Provincial Funding Research Articles

A mixed-methods evaluation of the MOREOB program in Ontario hospitals: participant knowledge, organizational culture, and experiences

BackgroundMOREOB (Managing Obstetrical Risk Efficiently) is a patient safety program for health care providers and administrators in hospital obstetric units. MOREOB has been implemented widely in Canada and gradually spread to the United States. The main goal of MOREOB is to build a patient safety culture and improve clinical outcomes. In 2013, 26 Ontario hospitals voluntarily accepted provincial funding to participate in MOREOB. The purpose of our study was to assess the effect of MOREOB on participant knowledge, organizational culture, and experiences implementing and participating in the program at these 26 Ontario hospitals.MethodsA convergent parallel mixed-methods study in Ontario, Canada, with MOREOB participants from 26 hospitals. The quantitative component used a descriptive pre-post repeated measures design to assess participant knowledge and perception of culture, administered pre-MOREOB and after each of the three MOREOB modules. Changes in mean scores were assessed using mixed-effects regression. The qualitative component used a qualitative descriptive design with individual semi-structured interviews. We used content analysis to code, categorize, and thematically describe data. A convergent parallel design was used to triangulate findings from data sources.Results308 participants completed the knowledge test, and 329 completed the culture assessment at all four time points. Between baseline and post-Module 3, statistically significant increases on both scores were observed, with an increase of 7.9% (95% CI: 7.1 to 8.8) on the knowledge test and an increase of 0.45 (on a scale of 1–5, 95% CI: 0.38 to 0.52) on the culture assessment. Interview participants (n = 15) described improvements in knowledge, interprofessional communication, ability to provide safe care, and confidence in skills. Facilitators and barriers to program implementation and sustainability were identified.ConclusionsParticipants were satisfied with their participation in the MOREOB program and perceived that it increased health care provider knowledge and confidence, improved safety for patients, and improved communication between team members. Additionally, mean scores on knowledge tests for obstetric content and culture assessment improved. The MOREOB program can help organizations and individuals improve care by concentrating on the human and organizational aspects of patient safety. Further work to improve program implementation and sustainability is required.

Improving Access to Safe Anesthetic Care in Rural and Remote Communities in Affluent Countries.

Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. This report summarizes the challenges facing the provision of anesthesia services in rural and remote regions. The current landscape of anesthesia providers and their training is described. We also explore innovative strategies and emerging technologies that could better support physician-led anesthesia care teams working in rural and remote areas. Ultimately, we believe that it is the responsibility of specialist anesthesiologists and academic health sciences centers to facilitate access to high-quality care through partnership with other stakeholders. Professional medical organizations also play an important role in ensuring the quality of care and continuing professional development. Enhanced collaboration between academic anesthesiologists and other stakeholders is required to meet the challenge issued by the World Health Organization to ensure access to essential anesthesia and surgical services for all.

2410-PUB: Insulin Pumps Accessed through Provincial Funding and Quality of Life: A Qualitative Study

The Nova Scotia Insulin Pump Program (NSIPP) subsidizes the cost of insulin pump (CSII) therapy for patients aged 25 and under with type 1 diabetes. Its medical eligibility criteria ensure structured care and follow-up with focused diabetes teams according to provincial guidelines. Studies on CSII and quality of life are mostly survey-based, thus first voice patient experiences are limited. This qualitative study examined patient/parent perspectives on how CSII affects quality of life and is unique in the context of provincial funding. A phenomenological approach was used. In-depth semi-structured telephone interviews averaging 36 minutes were completed with NSIPP enrollees and/or their parents, depending on age. Saturation was reached after 23 interviews. Verbatim transcripts were coded independently by two researchers using NVivo. Analysis began with a discussion of coding discrepancies, which were resolved using concept mapping to clarify relationships between codes and identify main themes. More freedom in daily life, feelings of control over life and diabetes, less worry and more positive intra/interpersonal social experiences were main themes, but how they were expressed depended on the patient’s stage of life. CSII facilitated precise insulin delivery, allowing more freedom in daily activities. This freedom led to feelings of control, less worry and improvements in social life. These outcomes manifested in how common life events were experienced. For example, parents often saw CSII as enabling their teen to gain independence, while young adults focused on CSII supporting them to function at work, school, and in relationships. Finally, NSIPP’s financial help was necessary for those without private insurance and experiences with NSIPP’s defined, structured care and follow-up were positive for all. Overall, NSIPP’s financial support to access CSII therapy and its structured care and follow-up improved quality of life, and the exact ways depended on the patients’ stage of life. Disclosure E.J. Haynes: None. M.N. Ley: None. P.J. Talbot: None. M. Dunbar: None. E.A. Cummings: None. Funding Dalhousie Medical Research Foundation

