Private Healthcare Sector Research Articles

Assessing the role of the for-profit private healthcare sector in malaria elimination efforts in Bangladesh: a cross-sectional study of challenges and opportunities

BackgroundAmong 13 endemic districts, the Chittagong Hill Tracts bear more than 90% of Bangladesh’s malaria burden. Despite the private sector’s prominence in rural healthcare, its role in malaria management remains underutilized. This study aimed to strategize leveraging the for-profit private sector, such as diagnostic and treatment centers, to bolster national malaria surveillance and control, advancing Bangladesh toward malaria elimination by 2030.MethodsThis mixed-method study commenced with a questionnaire-based cross-sectional survey followed by selected focused group discussions (FGDs) among the participants. Three FGDs were held with the for-profit service providers so that further insights and qualitative viewpoints of them can be utilized in situation analysis. Based on the endemicity and strategic priorities, a comprehensive mapping of private for-profit facilities from the regions comprising 15 sub-districts across 8 chosen districts (7 malaria endemic districts and the rest non-endemic districts) was created. For the non-endemic zone, the sub-districts were selected based on their proximity to an area with high malaria transmission.ResultsAmong the 104 representative participants, majority were male (n = 92, 88.5%), had a diploma in their respective fields (n = 53, 51%) and were involved either in laboratory work (n = 49, 47.1%) or as owners/managers of health centers (n = 41, 39.4%). The selected health facilities were close to the corresponding Upazila Health Complexes (mean distance 2.8 km), but were distantly located from the designated district hospitals (mean distance 48.9 km). The main sources of RDT kits (62.3%) and anti-malarial drugs (63.2%) were local wholesale markets. A large share of the corresponding facilities neither provided malaria treatment services (81.7%) nor worked with the NMEP (93.3%).ConclusionsThis study highlights challenges and recommendations for engaging private for-profit health facilities in Bangladesh’s malaria elimination efforts. The identified challenges include low-quality RDTs, staff shortages, and inadequate capacity building. Recommendations emphasize effective training, stakeholder interaction, and enhanced oversight for successful malaria control efforts.

Multicenter study on Clostridioides difficile infections in Mexico: exploring the landscape.

This study aims to outline Clostridioides difficile infection (CDI) trends and outcomes in Mexican healthcare facilities during the COVID-19 pandemic. Observational study of case series. Sixteen public hospitals and private academic healthcare institutions across eight states in Mexico from January 2016 to December 2022. CDI patients. Demographic, clinical, and laboratory data of CDI patients were obtained from clinical records. Cases were classified as community or healthcare-associated infections, with incidence rates calculated as cases per 10,000 patient days. Risk factors for 30-day all-cause mortality were analyzed by multivariate logistic regression. We identified 2,356 CDI cases: 2,118 (90%) were healthcare-associated, and 232 (10%) were community-associated. Common comorbidities included hypertension, diabetes, and cancer. Previous high use of proton-pump inhibitors, steroids, and antibiotics was observed. Recurrent infection occurred in 112 (5%) patients, and 30-day mortality in 371 (16%). Risk factors associated with death were a high Charlson score, prior use of steroids, concomitant use of antibiotics, leukopenia, leukocytosis, elevated serum creatine, hypoalbuminemia, septic shock or abdominal sepsis, and SARS-CoV-2 coinfection. The healthcare-associated CDI incidence remained stable at 4.78 cases per 10,000 patient days during the pre-and pandemic periods. However, the incidence was higher in public hospitals. Our study underscores the need for routine epidemiology surveillance and standardized CDI classification protocols in Mexican institutions. Though CDI rates in our country align with those in some European countries, disparities between public and private healthcare sectors emphasize the importance of targeted interventions.

Early Lessons From Working With Local Partners to Expand Private-Sector Health Care Networks in Burundi and Mali.

