extrasystole in 94%, ventricular 51%). Analysis of the lipid spectrum confirms the presence of hypercholesterolemia, dyslipidemia. Among the drugs used there are those that belong to class I or II of the list "Medicines and traffic safety", but at the time of separation of the driver / assistant driver from work, their appointment is possible. There is a tendency to replace medications at discharge with safer ones (class III).

ОЦЕНКА КРИТЕРИЕВ ИСПОЛЬЗОВАНИЯ КОЕЧНОГО ФОНДА РЕАБИЛИТАЦИОННОЙ СЛУЖБЫ АСТРАХАНСКОЙ ОБЛАСТИ

The relevance of the study - in recent years, close attention to the introduction and improvement of optimal medical rehabilitation for the formation of health at a high government level. The aim of the study - assessment of quantitative and qualitative indicators of the rehabilitation bed fund in the context of a separate entity (Astrakhan region) for the period from 2019 to 2022. Materials and methods – the study analyzed indicators of the level of hospitalization, average annual bed occupancy, bed turnover, and average length of stay in a bed. Results and discussion – the increase of the rehabilitation bed potential observed during the study period and the increase in the level of provision of the population with rehabilitation beds in the region is aimed at achieving the goals, indicators and results of the state program of the Russian Federation "Health Development", approved by the Decree of the Government of the Russian Federation of December 26, 2017 No. 1640. In the context of the state policy aimed at improving the efficiency of the use of healthcare resources, the optimization of inpatient medical care for medical rehabilitation in the region is carried out against the backdrop of the formation of a three-level system for the provision of medical care for medical rehabilitation, the use of infrastructure and bed capacity of private healthcare institutions on the terms of public-private partnership, timely re-profiling of inefficiently functioning beds, reduction of bed downtime, active use of hospital-replacing technologies, retraining of medical personnel in new specialties, provided for by the staff standards of procedures for medical rehabilitation. Conclusion - the data obtained can be used to adjust measures for the organization of this type of medical care to the population of the region.

TOOLKIT FOR MODERNIZATION OF PUBLIC POLICY IN THE SPHERE OF DEVELOPMENT OF PRIVATE HEALTHCARE INSTITUTIONS

In the study, attention is updated to the problem of stimulating the development of private business in the field of health care. The purpose of the study is to develop a toolkit for modernization of public policy in the field of development of private health care institutions. It has been established that the health care system is naturally considered as a prerequisite and an integral component of the sustainable development of society, and the modern trends that determine the priorities of state policy in this area are determined by such leading goals of the country’s socio-economic progress as sustainability of economic growth, social safety and improvement of the population’s well-being, strengthening of human potential, improvement of the quality of medical care and overcoming the demographic crisis. It is shown that today, in the conditions of existing challenges to the functioning and development of domestic medicine, the task of improving the public policy of stimulating the development of private health care institutions in Ukraine, providing medical and related services, especially on a systemic basis, has become critically relevant. The directions (vectors) of improving the public policy of stimulating the development of private health care institutions have been determined, namely: (1) improvement of regulatory and legal regulation; (2) improvement of financial and resource support; (3) improvement of the business environment. The applied value of the research results lies in the identification of obstacles to the development of small private health care institutions in Ukraine. The scientific novelty of the research results lies in the substantiation of the system of tools for stimulating the development of private health care institutions.

Newly qualified intensive care nurses’ lived experiences of being a shift leader in a private healthcare institution in Gauteng, South Africa

ObjectiveNewly qualified intensive care nurses (NQICNs) are expected to execute the shift-leading role immediately after graduation. Critical reasoning, problem-solving, decision-making, and evidence-based clinical judgment are thus essential skills for intensive care nursing graduates. This study aimed to explore and describe NQICNs’ lived experiences of being shift leaders. MethodsThis descriptive qualitative study was based on the data collected through semi-structured individual interviews. Five NQICNs in five hospitals from one region in Gauteng, South Africa, were interviewed between September and December 2019. NQICNs working as shift leaders for 10 to 12 months after intensive care training were eligible for inclusion in the study. Data were analyzed using the four steps suggested by Giorgi. ResultsThe results revealed three themes and seven sub-themes. NQICNs suffered greatly intrapersonally (NQICNs reported intrapersonal suffering, manifesting as pre-shift anxiety, severe work stress, and post-shift exhaustion; NQICNs employed coping mechanisms and either fought, fled, or froze during conflict or crises; NQICNs lack of shift-leading experience did not match their heavy load of responsibilities and accountability); the NQICNs interpersonally matured and empowered themselves (NQICNs experienced support and challenges on an interpersonal level; NQICNs improved their interpersonal relationships and felt proud of and empowered by their professional growth); NQICNs highlighted various requirements to help them manage the high demands of leading shifts (others should fulfill certain needs to enable NQICNs to handle the shift-leading role; self-awareness as a need to enable NQICNs to embrace the shift-leading role). ConclusionA greater understanding of NQICNs and their unmet needs will enable nurse managers, educators, and nurses to better support NQICNs’ evolution from novice to competent shift leaders.