Clinical nursing of anticipatory nausea and vomiting: a bibliometric analysis

Objective To systematically analyze the relevant literatures about anticipatory nausea and in our country, so as to provide reference and guidance in conducting relevant research in the future. Methods From June 30st, 2018 to July 15st, 2018, CNKI and Wanfang Databases were searched, and nausea and vomiting and were searched in title and keyword fields. Literatures related to the nursing of expectant nausea and were screened and analyzed quantitatively. Results A total of 34 literature were found and published in 24 journals. The number of literature as a whole showed an inclining trend. The degree of collaboration was 2.0, and the rate of co-authorship was 70.6%. The literature include five fields: experiments/experimental study, investigation and research, nursing experience, experience summary and reviews. Eight papers were supported by provincial and municipal fund projects. Conclusions Fund support can effectively promote research progress in related fields, and nursing managers should improve their support in this field. At present, most of the experiments/experimental studies focus on psychological intervention and traditional Chinese medicine intervention methods, and the evaluation index is not clear. In the future, more rigorous and systematic research methods should be used to conduct in-depth and extensive research in this field. Key words: Bibliometric analysis; Nausea; Vomiting; Chemotherapy; Nursing intervention

A Quality Improvement Initiative: Using Lean Methodology to Improve Efficiency of the Morning Cycle Monitoring at an Ambulatory Academic Fertility Clinic

Patients receiving fertility treatments require near-daily blood work and ultrasound for cycle monitoring. Patient volumes at an academic hospital-based ambulatory clinic were expected to increase with expanded provincial funding. The aim of this quality improvement project was for 85% of cycle monitoring patients to have a turnaround time (TAT) of 20 minutes or less from arrival until checkout. This is a time series study analyzed with statistical process control methodology. A baseline survey was conducted to understand patient priorities. Multiple site-specific change ideas were developed by front-line staff using lean methodology including standard processes, standard work, supportive tools, visual management, and staffing and scheduling to meet Takt time. Patient and staff satisfaction surveys were conducted after implementation (Canadian Task Force Classification II-2). With the start of funding in December 2015 the clinic accommodated a 17% increase in daily patient volumes and increased the proportion of patients receiving education at each visit from 50% to 100%. Despite increased patient volumes and added education time, the control chart showed special cause variation with decreased TATs from 38.2 to 34.7 minutes. Patient surveys showed that their priorities were being met or exceeded, and all staff reported increased satisfaction with the new process. By using lean methodology in an ambulatory fertility setting, the clinic was able to improve efficiency in the morning monitoring process to decrease patient TATs while accommodating increased patient volumes and improving the quality of patient care.

ПРОБЛЕМЫ ОБЕСПЕЧЕНИЯ СОХРАННОСТИ ДОКУМЕНТОВ ВЕДОМСТВЕННЫХ АРХИВОВ В АРХАНГЕЛЬСКОЙ ГУБЕРНИИ В 1917 - 1922 ГГ.

The article attempts to examine the history of the archival service in the Arkhangelsk province from the point of view of the approach of the Soviet authorities to ensure the safety of documents of the departments and organizations that existed on the territory of the province before the revolution of 1917. The events described in the article have not previously received their coverage on the pages of scientific and popular publications, as related documents have not yet been introduced into scientific circulation. The period of study was characterized by the great social upheaval, the consequences of which could not but affect the safety of the old archives. For the representatives of the new local administration, as well as for the majority of the population, such archives did not represent any practical or cultural and historical significance, and that fact left an imprint on the way the SNK decrees on archives administration were executed. In fact, it was only in 1920 that the issue started being resolved, when the Soviet power was re-established in the provincial center. In the conditions of the post-war devastation, the questions of the administration of the provincial archival fund were accomplished on the residual principle, there were neither personnel, nor the rooms suitable in size for archival storage. V. Ivanovsky, the only person, who was entrusted with the duties of preserving the documentary heritage of the region, became the ancestor of the archival service of the Arkhangelsk province.