The private health care sector is an important source of service delivery in low- and middle-income countries (LMICs). Yet, the private sector remains fragmented, making it difficult for health system actors to support and ensure the availability of quality health care services. In global health programs, social franchising is one model used to engage and organize the private health care sector. Two social franchise networks, ProFam in West Africa and Tunza in East and Central Africa, provide health care through branded networks of facilities. However, these social franchise networks include a limited number of private health care facilities, and in fragile contexts, like Burundi and Mali, they have faced challenges in integrating with national health systems. The MOMENTUM Private Healthcare Delivery (MPHD) project in Burundi and Mali sought to expand the number of health facilities it engaged beyond the existing ProFam and Tunza networks. The expansion aimed to help improve service quality in more private facilities while advancing localization and reducing fragmentation for improved stewardship by health system actors. MPHD achieved this expansion by removing barriers for private health facilities to join inclusive, nonbranded networks and engaging local partners to build and maintain these networks. We share lessons learned regarding the growing role of local organizations as actors within mixed health systems and provide insights on strengthening stewardship of the increasingly heterogeneous private health care delivery sector in LMICs, particularly in fragile settings.

Medicine needs of children not addressed in the National Cancer Strategic Framework: insights from a triangulation study

Aim A better understanding of the scope of the National Cancer Strategic Framework (NCSF) could lead to improvements aiding the framework’s ultimate objective of reducing the burden of cancer. Accordingly, this report evaluates whether the 2017-2022 NCSF adequately addressed issues related to childhood cancer treatment, in particular paediatric oncology medicines. Methods To identify determinants of current access to childhood oncology medicines in South Africa, in-depth interviews were conducted with 29 stakeholders in South Africa’s public and private healthcare sectors. Key health system stakeholders included policy makers and regulators, medical insurance scheme informants, medicine suppliers, healthcare providers and civil society stakeholders. Identified barriers were categorised according to the components of the pharmaceutical value chain, and combined with a health systems approach to acknowledge the linkages of medicines with other building blocks of the health system. Identified barriers were then compared to the limitations and interventions as discussed in the 2017-2022 NCSF to identify areas for improvement in the framework. Findings Three recurrent gaps in the NCSF in relation to childhood cancers were identified, representing a range of issues throughout the pharmaceutical value chain: 1) childhood cancers are neglected compared to adult cancers, in both the policy arena and the organisation of healthcare services; 2) there are particular challenges for childhood cancers due to their rarity, thus requiring targeted interventions (e.g., regulatory incentives, tailored pricing solutions, and customised evidence requirements by decision-making bodies); and 3) children must be accompanied by a caregiver during treatment, causing several social and financial issues for their families. Conclusions There is a pressing need for a strategic cancer plan that makes proper provisions for children. Such an endeavour must commence with acknowledging the areas in which childhood cancers are different from adult cancers, and which demand targeted intervention in an update of the NCSF.

Medicine Wastage in Private Clinics: Drug Suppliers’ Perspective on the Causes and Measures to Reduce It

This study examines the issue of medicine wastage in private clinics from the perspective of drug suppliers in Hong Kong. Medicine wastage refers to unused or expired medication along the supply chain, and it poses significant challenges to healthcare systems worldwide. In the private healthcare sector of Hong Kong, there is a notable issue of medicine wastage, resulting in considerable economic costs and environmental hazards. The paper explores the causes of medicine wastage, including the inefficient business model of private clinics, the frequent use of general medicines, the decline in medical tourists, disruptions in the supply chain due to the COVID-19 pandemic, and the lack of medicine recycling policy and facility. Additionally, the paper suggests implementing a centralized medicine procurement and inventory management system, separating medicine prescribing and dispensing, and developing a medicine recycling policy to reduce medicine wastage in Hong Kong.

A Capacity Audit of Medical Geneticists and Genetic Counsellors in South Africa, 2024: A National Crisis.

Community genetic services were introduced in South Africa almost seven decades ago, with medical geneticists and genetic counsellors being formally recognized for the past 30 years. Initial training platforms were established at academic centres countrywide, and posts for relevant healthcare professionals, including medical geneticists and genetic counsellors were created in the public sector. Despite these early advances, the number of these specialists required to address the rising burden of congenital disorders in the country remains far below required targets established by the National Department of Health. The aim of this study was to analyse the retrospective, current and projected number of medical geneticists and genetic counsellors in South Africa. The results indicate the number of practicing medical geneticists (n = 13) and genetic counsellors (n = 28) are currently at 10% and 5% of capacity targets, respectively. There is unequal distribution of these specialists between the public and private healthcare sectors, and geographical maldistribution. An alarming trend of emigration is particularly prevalent among newly qualified genetic counsellors. With the proportion of congenital disorders expected to continue to rise in coming years, together with the increasing proportion of ageing South Africans, it is imperative that health workforce planning addresses the ever-widening gap between the supply, demand and unmet need for these crucial specialists in South Africa.

