Provincial Health Department Research Articles

Human infection of avian influenza A H3N8 virus and the viral origins: a descriptive study

The H3N8 avian influenza virus (AIV) has been circulating in wild birds, with occasional interspecies transmission to mammals. The first human infection of H3N8 subtype occurred in Henan Province, China, in April, 2022. We aimed to investigate clinical, epidemiological, and virological data related to a second case identified soon afterwards in Hunan Province, China. We analysed clinical, epidemiological, and virological data for a 5-year-old boy diagnosed with H3N8 AIV infection in May, 2022, during influenza-like illness surveillance in Changsha City, Hunan Province, China. H3N8 virus strains from chicken flocks from January, 2021, to April, 2022, were retrospectively investigated in China. The genomes of the viruses were sequenced for phylogenetic analysis of all the eight gene segments. We evaluated the receptor-binding properties of the H3N8 viruses by using a solid-phase binding assay. We used sequence alignment and homology-modelling methods to study the effect of specific mutations on the human receptor-binding properties. We also conducted serological surveillance to detect the H3N8 infections among poultry workers in the two provinces with H3N8 cases. The clinical symptoms of the patient were mild, including fever, sore throat, chills, and a runny nose. The patient's fever subsided on the same day of hospitalisation, and these symptoms disappeared 7 days later, presenting mild influenza symptoms, with no pneumonia. An H3N8 virus was isolated from the patient's throat swab specimen. The novel H3N8 virus causing human infection was first detected in a chicken farm in Guangdong Province in December, 2021, and subsequently emerged in several provinces. Sequence analyses revealed the novel H3N8 AIVs originated from multiple reassortment events. The haemagglutinin gene could have originated from H3Ny AIVs of duck origin. The neuraminidase gene belongs to North American lineage, and might have originated in Alaska (USA) and been transferred by migratory birds along the east Asian flyway. The six internal genes had originated from G57 genotype H9N2 AIVs that were endemic in chicken flocks. Reassortment events might have occurred in domestic ducks or chickens in the Pearl River Delta area in southern China. The novel H3N8 viruses possess the ability to bind to both avian-type and human-type sialic acid receptors, which pose a threat to human health. No poultry worker in our study was positive for antibodies against the H3N8 virus. The novel H3N8 virus that caused human infection had originated from chickens, a typical spillover. The virus is a triple reassortment strain with the Eurasian avian H3 gene, North American avian N8 gene, and dynamic internal genes of the H9N2 viruses. The virus already possesses binding ability to human-type receptors, though the risk of the H3N8 virus infection in humans was low, and the cases are rare and sporadic at present. Considering the pandemic potential, comprehensive surveillance of the H3N8 virus in poultry flocks and the environment is imperative, and poultry-to-human transmission should be closely monitored. National Natural Science Foundation of China, National Key Research and Development Program of China, Strategic Priority Research Program of the Chinese Academy of Sciences, Hunan Provincial Innovative Construction Special Fund: Emergency response to COVID-19 outbreak, Scientific Research Fund of Hunan Provincial Health Department, and the Hunan Provincial Health Commission Foundation.

Collaboration and Conflict at Chief Minister’s Initiative on Primary Healthcare (CMIPHC)

This case study is about the organization Chief Ministers Initiative on Primary Health Care (CMIPHC). The organization was created as a collaboration between the Government of Punjab province in Pakistan and a local nonprofit organization named Punjab Rural Support Program (PRSP). CMIPHC was given control of Basic Health Units (BHU) in 12 out of 36 districts of Punjab. However, the provincial health department retained the infrastructure in other aspects of public health. Despite signs of success, CMIPHC had come under criticism from the provincial health department officials and the local government administration throughout its operation. In 2014, the conflict had reached a point where the provincial government had started considering the closure of CMIPHC and returning BHUs to the provincial health department. The final decision was to be taken after a third-party evaluation. While the CMIPHC leadership was confident that a third-party evaluation would favour the collaboration, they were still concerned about the financial and functional stability of their organization. This was because the leadership felt that some officials from the local health department were resentful of the fact that PRSP was treading on their turf. This instruction manual uses a resource dependency framework to analyse the facts presented by the case and aims to help the students better understand the opportunities and threats posed by collaborative approaches to public service delivery.