ECONOMIC JUSTIFICATION OF CORRUPTION RISKS IN THE FIELD OF HEALTHCARE

The purpose of the article is to identify the most common corruption offenses in the healthcare sector and their impact on the country's economy, and also to outline the main directions of the state anti-corruption policy in this area. Methodology. The research is based on the study of international treaties ratified by Ukraine, as well as domestic legal acts regulating the activities of the medical sector in the area of combating and preventing corruption. Results. The article analyzes the main directions of anti-corruption policy in the national healthcare system and determines their impact on the economy of the country. It is noted that corruption in this area is inherent in all socio-economic systems of the world, however, it is most widespread in the process of transformation of the economic and social environment. Corruption can manifest itself in various mechanisms. The author analyzes the monitoring of corruption risks in the field of security by Transparency International, which annually determines the Corruption Perceptions Index (CPI), and the European Commission. It is theoretically proven that a decrease in the score of the Corruption Perceptions Index leads to an outflow of capital from the country (one point corresponds to 0.5% of the country's gross domestic product). Using the examples of the United States of America, the Federal Republic of Germany, and Denmark, the paper examines the most common forms of corruption in the healthcare sector, as well as the positive experiences that should be implemented in order to improve the level of economic development of the country. The main corruption risks in the healthcare sector were analyzed. The role of the NAPC and the NABU in combating and preventing corruption in the healthcare sector is revealed. Practical implications. The article outlines the main steps that need to be taken to introduce changes in the direction of anti-corruption activities in private healthcare institutions. The role of the electronic system of public procurement of goods, works and services "ProZorro" in combating and preventing corruption in the healthcare sector is determined. The analytical data of the Independent Anti-Corruption Commission are studied. Value/originality. It is theoretically substantiated that the key task of the state anti-corruption policy in the healthcare sector is to develop and implement mechanisms for detection, prevention and elimination of conditions that facilitate the emergence and spread of corruption, the impact of which on the country's economy is quite dangerous, as it significantly impairs the effectiveness of the state's economic policy. The article highlights the consequences of corruption in the healthcare sector for the country's economy: expansion of the shadow economy; violation of competitive mechanisms; inefficient use of budget funds in the distribution of public contracts and benefits; price increases due to "corruption costs"; and deterioration of the investment climate. The article outlines the main areas of anti-corruption policy in the healthcare sector, including: an effective system of control and transparency; analysis of the causes of corruption; a high level of legal awareness and culture of citizens; involvement of specialists and scientists in the areas of activity in the preparation of relevant regulatory documents; improvement of the electronic healthcare system and, consequently, further automation of workplaces; change of the financing system; improvement of the anti-corruption policy in the healthcare sector as a component of the overall anti-corruption policy; implementation of positive international experiences.

Enhancing family medicine training to build capacity in Pakistan: a call for action

ABSTRACT A high-performing, integrated, primary healthcare system is essential to achieve universal health coverage (UHC) goals and improve health indicators. There is enough evidence that healthcare is cost-effective with significantly better outcomes in countries where primary care is delivered through trained family physicians. The concept of “Family Practice approach” is relatively new in developing countries like Pakistan, where majority of basic healthcare is provided by doctors without a formal postgraduate training. The intention to adopt this approach in primary care has increased in recent years in an effort to attain UHC, yet implementation requires a paradigm shift with intervention at multiple levels. There is an opportunity to learn from better developed primary care models for example in UK and Australia to develop a pragmatic and collaborative approach to develop the specialty of family medicine in primary care. This calls for academic interventions at multiple levels, such as mandating family medicine inclusion in undergraduate medical curricula, and ensuring quality of postgraduate training by investment in developing primary care sites for training, curricula, assessment, and quality assurance structures. Encouraging medical students and general practitioners to pursue a post graduate qualification in family medicine would also require promoting family medicine as a worthwhile career and developing a higher esteem for qualified family physicians than the conventional GPs in public and private sector healthcare institutions. These interventions would help evolution of locally grounded solutions to improve the quality of primary care, hence the health outcomes of the larger population of Pakistan.