A Quantitative Review of Un-licensed and Off-label Medicines Use in Children Aged 0-2 Years in the Private Sector in South Africa: Extent, Challenges, and Implications.

The global lack of suitable formulations for children leads to off-label and unlicensed medicine use, posing significant risks of adverse effects. Understanding this usage on a national level can help guide interventions for better formulations. This study aimed to measure the prevalence of off-label and unlicensed medicines among children in South Africa's private sector. The study used a point prevalence methodology to review medicine use in children aged 0-2 years enrolled in a selected pharmaceutical benefit management company in South Africa from January to June 2022. A sample size of 1055 prescriptions was calculated using a 90% confidence interval, 50% prevalence rate, and 5% error margin. A systematic random sampling approach selected every seventh entry from 91,973 total entries, resulting in a final sample size of 13,139. Data included patient age, number and characteristics of medicines, quantity, and indications. Descriptive statistics analysed and reported the prevalence of unlicensed and off-label medicine use. Among the 13,139 prescribed medicines, 40% (5,246) were off-label or unlicensed, and 60% (7,893) were on-label. Of the off-label/unlicensed medicines, 16.85% (2,214) were unlicensed, and 23.08% (3,032) were off-label. Methylprednisolone was the top off-label medicine, probiotics were the top unlicensed, and the ICD10 code Z76.9 was the top diagnosis. The study found that 40% of children aged 0-2 years were prescribed unlicensed or off-label medicines in South Africa's private healthcare sector between January and June 2022. This suggests a widespread practice of off-label or unlicensed prescriptions in paediatric treatment in the South African private sector.

La administración sanitaria privada en España: análisis de sus resultados desde 2015 al 2021.

This study details the economic progression of the private healthcare sector in Spain from 2015 to 2021,focusing on the financial statements of the main entities. Using a quantitative approach, data from the SpanishMercantile Register was examined, applying ratio and trend analysis. The results highlight a notable improve-ment in financial profitability and the soundness of the capital structure, evidencing a reduction in long-termindebtedness. The research highlights the predominance of the Quirónsalud group, which demonstrateda substantial increase in equity and achieved outstanding financial profitability. The profitability of thecompanies in the sector is observed to have evolved positively, standing out for their ability to adapt andprosper even in the context of the pandemic. The conclusion emphasises the favourable economic evolutionof the sector, highlighting the improvements in profitability and financial structure of the companies analysed.

Implementation of the ARIMA model for prediction of economic variables: evidence from the health sector in Brazil

In recent decades, quantitative models for forecasting economic crises have garnered significant interest from researchers, policymakers, and public and private institutions. Identifying the most appropriate models for predicting economic time series behaviors during crises is a pressing challenge. Effective techniques can be instrumental in forestalling financial irregularities, thus empowering institutions to deploy remedial actions and swiftly minimizing further economic setbacks. Contemporary literature introduces various forecasting models, such as the autoregressive integrated moving average (ARIMA) model. Recognized for its statistical alignment with numerous linear models, the ARIMA model has demonstrated its efficacy across various domains. This paper delves into applying the ARIMA model to predict five critical economic time series that substantially influenced Brazil’s public and private healthcare sectors throughout the economic crisis between 2000 and 2020. These time series encompassed the variables (i) the gross domestic product—GDP, (ii) the Extended National Consumer Price Index—IPCA, (iii) the unemployment rate, (iv) the total number of health plan beneficiaries, and (v) total number of individual health plan beneficiaries. Importantly, this study provides a comprehensive outline of the ARIMA implementation process, underscoring that precise forecasting is pivotal for managers aiming to curtail financial anomalies and avert resource shortages. The findings highlight the ARIMA model’s (1, 0, 2), (2, 2, 1), (0, 1, 2), (1, 1, 2), and (2, 2, 1) viability in accurately forecasting health-related time series, exceeding 95% accuracy for economic variables analyzed. These results have significant practical implications for healthcare managers and decision-makers. By offering accurate forecasts of critical economic metrics, such as the unemployment rate and the transition of beneficiaries between public and private health systems during economic downturns, this research provides valuable insights for strategic planning within the healthcare sector.