Coordinating Policy Layers of School Fundraising in Toronto, Ontario, Canada: An Institutional Ethnography

In this article, I report findings from an investigation into the politics and coordination of school fundraising in the Toronto District School Board (TDSB) in Toronto, Ontario, Canada. Theoretically grounded in institutional ethnography and critical policy analysis, the study began from the standpoint of parents asked to give money to their children’s school(s). I show how provincial and TDSB funding, parent involvement, fundraising, and school council policies organize parents’ experience of school fundraising. I also explore how participating in fundraising enables parents to meet neoliberal expectations of a “good parent” and how through their efforts to secure advantages for their children, fundraising parents are accomplices in the privatization of public education. I conclude by discussing possibilities for intervention into the social organization of school fundraising in TDSB schools.

What does mainstream media say about enzyme replacement therapies?

Enzyme replacement therapies (ERTs) are expensive drugs that can be used to treat certain inherited diseases. ERTs are not universally covered across provinces and costs are beyond the means of most patients. Media reports are commonly used to lobby for provincial ERT funding for specific patients. As physicians may be confronted with these media reports by patients, this study explored medical reporting regarding ERTs in print media. Canadian Newsstream database was searched for articles about three ERTs-Elaprase™, Naglazyme™ and Vimizim™. Articles meeting inclusion criteria were reviewed for data regarding efficacy and adverse events, mention of role of health care professionals and medical information sources. Thematic analysis explored how efficacy was described within the articles. Data from product monographs and recent meta-analyses served as a basis for comparison. Of 57 articles retained for the study, 9% mentioned clinical trial data regarding drug efficacy; 7% mentioned adverse events. Only 23% of opinions about medical necessity or efficacy of the drug were from a physician. The majority were those of politicians. Information describing the condition was accurate in 90% of cases, although usually incompletely. Incomplete or inaccurate reporting about efficacy and safety may influence families that appear to be candidates for ERT. Poor reporting of medical information may also influence the social pressures placed on the government and affect funding approval for these drugs. Physicians should be aware that their patients may be exposed to misleading information.

Early Successes in an Open Access, Provincially Funded Hepatitis C Treatment Program in Prince Edward Island

Introduction. The availability of curative hepatitis C therapies has created an opportunity to improve treatment delivery and access. Local providers, government, industry, and community groups in Prince Edward Island developed an innovative province-wide care model. Our goal was to describe the first year of program implementation.Material and methods. Using a communitybased prospective observational study design, all chronic hepatitis C referrals received from April 2015 to April 2016 were recorded in a database. Primary analysis assessed the time from referral to assessment/treatment, as well as the number of referrals, assessments, and treatment initiations. Secondary objectives included: (1) treatment effectiveness using intention-to-treat analysis; and (2) patient treatment experience assessed using demographics, adverse events, and medication adherence.Results. During the study period 242 referrals were received, 123 patients were seen for intake assessments, and 93 initiated direct-acting antiviral therapy based on medical need. This is compared to 4 treatment initiations in the previous 2 years. The median time from assessment to treatment initiation was 3 weeks. Eighty-two of 84 (97.6%, 95% CI 91.7 - 99.7%) patients for whom outcome data were available achieved sustained virologic response at 12 weeks post-treatment; 1 was lost to follow-up and 1 died from an unrelated event. In the voluntary registry, 39.7% of patients reported missed treatment doses.Conclusion. In conclusion, results from the first 12 months of this multi-phase hepatitis C elimination strategy demonstrate improved access to treatment, and high rates of safe engagement and cure for patients living with chronic hepatitis C genotype 1 infections.

COOPERATION BETWEEN THE MINISTRY OF NATIONAL EDUCATION AND LOCAL SELF-GOVERNMENT BODIES OF THE PERM PROVINCE DURING THE PERIOD “PREPARATORY WORK FOR THE COMPULSORY EDUCATION INTRODUCTION”