PENGARUH ANGKA KEMATIAN BAYI, ANGKA PARTISIPASI SEKOLAH, DAN RASIO KETERGANTUNGAN TERHADAP INDEKS PEMBANGUNAN MANUSIA

This study aimed to analyze the effect of infant mortality, school enrollment rate, and dependency ratio on the Human Development Index in districts/ cities of Bali Province. The data used in this study is secondary data for 6 years in 9 districs/cities Bali Province were obtained from various sources such as CPM and the Bali Provincial Health Department. The analysis technique used is panel data regression. The study showed that the infant mortality,school enrollment rate, and dependency ratio simultaneously affect the human development index in districts/ cities of Bali Province. Partially, the infant mortality rate and dependency ratio have a significant and negative effect on the human development index in n districts/ cities, Bali Province, while the school enrollment rate was positive effect but an insignificant effect. 
 keyword: infant mortality rate, school enrollment rate, dependency ratio, human development index

The Sehat Ghar: An Innovation to Improve Primary Healthcare in Rural Punjab

An effective healthcare sector essentially relies on a strong primary healthcare system. The primary healthcare system governs all major aspects of preventive healthcare and family planning services including immunization, hygiene, communicable disease prevention, sanitation, etc. In addition to this, a major bottleneck limiting the quality of healthcare at secondary and tertiary health facilities is the very high patient footfall that these hospitals. The primary healthcare facilities are designed to be the first tier of facility that a patient falls onto, and hence is either treated there or referred to higher level facilities by screening and limiting patient flow to next levels. Supporting this tier hence helps reduce burden on secondary and tertiary facilities of patients that could have been treated at primary facilities and hence exponentially improve the quality of health services in these lager hospitals. The document discusses some of the major issues faced by the primary healthcare sector in Punjab. These issues were studied and analyzed in detail at South Punjab Health Department, which is an arm of the provincial health department governing 11 districts of Southern Punjab – districts where socio-economic conditions are generally much poorer than the rest of Punjab. This document discusses the initiative of Sehat Ghar, its model, potential to ensure basic health services delivery to the local population and its direct & indirect contribution to tackle major issues of primary healthcare in Punjab.

Child Mortality, Fertility and Poverty: A Counterfactual Analysis

Larger sizes of households tighten the resources of families particularly those in lower wealth quintiles. Households in poorer quintiles are trapped into high child mortality. The risk of child survival leads to high fertility and little investment in children. The conditions to pull these households from this malicious trap are already absent. For instance, the indicators like, women’s low rates of education, early marriages and early pregnancies, and too little birth intervals are very discouraging in Pakistan. Unfortunately, households in poorer quintiles are the least beneficiaries from national revenues and policies in developing countries, in general, are designed for general public and benefit from those policies rarely reach to most needy households. The objectives of this paper are: (i) to emphasize the changing dynamics of fertility behavior and incidence of child mortality across the wealth distribution through an empirical investigation of five wealth quantiles, (ii) to explore the causal relationship between under 5 child mortality and fertility, and finally to examine the counter effect of a few policy instruments. For this purpose, the paper exploits the latest Pakistan Demographic Health Survey to examine few important policy variables to break the nexus between poverty, child mortality and high fertility. The counterfactual analysis suggests marginal improvement in a few variables; like female education, delay in first conception and incremental increase in birth intervals if in targeted households, will significantly change the child mortality and fertility rates. The analysis will be helpful for designing interventions. This analysis can also provide guidelines for women centered institutions like Banazir Income Support Programme, federal and provincial mother and child health departments and family planning offices.