Perverse Development-Examining German Development Finance Institutions’ Engagement in Private Healthcare Sector in India

Perverse Development-Examining German Development Finance Institutions’ Engagement in Private Healthcare Sector in India

Therapeutic drug monitoring for valproate: deriving a novel formula for calculation of free concentration

BackgroundMonitoring free valproate concentrations, as with other highly protein-bound anticonvulsants, is essential in clinical situations where protein binding may be disrupted. Conversion of measured total concentrations to approximate free concentrations offers a cost-effective alternative. This study evaluated the relationship between total and free valproate concentrations for discordance and the impact of key determinants. A novel formula was devised that incorporates significant variables.MethodsA multicentre, cross-sectional observational analytical study included 101 subjects 18 years and older using valproate for 6 months or longer. Participants were recruited from private and public sector healthcare settings from primary to tertiary level in, South Africa, during 2017–2019.ResultsFree valproate concentrations could be measured for 84 subjects. Discordance for concomitant total and free valproate concentrations was 79.1%. Among 19 participants with elevated free concentrations, 15 (78.9%) had total valproate concentrations within the recommended reference range. Calculations based on the study-derived formula were more accurate in predicting free valproate concentration than previously proposed methods.ConclusionThis study proposes that the novel formula for calculating free valproate enables more accurate prediction.

Assessment of selected elements of healthcare in the opinion of healthcare workers

The healthcare system is an important part of the functioning of any country. A special role in this system is played by the personnel — especially medical, but also non-medical personnel, who perform their tasks based on the available resources. The article considers the opinions of healthcare workers about selected elements of this system proposed by Zgliczyński. The opinions of employees regarding the current healthcare system compared to the one in 2019 are also included, highlighting the nature of these changes. Bearing in mind the relatively limited literature in the field of the considerations undertaken in this article, they can be regarded as important, up-to-date, and filling the research gap in this respect. The aim of the study was achieved using a critical analysis of the literature on the subject and a diagnostic survey. Empirical data were obtained from fieldwork conducted among staff of public and/or private sector healthcare facilities.

Estimation of the Clinical, Economic, and Social Burden of Stage IV Non-Small Cell Lung Cancer in Mexico.

Lung cancer continues to be the leading cause of death among cancer patients worldwide. This study aimed to estimate the clinical, economic, and social burdens of stage IV non-small cell lung cancer (NSCLC) in private and public healthcare centers in Mexico, utilizing real-world evidence. The study population included patients >18 years of age diagnosed with stage IV NSCLC who received cancer treatment at the Centro Médico Nacional Siglo XXI (IMSS), the Centro Médico Nacional "20 de Noviembre" (ISSSTE), the Mexican Institute of Respiratory Diseases (INER), and the Medical Center ABC (American British Cowdray) from 1 January 2019 to 31 December 2020. The analysis included evaluation of epidemiological data, treatment regimens, and clinical outcomes, and emphasized pharmacological and non-pharmacological treatments, including detailed follow-up investigations, as part of comprehensive clinical management. Additionally, the study assessed the social burden through variables such as working-age absenteeism and presenteeism and caregiver productivity loss, as well as economic burden, considering both clinical and social components, with costs adjusted to 2022 Mexican pesos (MXN) values. A total of 188 patients with metastatic NSCLC were studied. The main type of NSCLC tumor found in the sample was adenocarcinoma (81%). Treatment regimens included pharmacological treatments (78%), non-pharmacological treatments (25%), and palliative care (24%). Complications were present in 73% of the cohort, while 60% presented adverse events. Clinical management costs of up to MXN1,001,579 per patient in the public sector and MXN2,140,604 in the private sector were reported. It was estimated that working-age patients lose 84-335 days yearly due to absenteeism and presenteeism, while caregivers report a productivity loss equivalent to 13-30 days due to the management of NSCLC patients. These indirect costs of NSCLC contribute to the social burden. A working-age patient with stage IV disease is associated with an average indirect cost of MXN49,731-178,287 in public institutions, while in private institutions, the cost elevates to MXN438,103. This study highlights the substantial clinical, economic, and social burdens of stage IV NSCLC in Mexico, revealing significant disparities between public and private healthcare sectors. It underscores the urgent need for standardized practices and equitable care across all systems.