Introduction. In the history of education, there is still considerable shortfall of the question on mechanisms realization of the general literacy idea in Russia in the beginning of the last century, which gained its popularity around the world at the turn of the 19–20th centuries. Meanwhile, the stage of preparation for cosmopolitan diffusion of compulsory primary education in the Russian Empire, marked by emergence of the special bill drafted by the Ministry of National Education in 1907, is of great interest to the research of opportunities of interaction of the state institutes and regional local self-government bodies (Zemstvo in the Russian language). The aim of the publication is to show the efficiency of joint activities of local self-government bodies and national administrative bodies with reference to example of the system of primary national education formation during 1908–1913 in the Perm province. Methodology and research methods. The methodological base of the present research is based on: the “center-periphery” conceptual model; methods of the retrospective chronological analysis, synthesis, generalization and interpretation of archival documents. Results and scientific novelty. The methodological perspective of studying the history of primary schools organization in pre-revolutionary Russia is proved. The choice of regional (provincial) scale of this process enables to consider features of the public educational policy at the subcountry level; the center-periphery approach to the discussed subject makes it possible to understand more deeply the essence and purposes of the major educational reform. The assessment of the contents on the introduction of compulsory primary education in the Russian Empire is given; the draft bill established standards, new to educational practice, can be listed as follows: “normal duration of training”, “normal school age”, “normal number of children”, “normal school area” (“normal school radius”) and “normal school kit”. The key value and importance of the document consisted in differentiation of powers: in contrast to the Ministry of National Education, the structures of territorial and municipal government bodies had greater freedom of action and were assigned a leading part to put the idea of a compulsory education (Vseobuch in the Russian language) into reality. Dynamics of statistical data on financial government aid to national education is analysed. Activities of all-imperial and provincial school building funds are characterized. It is proved that the essential growth of public financial recourses against the background of vigorous territorial activity not only led to rapid increase in number of schools, but also turned them from local-regional into ministerial-local ones. The conclusion is drawn that due to close cooperation of the Ministry of National Education with local government bodies, the period 1907– 1913 was a key stage of an institutionalization of the Russian compulsory education during the pre-revolutionary times. Practical significance . The results of the research can be adopted when preparing academic courses on the History and Sociology of Education, as well as the Economics of Knowledge.

Moving with and away from Reconciliation

Moving with and away from Reconciliation Laura J. Beard I want to get rid of the Indian problem […] Our objective is to continue until there is not a single Indian in Canada that has not been absorbed into the body politic and there is no Indian Question and no Indian Department. -Duncan Campbell Scott, Deputy Superintendent of Indian Affairs, 1920 Reconciliation to me is about not having to say sorry a second time. -Cindy Blackstock, First Nations Child and Family Caring Society, 2015 Canada's Truth and Reconciliation Commission (TRC) held hearings across Canada, providing opportunities for Indian residential school survivors, their families, and others to share their stories of the Indian Residential School System and its impacts on their lives. For many, the TRC began in 2008 with a great sense of purpose, and importance was placed throughout on allowing people a space to tell their stories and to have those stories heard and received in dignity. For the TRC, "reconciliation is about establishing and maintaining a mutually respectful relationship between Aboriginal and non-Aboriginal peoples in this country" (Final Report 6). It is not the reestablishment of a previous positive relationship, as might be thought of in other contexts. The testimonies at the TRC hearings were intended to create, in a sense, a set of shared memories to draw from in that relationship. But will the stories that bear witness to the residential school experience be enough to move non-Indigenous people in Canada beyond the racist structures of 150-plus years of colonization to a new future? Can shared stories do that? If the memories on one side are of generations of lived, residential school experiences in one's family while the memory on the other side is that of an afternoon spent listening [End Page 653] to other people telling stories at a TRC gathering,1 are those really the collective memories that create communities? In the same way, for life narrative scholars, does an afternoon reading a life narrative from another culture change our sense of community? Does reading a life narrative change us? Does it change our communities and our nations? In the end, are we moved to action by life narratives? The TRC process has clearly been a complex one, with the terms themselves particularly charged. For example, Dakota scholar Kim TallBear rejects the concept of reconciliation, noting that reconciliation implies equal complicity in colonization. In a talk at the 2016 Indigenous Feminism Workshop at the University of Alberta, she paraphrased from Dakota scholar Elizabeth Cook Lynn, stating: "I don't want reconciliation. I want restitution of land." Like Cook Lynn and TallBear, Mohawk scholar Taiaiake Alfred is also critical of what he refers to as the "pacifying discourse of reconciliation": Without massive restitution made to Indigenous peoples, collectively and as individuals, including land, transfers of federal and provincial funds, and other forms of compensation for past harms and continuing injustices committed against the land and Indigenous peoples, reconciliation will permanently absolve colonial injustices and is itself a further injustice. (182) Reconciliation is thus not a term that moves everyone to embrace the TRC project, as they see it as a "virtual minefield of assimilative dangers" that appeals to "a settler-colonial state hoping to put its genocidal past behind it" (Robinson and Martin 6). Gitxan scholar Cindy Blackstock has taken up the term reconciliation, but uses it to turn attention to the ongoing issues with First Nations children in Canada that still need addressing. In February 2007, "as Executive Director of the First Nations Child and Family Caring Society (FNCARES), [Blackstock] brought a landmark discrimination case to the Canadian Human Rights Tribunal to challenge the federal government's chronic underfunding of children's services on First Nations reserves and for First Nations children in the Yukon" ("Reconciliation"). In powerful speeches and interviews about the situation of First Nations children in Canada today, she urges the Canadian government to address current conditions, and points out, "Reconciliation to me is about not having to say sorry a second time" ("Reconciliation"). Yet others think through the TRC process differently. In the same panel at the 2016 Indigenous Feminism Workshop, Cree-Métis scholar Shalene Jobin...