Frequency of HIV Positivity in Healthy Blood Donors presenting to a Tertiary Care Hospital

Background: HIV has been under serious consideration by the World Health Organization as well as the Federal government and Provincial health departments. Strict measures have been taken and protocols implemented to curtail the spread of HIV along with Hepatitis B and Hepatitis C. Data from privately-run blood banks have not been reflected in the last 15 years. Aim: To identify current trends of HIV positivity in Lahore Methods: This prospective cross-sectional study was conducted at the Department of Pathology & Laboratory, Doctors Hospital & Medical Centre, Lahore from August 2021 to January 2022. After fulfilling the selection criteria 3160 non-remunerated blood donors selected through non-probability consecutive sampling, were enrolled. Anti-HIV test was performed using chemiluminescence. Results: 3160 voluntary blood donors were investigated. All subjects were males with mean age 29.7 years ranging from 21 years to 46 years. 2 candidates for blood donation (0.06%) were tested positive for HIV. Conclusion: This study reflects stagnation in HIV control as depicted by the frequency of its positivity. There is need to enhance awareness programs in controlling the spread of blood borne diseases especially HIV. Keywords: HIV, blood donor, blood borne diseases, blood transfusion

Evaluating the Implementation of the GREAT4Diabetes WhatsApp Chatbot to Educate People With Type 2 Diabetes During the COVID-19 Pandemic: Convergent Mixed Methods Study.

BackgroundIn South Africa, diabetes is a leading cause of morbidity and mortality, which was exacerbated during the COVID-19 pandemic. Most education and counseling activities were stopped during the lockdown, and the GREAT4Diabetes WhatsApp Chatbot was innovated to fill this gap.ObjectiveThis study aimed to evaluate the implementation of the chatbot in Cape Town, South Africa, between May and October 2021.MethodsConvergent mixed methods were used to evaluate the implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, cost, coverage, effects, and sustainability. Quantitative data were derived from the chatbot and analyzed using the SPSS. Qualitative data were collected from key informants and analyzed using the framework method assisted by Atlas-ti. The chatbot provided users with 16 voice messages and graphics in English, Afrikaans, or Xhosa. Messages focused on COVID-19 infection and self-management of type 2 diabetes.ResultsThe chatbot was adopted by the Metro Health Services to assist people with diabetes who had restricted health care during the lockdown and were at a higher risk of hospitalization and death from COVID-19 infection. The chatbot was disseminated via health care workers in primary care facilities and local nonprofit organizations and via local media and television. Two technical glitches interrupted the dissemination but did not substantially affect user behavior. Minor changes were made to the chatbot to improve its utility. Many patients had access to smartphones and were able to use the chatbot via WhatsApp. Overall, 8158 people connected with the chatbot and 4577 (56.1%) proceeded to listen to the messages, with 12.56% (575/4577) of them listening to all 16 messages, mostly within 32 days. The incremental setup costs were ZAR 255,000 (US $16,876) and operational costs over 6 months were ZAR 462,473 (US $30,607). More than 90% of the users who listened to each message found them useful. Of the 533 who completed the whole program, 351 (71.1%) said they changed their self-management a lot and 87.6% (369/421) were more confident. Most users changed their lifestyles in terms of diet (315/414, 76.1%) and physical activity (222/414, 53.6%). Health care workers also saw benefits to patients and recommended that the service continues. Sustainability of the chatbot will depend on the future policy of the provincial Department of Health toward mobile health and the willingness to contract with Aviro Health. There is the potential to go to scale and include other languages and chronic conditions.ConclusionsThe chatbot shows great potential to complement traditional health care approaches for people with diabetes and assist with more comprehensive patient education. Further research is needed to fully explore the patient’s experience of the chatbot and evaluate its effectiveness in our context.

Improving public health sector service delivery in the Free State, South Africa: development of a provincial intervention model