O-158 Social disparities in achieving a live birth after initiating ART treatment: a national register-based study among women in Denmark

Abstract Study question How are educational level, labor market attachment and income associated with achieving a live birth after initiating ART treatment among women in Denmark? Summary answer Higher educational level, labor market attachment and higher income were strongly associated with achieving a live birth after initiating ART treatment among women in Denmark. What is known already Infertility is increasing in populations worldwide with an estimated lifetime prevalence of 17.5%. Approaches to this issue differs between societies and healthcare systems. In the public Danish healthcare system, three fresh ART treatments are currently offered free of charge. Additional ART treatments are self-financed in the private healthcare sector. Socioeconomic disparities in health are widely recognized. Previous studies have indicated that higher socioeconomic position (SEP) is associated with a greater probability of achieving a live birth after initiating ART treatment. However, there is limited knowledge about SEP and its relation to outcomes of ART treatment. Study design, size, duration This is a national, register-based study based on the DANAC II Cohort. Women undergoing ART treatment during 1994–2017 registered in the Danish IVF register were individually linked with data from sociodemographic registries and the Medical Birth Registry using the Danish Personal Identification number. The study population consisted of 68,738 women treated with ART. The outcome was a live birth. The women were followed until outcome, death, migration, or end of study (31/12/2017). Participants/materials, setting, methods Women included in the analyses were aged 18–45 years. Overall associations between achieving a live birth after initiating ART treatment and educational level, labor market attachment and income were examined and further stratified by nulliparity at baseline and age group. Hazard ratios (HRs) with confidence intervals (CIs) were estimated by Cox proportional hazards regression, and with adjustment for potential confounders age and ethnicity. Death was incorporated as a competing risk in all analyses. Main results and the role of chance Adjusted results showed that educational level, labour market attachment and income significantly determined the probability of achieving a live birth after initiating ART treatment. HRs of achieving a first live birth after initiating ART treatment increased stepwise with higher education and income level, respectively. Compared with primary school education the highest HR was found among women with a research education (HR = 3.02 [95% CI 2.71; 3.35]). Unemployed women had the lowest HR of achieving a live birth after initiating ART treatment (HR = 0.67 [95% CI 0.64; 0.69]) compared to employed women. Women in the highest income group had two times higher HR of achieving a live birth after initiating ART compared to women in the lowest income group. Analyses of different age groups showed that higher SEP was associated with a live birth after ART treatment in all ages. The same consistency was found for both childless women and women who had a child or children prior to ART treatment. Subanalyses showed that women with higher SEP were more likely to continue ART treatment after unsuccessful attempts, which could explain the observed social inequality in achieving a live birth after ART treatment. Limitations, reasons for caution The Danish IVF register did not register non-ART treatments (intrauterine inseminations) before 2007, thus these treatments are not included. Whether severity of infertility/prognosis differs among SEP groups is unclear. Also, geographical distance to fertility clinics could have provided additional perspectives. Wider implications of the findings Free access to fertility treatment in public healthcare should ideally provide equal access. Patients encounter barriers during treatment and, as shown, treatment success differs based on socio-economic background. Difficulties encountered during treatment that challenge certain patients more than others based on their socio-economic background needs to be addressed. Trial registration number Not applicable

The demographic, social and professional factors affecting choice of employment place and labor motivation of general practitioners and districts therapists

The article considers social, demographic and professional factors determining choice by general practitioners and district therapists of place of employment and their professional motivation. The special questionnaire was developed to be applied in sociological survey. The sampling included general practitioners and district therapists of outpatient medical organizations of the Health Department and the private health care sector of Moscow. The final analysis included 399 questionnaires. It is established that possibility of job combining depends on number of children physician has. The significance of conditions for career growth increases with physician age and availability of adult children. The opportunities for research and education activities are of great value for physicians of private health sector who obtained higher education in Russia and having adult children. The preferred management style of line manager and model of communication with patient are affected by level of workload, working conditions and income level. The preferences regarding type of organizational culture are affected by place of birth. For physicians who graduated from Russian universities, significant factor of non-material incitement is possibility of additional rest. The physicians of older age working in private health sector more often consider career advancement as professional development goal. The factors influencing choice of place of employment and professional motivation in general practitioners and district therapists are summarized. The proposals for attracting, retaining and stimulating physicians are formulated.