Mobilizing Mercy: A History of the Canadian Red Cross by Sarah Glassford

Reviewed by: Mobilizing Mercy: A History of the Canadian Red Cross by Sarah Glassford Sasha Mullally Sarah Glassford. Mobilizing Mercy: A History of the Canadian Red Cross. McGill-Queen’s/Associated Medical Services Studies in the History of Medicine, Health, and Society. Quebec: McGill-Queen’s University Press, 2017. xx + 390 pp. $39.95 (978–0–7735–4775–9). Charitable and voluntary organizations are powerful social institutions, and many play an important role in shaping the history of health care. In Mobilizing Mercy, Sarah Glassford provides the first book-length, scholarly study of one such institution, the Canadian Red Cross Society (CRCS). Founded to provided mobile medical support for troops in the First World War, Glassford traces its evolution through war and peace over more than a half century. Over six chapters we learn how the organization filled many gaps in government aid and public health, from creating the nation’s first blood transfusion service to offering swimming lessons for Canadian youth. Moving back and forth between the organizational story and the perspective provided by influential leaders, Glassford articulately charts the social, political, and economic changes in the CRCS structure and mandate, making astute assessments of how this national organization both cultivated and deployed a Red Cross “brand” to maintain relevance. The organization continually tapped into the concerns of a wide range of key constituents across the voluntary health and social services landscape: middle-class women social reformers, education activists, clinicians in the armed forces, and government officials intent on creating a modern twentieth-century infrastructure for public health. Successful outreach meant the Canadian Red Cross Society could insert itself into many different and overlapping conversations about health, broadly defined, and authoritatively step in to influence the practical organization of services. In the interwar period, for instance, the CRCS continued to provide relief during periods of natural disaster, in the absence of regular and formal health service, and during epidemics. [End Page 711] The Second World War then refocused CRCS activities in support of the war effort, and the organization reached a high point of its status and institutional power. The activities of the largely female membership varied widely, and their history adds to our understanding of gender, work, and public life over these decades. Glassford industriously mined the local records of provincial Red Cross societies, uncovering many rich testimonials to CRCS volunteers’ work. Such records help us understand the affective and symbolic value of women’s wartime work, which underpinned the image of the Red Cross nurse that emerged and solidified at this time. Yet, the organization was engaged in a wide range of activities beyond nursing. Mobilizing Mercy is, in large part, a story of women in service work, including their struggle to carve out authoritative space in public life. Over the final years of the Second World War, the Red Cross took up the challenge of blood collection in Canada to support of the mobile hospital service units with blood serum. After the war, the CRCS continued this work, supplying the technical services to collect and distribute blood across the country to Canadian hospitals. They were so successful that, in 1959, the Red Cross began to receive substantial provincial and federal government funding to support these activities. In the two decades after war’s end, Canadian health care was increasingly underwritten by the state, including blood services. In this context, the voluntary organization attempted to fit within the emerging national system of publicly funded hospital treatment, and then physician services in private practice. The ability of the CRCS to continually reinvent itself, to negotiate its “philanthropic scope of practice,” and to adapt to new environments and public concerns, was key to its longevity. Glassford’s final chapter puts the CRCS at another crossroads, as the organization considered the challenges of reinventing itself for survival in late-twentieth-century Canada. Here, the discussion of CRCS activities and importance become more suggestive. A lack of secondary records hampered Glassford’s ability to assess the international work of the society, although she is able to describe in very broad terms the institutional framework that supported the “overseas humanitarian awakening” of the CRCS in the postwar decades (p. 244). She describes...