BackgroundPublic health sector service delivery challenges leading to poor population health outcomes have been observed in the Free State province of South Africa for the past decade. A multi-method situation appraisal of the different functional domains revealed serious health system deficiencies and operational defects, notably fragmentation of healthcare programmes and frontline services, as well as challenges related to governance, accountability and human resources for health. It was therefore necessary to develop a system-wide intervention to comprehensively address defects in the operation of the public health system and its major components.MethodsThis study describes the development of the ‘Health Systems Governance & Accountability’ (HSGA) intervention model by the Free State Department of Health (FSDoH) in collaboration with the community and other stakeholders following a participatory action approach. Documented information collected during routine management processes were reviewed for this paper. Starting in March 2013, the development of the HSGA intervention model and the concomitant application of Kaplan and Norton’s (1992) Balanced Scorecard performance measurement tool was informed by the World Health Organization’s (2007) conceptual framework for health system strengthening and reform comprised of six health system ‘building blocks.’ The multiple and overlapping processes and actions to develop the intervention are described according to the four steps in Kaplan et al.’s (2013) systems approach to health systems strengthening: (i) problem identification, (ii) description, (iii) alteration and (iv) implementation.ResultsThe finalisation of the HSGA intervention model before end-2013 was a prelude to the development of the FSDoH’s Strategic Transformation Plan 2015–2030. The HSGA intervention model was used as a tool to implement and integrate the Plan’s programmes moving forward with a consistent focus on the six building blocks for health systems strengthening and the all-important linkages between them.ConclusionThe model was developed to address fragmentation and improve public health service delivery by the provincial health department. In January 2016, the intervention model became an official departmental policy, meaning that it was approved for implementation, compliance, monitoring and reporting, and became the guiding framework for health systems strengthening and transform in the Free State.

Практика издания в Саратовской губернии в 1920-е гг. литературы для высшей школы

Against the background of an acute shortage of educational literature in support of higher education in the 1920s, dozens of famous teachers of Saratov universities acted as authors of textbooks and manuals. The provincial department of the state publishing house was responsible for their publication, and the preparation of the manuscript for publication was carried out by such organizations as: the subdivision of social security for students at Saratov State University, the general student fund for mutual assistance, the provincial departments of health and education, etc. A lot of educational literature for students of humanities were published by V. Z. Yaksanov’s private publishing house. The article examines the dynamics of educational book publishing to meet the needs of higher education in the region, its characteristic features and characteristics.

Feasibility of implementing the advanced HIV disease care package as part of community-based HIV/TB activities: a mixed-methods study protocol

IntroductionAlthough the advanced HIV disease (AHD) care package reduces morbidity and mortality in people with AHD (defined in people living with HIV as WHO stage 3 or 4, CD4 count...

Assessment of the Current State of Pharmacovigilance System in Pakistan Using Indicator-Based Assessment Tool.

Objectives: Pakistan felt the need for an effective and robust pharmacovigilance (PV) system after one of the deadliest drug-related tragedies causing more than 300 deaths in 2012. The country set up its national PV center in 2015 and joined WHO’s Program for International Drug Monitoring (PIDM) in 2018 as a full member. The current study was aimed to evaluate the PV system’s functionality, identify the gaps, areas of improvement, and a strategy to lead a functional PV system in Pakistan. Methods: The descriptive cross-sectional study was conducted by providing an interviewer-administered questionnaire of the PV system across Pakistan by utilizing the Indicator based Pharmacovigilance assessment tool (IPAT). By a convenience sampling method 36 study participants were selected from the Drug Regulatory Authority of Pakistan (DRAP), drug administration of provincial health departments of 4 provinces and federally affiliated areas, 5 national public health programs, and 23 public and private hospitals. The assessment includes document review, interviews of the key informants by structured open-ended questions, and a review of websites of relevant organizations. Results: Drug Regulatory Authority of Pakistan (DRAP) with a national PV center received a 75% overall performance score on IPAT. To be regarded as “minimally functioning,” a country’s PV and drug safety system must meet all core indicators. DRAP scored 80.76% on the core indicators so cannot be deemed functional at this time. The only province with a regional PV center, Punjab, had scored 72.13% on relevant parameters. Despite receiving funding from the Global Fund, none of the National Public Health Programs (PHPs) have PV centers or associated activities. All hospitals except two private hospitals could not qualify the minimum requirements for functional PV. The absence of a legal framework for mandatory ADR reporting, lack of drug information center, budgetary constraints, no active surveillance activities, the nonexistence of pharmacovigilance risk assessment expert committee, and insufficient coordination among stakeholders were identified as major gaps. Conclusion: The results of the study reveal that Pakistan’s PV system is not fully functional at all levels. A two-phased strategy encompassing the non-financial and financial interventions is proposed to improve the PV systems at the national, provincial, PHPs, and hospitals levels.