Health system performance assessment and reforms, Oman.

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

THE INFLUENCE OF ORGANISATIONAL INTEGRITY CULTURE ON ETHICAL PERFORMANCE IN PRIVATE HEALTHCARE: A STUDY

This study thoroughly investigates the vital role of organisational integrity culture (OIC) in Malaysia's private healthcare sector, highlighting the complex interplay between employee integrity performance (EIP) and the resulting competitive advantage derived from effective integrity practices. By combining resource-based and ethical theories into OIC, the research emphasises its strategic importance as a fundamental asset driving competitive advantage by cultivating integrity practice and boosting EIP. The study aims to analyse model fit and quantify significant construct correlations. Research inquiries, objectives, and hypotheses focus on understanding the influence of OIC on integrity practice, the impact of integrity practice on EIP, and the mediating role of integrity practice in the OIC-EIP relationship. SmartPLS provides methodological rigour in study design, target population delineation, sample, and reasoning. The study also seeks to fill gaps in private healthcare ethics literature and better understand how OIC affects staff ethics. Through empirical investigation, the study pioneers the exploration of the relationship between OIC and EIP in Malaysia's private healthcare sector, utilising the Malaysian Institute Integrity Index to illuminate this association. Ultimately, the researcher expects the findings to provide actionable insights for improving EIP through effective integrity practices while highlighting the critical role of organisational resources in sustaining competitive advantage.

Cardiac rehabilitation centers in Romania: Where are we now?

Purpose: In 2024, Romania is still facing a critical challenge with high cardiovascular disease mortality rates despite extensive research and policy initiatives. Our study sought to examine the actual state of cardiac rehabilitation in Romania by identifying the healthcare facilities that provide and deliver cardiac rehabilitation services. Methods: The research began with a comprehensive investigation into cardiac rehabilitation centers across Romania. This involved leveraging search engines to identify these facilities. Keywords like “cardiac rehabilitation”, “cardiovascular rehabilitation”, and “cardiac rehabilitation centers” were instrumental in pinpointing relevant information, which included names, geographical locations, and contact details of the centers. Upon identification of potential centers, our research team initiated direct engagement with these facilities via telephonic interviews. Results: The data collected in 2024 was compared to previous findings from a 2017 research report to evaluate the progress and impact of prevention efforts over time. While the number of cardiac rehabilitation centers has grown (69.2% increase in the nationwide count of cardiac rehabilitation centers/facilities), an uneven geographic distribution persists, exacerbated by disruptions during the COVID-19 pandemic. Among the cardiac rehabilitation centers identified, 23% are located in balneoclimatic resorts, but the majority of cardiac rehabilitation centers are located in Bucharest. Overall, 65.3% of all identified centers in Romania belong to the private healthcare sector. Among these private centers, 41.1% offer cardiac rehabilitation programs as continuous inpatient care, with durations ranging from 5 to 16 days. All cardiac rehabilitation centers are equipped with the necessary equipment to perform basic cardiological investigations as well as physio-kinesiological rehabilitative procedures, in addition to aerobic physical training (53.8%). In 33.3% of the identified centers, diabetologists and psychologists/psychotherapists are integral members of the multidisciplinary cardiac rehabilitation team, while only 19.2% of the centers include a dietitian/nutritionist. Regarding costs, there is significant variation depending on the geographical area. In Bucharest, a single rehabilitation session costs between 100 to 400 lei (20 to 80 €), and a rehabilitation program spanning 4-6 weeks can cost up to 3350 lei. Comparing costs identified in 2017, we have observed an increase ranging from 47% to 188% in 2024. Conclusions: Despite an increase in the number of cardiac rehabilitation centers, their prevalence remains inadequate to fulfill the demands of the population. Telerehabilitation emerges as a promising solution, with limited adoption in only one center. Cost variations across regions pose a barrier to patient participation. Our article proposes strategies including decision algorithms for personalized recommendations, expanding cardiac rehabilitation centers, and advocating for comprehensive cost reimbursement. The urgent need for collaborative efforts is emphasized, envisioning innovative solutions like mobile applications to foster a sense of community and optimize cardiac rehabilitation, ultimately improving cardiovascular health outcomes in Romania. Keywords: cardiac rehabilitation, telerehabilitation, cardiac rehabilitation centers, healthcare disparities, cardiovascular health

Job Satisfaction and Associated Factors Among Primary Healthcare Workers: A Cross-Sectional Study From Qassim Region, Saudi Arabia.