OP134 Pan-Canadian Oncology Drug Review Decisions And Access To Anticancer Treatments In Canada

Introduction:The Canadian Agency for Drugs and Technologies in Health (CADTH) pan-Canadian Oncology Drug Review (pCODR) plays an important role in public reimbursement decision-making for oncology drugs in Canada. This research studies the relation of positive pCODR decisions to new cancer treatment and their subsequent inclusion in Canada's public drug plans.Methods:We studied all oncology drugs that received an approval from Health Canada and were reviewed by the pCODR from inception till 26th Sep, 2017. The data was obtained from CADTH and Health Canada. Data such as indication, submission type and date, recommendation date, final recommendation, and subsequent provincial funding status was extracted and analyzed. Impact was evaluated by analyzing the percentage of drug submissions with assessment outcome (positive recommendation rate and conditional recommendation rate) and time taken for the final decision (recommendation gap). The percentage of drugs included in public formulary after positive recommendation by pCODR (coverage rate) and the gap in days from positive recommendation to subsequent coverage in provinces (coverage gap) was also assessed.Results:Among 119 drugs reviewed by pCODR, the positive recommendation rate was eight percent. Nine applications comprising seven drugs for six indications received positive recommendations, and genitourinary treatments received maximum positive recommendations. The conditional recommendation rate was 52 percent; 62 applications of 45 drugs for 46 indications received conditional recommendation. Lymphoma and myeloma treatments received maximum conditional recommendations. The average recommendation gap for positive and conditional recommendations was 180 and 172 days, respectively. The coverage rate for drugs with positive recommendation was 100 percent for all provinces except 89 percent for Newfoundland and Labrador, and 67 percent for Prince Edward Island. Among the provinces, British Columbia had a maximum of 433 days and Saskatchewan has the minimum of 165 days coverage gap.Conclusions:Despite Health Canada's approval, only a fraction of oncology drugs receive positive pCODR recommendation; furthermore, provincial drug plans take time to include these in the reimbursement formularies. While health technology assessment is crucial for appropriate allocation of limited resources, efforts should also be made to reduce access barriers, particularly to positively recommended oncology drugs inclusion in provincial formularies.

Allocation Priority Determination System for Provincial Bridge Maintenance Fund in Special Region of Yogyakarta By Examining Physical Conditions, Operational Cost and Volume of Traffic

<p class="Abstract">The maintenance of bridges is relatively expensive. Those may lead the maintenance program into a classical problem which is limited of the fund. Therefore, the priority level of bridges maintenance is needed in order to attain an effective and efficient fund usage toward prevalent condition of every bridges in Special Region of Yogyakarta. The objective of this research was to provide the maintenance fund for provincial bridges in Special Region of Yogyakarta. The research covered 10 bridges in Special Region of Yogyakarta. The Assessments method for bridge physical condition was based on guide of Bridge Management System (BMS). As the bridge physical condition was known, the maintenance measure and its needed maintenance cost can be determined. The allocation of fund for each bridge was calculated based on Dynamic Programming Method. The result can be draw that by 5 million rupiah the maintenance fund for each of those 10 bridge of Yogyakarta Special Region is 5 million rupiah for Demak Ijo Bridge, 13 million rupiah for Bedingin Bridge, 10 million rupiah for Denggung Bridge, 5 million rupiah for Ngentak Bridge, 5 million rupiah for Karang Semut Bridge, 8 million rupiah for 2rd Kronggahan Bridge, 7 million rupiah for Besi Bridge, 8 million rupiah for Cebongan Bridge, 2 million rupiah for Kembang Songo Bridge, 2 million rupiah for 1st Kronggahan Bridge. Those allocation system provide 78,7% an average percentage on provincial bridges in Special Region of Yogyakarta. </p>

Do Subnational Governments Fund Organizations in Neoliberal Times? The Role of Critical Events in Provincial Funding of Women’s Organizations

Countries around the world have adopted neoliberal or austerity policies. Among states that fund organizations, this may have a detrimental effect on civil society. Looking at the Canadian context, this article examines whether subnational governments, provinces, step in during times of national budget cuts and changing political environments to fund organizations. We do this by analyzing the effect of critical events, regime changes, and the founding of key organizations on state funding in the province of Nova Scotia between 1960 and 2014. We do this to examine how the interaction of national and subnational political context shapes subnational funding of organizations. We find that critical events appear to be linked to increases in provincial funding, however, do not appear to be linked to cuts in funding. Regime changes and founding of key organizations have less clear-cut relationships with provincial funding.