Eye health promotion-oriented policy statements in various national and provincial health policy documents in South Africa

Background: There are many fragmented public health policies that give directives towards various aspects of healthcare needs and implementation. However, none of these policies make specific reference to eye health promotion (EHP) as an enabler for individuals to take control of the determinants of their eye health (EH) needs.Aim: The current study sought to identify EHP messages in the various available policy documents at both national and provincial health department levels with a view to assessing awareness on the available gaps for the development of an integrated EHP policy in South Africa.Setting: The study used documents provided by the National Department of Health and those that were available online from various other provincial Departments of Health in the country.Methods: Content analysis of EH policies requested from the Directorate of Chronic Diseases, Disabilities and Geriatrics was conducted. Various other health policies that were enacted post-1994 and endorsed by the National and Provincial Departments of Health were also considered for analysis.Results: Twenty-four documents were considered for content analysis. The national guidelines on eye healthcare made reference to EH activities such as immunisation of children, vision screening of the elderly, vitamin A supplementation and maternal services to detect sexually transmitted diseases, amongst others. Of the 20 national and provincial health documents analysed, only four made reference to EH. None of these documents made any specific reference to EHP.Conclusion: Although four national guidelines contain content related to EHP, the fragmentation and lack of integration with other health policy documents may lead to eye healthcare messages not being prioritised for dissemination even where they are highly required. Also, public eye healthcare services in general will continue to lag behind as is the case in most provinces in South Africa.

The Interplay Between Technology Performativity and Health Care Professionals in Hospital Settings: Service Design Approach.

BackgroundThe unexpected outbreak of the COVID-19 pandemic and the preventive measures of physical distancing have further necessitated the application of information and communication technologies (ICTs) to enhance the efficiency of work activities in health care. Although the interplay between human agency and technology performativity is critical to the success or failure of ICTs use in routine practice, it is rarely explored when designing health ICTs for hospital settings within the sub-Saharan Africa context.ObjectiveThe objective of this study is to explore how the service delivery quality is being influenced by the technology-enabled activities of health care professionals at points of care using a service design strategy.MethodsAn interpretivist stance was assumed to understand the socially constructed realities of health care professionals at points of care in a hospital setting. A service design strategy was identified as suitable for engaging health care professionals in co-design sessions to collect data. A purposive sampling technique was used to identify the participants. Open-ended questions were administered to gain insights into the work activities of physicians and nurses at points of care. Qualitative (textual) data were analyzed using thematic analysis. Ethical concerns about the safety and privacy of participants’ data were addressed as per the university ethics review committee and provincial department of health.ResultsThe findings show that the attributes of human agency and technology features that drive technology performativity result in an interplay between social concepts and technical features that influence the transformation of human-machine interactions. In addition, the interplay of the double dance of agency model can be divided into 2 successive phases: intermediate and advanced. Intermediate interplay results in the perceived suitability or discomfort of health ICTs as experienced by health care professionals at initial interactions during the execution of work activities. Subsequently, the advanced interplay determines the usefulness and effectiveness of health ICTs in aiding task performance, which ultimately leads to either the satisfaction or dissatisfaction of health care professionals in the completion of their work activities at points of care.ConclusionsThe adopted service design strategy revealed that the interaction moments of the tasks performed by health care professionals during the execution of their work activities at point of care determine the features of health ICTs relevant to work activities. Consequently, the ensuing experience of health care professionals at the completion of their work activities influences the use or discontinuation of health ICTs. Health care professionals consider the value-added benefits from the automation of their work activities to ultimately influence the quality of service delivery. The major knowledge contribution of this study is the awareness drawn to both the intermediate and advanced interplay of human-machine interaction when designing health ICTs.

Health Technology Assessment in Support of National Health Insurance in South Africa.

South Africa has embarked on major health policy reform to deliver universal health coverage through the establishment of National Health Insurance (NHI). The aim is to improve access, remove financial barriers to care, and enhance care quality. Health technology assessment (HTA) is explicitly identified in the proposed NHI legislation and will have a prominent role in informing decisions about adoption and access to health interventions and technologies. The specific arrangements and approach to HTA in support of this legislation are yet to be determined. Although there is currently no formal national HTA institution in South Africa, there are several processes in both the public and private healthcare sectors that use elements of HTA to varying extents to inform access and resource allocation decisions. Institutions performing HTAs or related activities in South Africa include the National and Provincial Departments of Health, National Treasury, National Health Laboratory Service, Council for Medical Schemes, medical scheme administrators, managed care organizations, academic or research institutions, clinical societies and associations, pharmaceutical and devices companies, private consultancies, and private sector hospital groups. Existing fragmented HTA processes should coordinate and conform to a standardized, fit-for-purpose process and structure that can usefully inform priority setting under NHI and for other decision makers. This transformation will require comprehensive and inclusive planning with dedicated funding and regulation, and provision of strong oversight mechanisms and leadership.