Background The healthcare sector is one of the most important sectors in any country. Any disruption in the productivity of the workforce majorly affects healthcare entities. Job satisfaction directly interferes with the individual's productivity. Hence, the job satisfaction of healthcare workers (HCWs) is a fundamental issue to discuss, investigate, and study to improve the outputs to their maximal levels, especiallyif limited studies are done in this regard. Methodology A descriptive, cross-sectional, facility-based study was conducted among 302 HCWs in 30 primary healthcare centers (PHCCs) in the Qassim region, Saudi Arabia, using a pretested, validated, electronically self-administered "Satisfaction of Employees in Health Care" (SEHC) questionnaire. Our sample included physicians, nurses, pharmacists, dental workers, and lab and radiology technicians. Data were analyzed using SPSS version 29 (IBM Corp., Armonk, NY). Results The mean score of the overall perception of job satisfaction in primary healthcare staff was 3.9 (±1.01) out of one to five scale questions. This implies a high satisfaction in 71.2% (n = 215) of the sample. Nurses expressed the highest satisfaction with their roles, comprising 26.5% (n = 80)who reported high satisfaction. Second in line were physicians, demonstrating high satisfaction levels with 14.2% (n = 43). The third place was for lab technicians, 4.6% (n = 14) of whom expressed high satisfaction. Many factors were found to be significantly statistically associated with job satisfaction, including gender (p = 0.015), age (p = 0.001), job rank (p = 0.027), number of patients seen per day (p = 0.002), type of primary healthcare duty (p = 0.042), and health workers' years of experience (p = 0.000). Conclusion The study revealed that HCWsat primary healthcare facilities in the Qassim region, Saudi Arabia, were highly satisfied with their jobs. Significant statistical relationships were found between job satisfaction and factors such as years of experience, type of duty in PHCCs, and number of attendees per day. To improve HCWs' job satisfaction, we recommend that they receive additional organizational support and response to feedback, a reduced workload achieved through increased staffing, and flexible work shifts. We also recommend investigating satisfaction in the private healthcare sector.

Engagement of private healthcare sector in addressing noncommunicable diseases at primary care level in the Eastern Mediterranean Region.

The private healthcare sector is a critical stakeholder in the provision of health care services, including noncommunicable diseases (NCDs), and engagement with the sector is increasingly being advocated in efforts to achieve Universal Health Coverage. This study was conducted to explore the role of the private health sector in delivering NCD-related primary care services in selected countries of the WHO Eastern Mediterranean Region (EMR): Jordan, Oman, Pakistan, Sudan, and the Syrian Arab Republic. We adapted the analytical framework for this study from the "Framework for action to implement the United Nations political declaration on noncommunicable diseases". We conducted a desk review to gather evidence, identify gaps and provide direction for the subsequent stakeholder interviews. Key informant interview respondents were selected using the snowball sampling method. Data from the interviews were analysed using MAXQDA, version 2020. We reviewed 26 documents and interviewed 19 stakeholders in Jordan, Oman, Pakistan, Sudan and the Syrian Arab Republic. Our results indicated increasing advocacy at the regional and national levels to align the private and public health sectors, just as there were efforts to reduce the risk factors for NCDs by implementing tobacco laws, introducing food labelling guidelines, increasing taxes on soft drinks, and promoting the healthy cities approach. NCDs health information systems varied widely among the countries, from being organized and developed to having poor recordkeeping. The private health sector is the predominant provider of care at primary level in most of the EMR countries. Increased collaboration between the public and private sectors is essential for better management of NCDs in the EMR. Governments need to strengthen regulation and defragment the private health sector and harness the sector's strengths as part of efforts to achieve national health targets, NCD goals and Universal Health Coverage.