Early Successes in an Open Access, Provincially Funded Hepatitis C Treatment Program in Prince Edward Island

IntroductionThe availability of curative hepatitis C therapies has created an opportunity to improve treatment delivery and access. Local providers, government, industry, and community groups in Prince Edward Island developed an innovative province-wide care model. Our goal was to describe the first year of program implementation. Material and methodsUsing a community-based prospective observational study design, all chronic hepatitis C referrals received from April 2015 to April 2016 were recorded in a database. Primary analysis assessed the time from referral to assessment/treatment, as well as the number of referrals, assessments, and treatment initiations. Secondary objectives included: 1) treatment effectiveness using intention-to-treat analysis; and 2) patient treatment experience assessed using demographics, adverse events, and medication adherence. ResultsDuring the study period 242 referrals were received, 123 patients were seen for intake assessments, and 93 initiated direct-acting antiviral therapy based on medical need. This is compared to 4 treatment initiations in the previous 2 years. The median time from assessment to treatment initiation was 3 weeks. Eighty-two of 84 (97.6%, 95% CI 91.7 - 99.7%) patients for whom outcome data were available achieved sustained virologic response at 12 weeks post-treatment; 1 was lost to follow-up and 1 died from an unrelated event. In the voluntary registry, 39.7% of patients reported missed treatment doses. ConclusionIn conclusion, results from the first 12 months of this multi-phase hepatitis C elimination strategy demonstrate improved access to treatment, and high rates of safe engagement and cure for patients living with chronic hepatitis C genotype 1 infections.

Ontario’s Clean Water Act and Capacity Building: Implications for Serviced Rural Municipalities

This research explores Ontario’s Clean Water Act (S.O. 2006, c. 22) and its contribution to capacity building for rural municipalities impacted by source protection plans created under the Act. Source water protection (SWP) under the Clean Water Act (S.O. 2006, c. 22) is explored drawing from a capacity framework. A nested case study approach has been employed to allow for in depth exploration of the experience within the Cataraqui Source Protection Area and the North Bay-Mattawa Source Protection Area, where key informant interviews were conducted. Findings are outlined looking at four elements of capacity for SWP: institutional, financial, social, and technical/human. It was found that the process was successful for building capacity in the serviced rural municipalities involved, but did not provide any meaningful protection for areas reliant on private drinking water systems such as wells. Several improvements to the legislated process were suggested including greater flexibility for local circumstance and better methods for engagement of First Nations and the general public. It is unknown if this capacity will be sustained as the program continues and provincial funding is reduced. Reduced funding will particularly impact rural communities that lack the internal human and financial capacity to implement SWP policies without the assistance of provincial funding and conservation authority staff (who also rely on provincial/municipal funding sources). Ultimately, it was found that SWP in rural areas requires enforceable mandatory legislation; sustainable provincial funding and municipal fiscal frameworks to support ongoing SWP planning and implementation; technical aid at the regional level; and support and commitment to SWP at the local level (e.g., municipalities, local health units, landowners, residents and watershed users).

Interventional Radiology in China: Current Status and Future Prospects.

Interventional Radiology in China: Current Status and Future Prospects.

Analysis on the performance evaluation of the Global Fund Malaria Programme in China from 2003 to 2013