Local Government and the Conundrum of Constitutional Competencies in South Africa: The Tussle Between City of Tshwane Municipality and the Gauteng Health Department Over Ambulance Services

Local government’s autonomy in post-apartheid South Africa is constitutionally guaranteed. A reading of the Constitution of the Republic of South Africa, 1996 shows that local government, made up of 257 municipalities, has a wide range of powers and functions. However, confusion over the scope of constitutional distribution of powers and functions vis-à-vis other spheres of government often constrains the ability of municipalities to take action over a function not expressly assigned to local government in Schedules 4B and 5B of the Constitution. The squabbles between the City of Tshwane and the Gauteng Health Department over the power to provide ambulance services in March 2021 show how some municipalities may be hamstrung from taking action that seeks to operationalise and deliver a function that is not expressly conferred on local government in terms of Schedules 4 and 5 of the Constitution. This article discusses why and how municipalities with the requisite capacity should be able to provide ambulance services, although this is listed in Schedule 5A of the Constitution as a functional area of exclusive provincial legislative competence. I argue that three features in the Constitution give the power to provide ambulance services to municipalities that have the requisite capacity: the framing of health rights and concomitant obligations; the incidental powers of municipalities; and the principle of allocative subsidiarity. It is argued that, given the mandatory wording of the principle of allocative subsidiarity in sections 156(4) of the Constitution and 32(2) of the National Health Act 61 of 2003, where a provincial health department is averse to assigning the provision of ambulance services to a municipality that has the requisite capacity, such a municipality can approach the High Court for an order compelling the department to assign this function.

Status of malaria and its implications for elimination in an endemic province of South Africa: retrospective analysis

South Africa set a target to eliminate malaria by 2018. Kwa-Zulu-Natal (KZN) province was earmarked to reach the elimination goal first. However, recent evidence suggests that the province has not yet achieved the elimination goal. This study set out to assess the status of malaria in KZN province of South Africa and its implications for elimination. Using retrospective analysis, the study quantified and described 5 787 cases of malaria for the years 2010-2019 in KZN province of South Africa. Data on reported malaria cases were obtained from the Malaria Information System of the KZN Provincial Department of Health. More than 65% of the cases came from male patients aged 16 years and above. A high number of cases were reported in the years 2014, 2017 and 2018. More than 40% of the cases were imported from countries outside of South Africa. The study confirms an increase in malaria cases, especially during the elimination year. The imported malaria cases and other related factors pose a threat to achieving the elimination goal. The KZN province needs to strengthen elimination efforts, including strategies to prevent imported malaria cases to achieve the new elimination goal.

Eye health promotion-oriented policy statements in various national and provincial health policy documents in South Africa

Background: There are many fragmented public health policies that give directives towards various aspects of healthcare needs and implementation. However, none of these policies make specific reference to eye health promotion (EHP) as an enabler for individuals to take control of the determinants of their eye health (EH) needs. Aim: The current study sought to identify EHP messages in the various available policy documents at both national and provincial health department levels with a view to assessing awareness on the available gaps for the development of an integrated EHP policy in South Africa. Setting: The study used documents provided by the National Department of Health and those that were available online from various other provincial Departments of Health in the country. Methods: Content analysis of EH policies requested from the Directorate of Chronic Diseases, Disabilities and Geriatrics was conducted. Various other health policies that were enacted post-1994 and endorsed by the National and Provincial Departments of Health were also considered for analysis. Results: Twenty-four documents were considered for content analysis. The national guidelines on eye healthcare made reference to EH activities such as immunisation of children, vision screening of the elderly, vitamin A supplementation and maternal services to detect sexually transmitted diseases, amongst others. Of the 20 national and provincial health documents analysed, only four made reference to EH. None of these documents made any specific reference to EHP. Conclusion: Although four national guidelines contain content related to EHP, the fragmentation and lack of integration with other health policy documents may lead to eye healthcare messages not being prioritised for dissemination even where they are highly required. Also, public eye healthcare services in general will continue to lag behind as is the case in most provinces in South Africa.

Rosalie Sattler-Feuerstein: An Austro-Hungarian Official Female Physician in Bosnia and Herzegovina, 1914-1919.

This short biography traces the life and medical activities of Rosalie Sattler, née Feuerstein (1883-19??), who was employed as an official female physician at the Austro-Hungarian (AH) provincial public health department in Sarajevo from 1914-1919. Born in 1883 into a Jewish middle-class family in Chernivtsi (then Czernowitz), Ukraine, in Bukovina, the easternmost province in Austria, Feuerstein moved to Vienna in 1904 to study medicine. After earning her MD from Vienna University in 1909, she started her career as an assistant physician at the Kaiser Franz Josef Hospital in Vienna. In spring 1912, Feuerstein moved to Sarajevo to work as an intern at the local provincial hospital (Landeskrankenhaus). In the same year, she married AH district physician Moritz Sattler (1873-1927) in Vienna. In 1914, Sattler-Feuerstein successfully applied to be an AH official female physician in Bosnia. She was an employee of the provincial public health department in Sarajevo and never functioned as an official female physician in the sense of the relevant AH service ordinance. After the collapse of the monarchy, Sattler-Feuerstein continued to be employed as an official female physician of the Kingdom of Serbs, Croats, and Slovenes. She resigned from service in 1919 and established herself as a private general practitioner in Sarajevo with her husband, who had also resigned as an official physician and started to practice privately at that point. Widowed in 1927, she left Sarajevo for an unknown destination, likely in 1938-1939, and vanished from historical records. CONCLUSION: Rosalie Sattler-Feuerstein (1883-19??) came to Bosnia as the eighth AH official female physician and worked as an employee of the AH provincial public health department in Sarajevo from 1914-1919, after which she practiced as a private physician in Sarajevo for more than 25 years.

Strengthening public financial management in the health sector: a qualitative case study from South Africa

IntroductionEffective public financial management (PFM) ensures public health funds are used to deliver services in the best way possible. Given the global call for universal health coverage, and concerns about...

ANALISIS FAKTOR-FAKTOR YANG MEMENGARUHI TINGKAT PENYERAPAN ANGGARAN DENGAN VARIABEL INTERVENING EFEKTIVITAS ANGGARAN BERBASIS KINERJA PADA DINAS KESEHATAN PROVINSI BANTEN

Delay in budget absorption is a classic problem in government agencies that generally occurs in the first trimester and swells at the end of the year Some of the fundamental causes of low budget absorption include the preparation process for the implementation of an immature budget, preparation of budget absorption plans is less accurate, and a late auction process. This study aims to determine the relationship of understanding, training, external pressure on budget absorption with intervening variables on the effectiveness of performance-based budgeting. The study population was 55 Provincial Health Department employees. Data analysis was performed using the Structural Equation Model (SEM) method using PLS. From the results of the hypothesis test, it can be concluded that 1) Understanding has a positive effect on budget absorption, so the higher understanding an employee has regarding budget planning, the higher the level of budget absorption, 2) Training has a positive effect on budget absorption, so that more training is ever followed by an employee related to budget planning institutions, the higher the level of budget absorption, 3) External pressure does not affect the absorption of the budget, 4) Understanding has a positive effect on the effectiveness of performance-based budgeting, so the higher the understanding of an employee related to budget planning institutions will the higher the effectiveness of performance-based budgeting, 5) Training has a positive effect on the effectiveness of performance-based budgeting, so that more training is ever attended by an employee related to the agency's budget planning. the higher the effectiveness of performance-based budgeting, 6) External pressure does not affect the effectiveness of performance-based budgeting, and 7) The effectiveness of performance-based budgeting has a positive effect on the absorption of the budget, so the more effective the performance-based budget that is applied the higher the level of budget absorption