Objective: To analyze the performance of the 5 Global Fund Malaria Programmes in China from 2003 to 2013. Methods: All of the proposals, summaries, progress reports, survey reports, Monitoring& Evaluation reports, and performance rating reports of the 5 Global Fund Malaria Programmes in China and the epidemic data of program areas were collected for statistical analysis from 2012 to 2014. Symposiums were held with relevant experts from national and provincial Centers for Disease Control and Prevention, program managers and staffs from national and provincial Global Fund Malaria Programme offices. The completion of the relevant programme indicators (including the general grant information such as program areas, beneficiaries and funding; the implementation of malaria control measures; the performance of malaria control measures; the malaria incidence in the program areas; the prevalence of malaria parasites; and program management and performance evaluation) were analyzed, and the results: of the symposiums were summarized. Results The implementation period of the 5 Global Fund Malaria Programs were as follows: Round 1 from 2003 to 2008, Round 5 from 2006 to 2010, Round 6 from 2007 to 2012, Round 10 from 2012 to 2013, and National Strategy Application (NSA) from 2010 to 2012. Under the support of all the Global Fund Malaria Programs, a total of 11 936 726 fever cases received microscopic tests, 1 485 915 confirmed and suspected malaria cases were treated, 1 579 773 Long Lasting Insecticide-treated Nets were distributed, 3 414 633 regular nets were treated by insecticide, 40 298 284 primary and middle school students received health education on malaria control. Compared with the baseline value, the completion rates of each indicator increased after the implementation of the programs. The growth value ranged from 12.83% to 83.11%, among which the biggest growth was the value of the indicator'Percentage of households with at least one LLIN/ITN in target areas', and it increased from 9.2% (baseline value of 2006) to 92.31% (value of 2012). The malaria incidence in program areas has dropped significantly year by year, the annual reported malaria incidence in Yunnan and Hainan provinces decreased from 1 950/100 000, 3 850/100 000 in 2002 to 3.31/100 000, 0.15/100 000 in 2012, the P. falciparum malaria incidence in target counties in Hainan province decreased from 90.6/100 000 in 2002 to 0/100 000 in 2012. As from the implementation of NSA grant in 2010 to 2012, the annual reported malaria incidence in 92% of the 75 Type 1 counties was less than 1 per 10 000, 60.00% of Type 1 counties and 98.69% of the 687 Type 2 counties reported zero locally transmitted malaria cases. The Global Fund Secretariat had conducted a total of 37 performance evaluations, of which 9 have been rated as A1, 4 rated as A2, 19 rated as B1 and 5 rated as B1. Conclusions: The Global Fund Malaria Program in China has been closely integrated with the goal and task of National Malaria Control Program, reducing malaria burden in target areas, and pushing Chinese malaria control efforts to move from control to elimination.

New and Improved: How Institutional Investment in Public Infrastructure can Benefit Taxpayers and Consumers

Canadian governments are on the verge of the largest infrastructure spending increases in decades. The challenge for policymakers at all levels of governments is to decide whether they should seek more private funding. Canadian institutional investors – notably the seven largest Canadian public pension plans as well as global investors – are looking to participate in new user-fee-supported infrastructure: both in existing assets and in new projects. To provide Canadian retirees with the best possible returns, Canada’s largest pension plans have invested $87 billion of their $1 trillion-plus in assets in infrastructure, but mostly abroad. Meanwhile, Canadian and foreign institutional investors such as pension funds and insurance companies would likely place a high value on Canadian user-fee financed infrastructure, but Canadian governments have opened few opportunities for such investment. Indeed, this Commentary argues that government ownership of infrastructure has led to inefficient management, poor project selection, and higher risks on taxpayers disguised by low government borrowing costs. To provide opportunities for investors to meet beneficiaries’ needs through financing infrastructure, Canadian governments should create policies that support institutional investment in both existing assets and for new infrastructure. Existing government-owned, user-fee-financed assets offer the greatest potential for government revenue from asset sales, including partial sales in which governments retain economic control. Governments could use the proceeds from such institutional investment to fund new infrastructure – particularly social-service infrastructure like schools and hospitals and other non-fully-self-financing infrastructure – alongside institutional investors. Taxpayers would benefit from better use of existing assets, as would users of more efficient infrastructure. The federal government recently announced plans to create an infrastructure bank that it would initially bankroll, but with a mandate to foster institutional investment capital for new public infrastructure. It is critical that Ottawa get right the design details of such a bank as well as other related institutions. There are differences between private investment in new versus existing infrastructure. But many policy issues are the same. In addition to an infrastructure bank, Canadian governments should take the following steps to encourage more institutional infrastructure investment: • where necessary, create independent regulatory bodies to oversee infrastructure assets that ensure their owners, either government-owned corporations or institutional investors, act in the public interest ahead of private profit and for long-term sustainability; • open infrastructure investment opportunities to the highest bidder among domestic or foreign investors and do not require any provincial or federal pension funds to invest. This requires the federal government to have expertise it can lend to smaller communities on business cases for institutional investors; • seek out opportunities to “recycle” user-fee financed assets at their maximum value to taxpayers or allocate contracts to operate new non-full-user fee assets that provide the highest savings or cost-avoidance; and • provide financial encouragement to provincial and municipal governments to work with the federal infrastructure bank since they own the vast majority of existing and potential user-fee financed infrastructure of interest to institutional investors.