Package Of Services Research Articles

Customer Preference Shift: A Laundry Shop Experience

This study was an attempt to investigate the dynamics of a phenomenon that happened in a self-service laundry shop. In the beginning, very few customers would patronize it. But little by little more customers began to frequent the shop and most of these were from the locality. The preference shift of customers was interesting. This situation was believed to reveal some findings that could be used in similar businesses. Qualitative was the method and specifically a case study. It made use of observations and informal interviews of two laundry attendants who have been in at least two years in the laundry shop, one maintenance personnel who has been present since the start of the establishment, and over five hundred regular customers. The observations and interviews revolve around the areas of concern at the start of the laundry shop, key characteristics of regular customers, reasons why customers made the preference shift from going with what they used to do towards availing the new service package, and the challenges encountered in the process of service delivery. Conclusions on the four areas of inquiry were; service value realization was slow and this influenced the initiatives that were made; customer satisfaction was dependent on price, service quality, and rapport and subsequently led to referrals; customers realized that it is more convenient to avail of the new service package, and competition served as a reason to improve service delivery; and sustained customer loyalty and organizational citizenship provide an environment for growth.

Costs and resource needs for primary health care in Ethiopia: evidence to inform planning and budgeting for universal health coverage.

The Government of Ethiopia (GoE) has made significant progress in expanding access to primary health care (PHC) over the past 15 years. However, achieving national PHC targets for universal health coverage will require a significant increase in PHC financing. The purpose of this study was to generate cost evidence and provide recommendations to improve PHC efficiency. We used the open access Primary Health Care Costing, Analysis, and Planning (PHC-CAP) Tool to estimate actual and normative recurrent PHC costs in nine Ethiopian regions. The findings on actual costs were based on primary data collected in 2018/19 from a sample of 20 health posts, 25 health centers, and eight primary hospitals. Three different extrapolation methods were used to estimate actual costs in the nine sampled regions. Normative costs were calculated based on standard treatment protocols (STPs), the population in need of the PHC services included in the Essential Health Services Package (EHSP) as per the targets outlined in the Health Sector Transformation Plan II (HSTP II), and the associated costs. PHC resource gaps were estimated by comparing actual cost estimates to normative costs. On average, the total cost of PHC in the sampled facilities was US$ 11,532 (range: US$ 934-40,746) in health posts, US$ 254,340 (range: US$ 68,860-832,647) in health centers, and US$ 634,354 (range: US$ 505,208-970,720) in primary hospitals. The average actual PHC cost per capita in the nine sampled regions was US$ 4.7, US$ 15.0, or US$ 20.2 depending on the estimation method used. When compared to the normative cost of US$ 38.5 per capita, all these estimates of actual PHC expenditures were significantly lower, indicating a shortfall in the funding required to deliver an expanded package of high-quality services to a larger population in line with GoE targets. The study findings underscore the need for increased mobilization of PHC resources and identify opportunities to improve the efficiency of PHC services to meet the GoE's PHC targets. The data from this study can be a critical input for ongoing PHC financing reforms undertaken by the GoE including transitioning woreda-level planning from input-based to program-based budgeting, revising community-based health insurance (CBHI) packages, reviewing exempted services, and implementing strategic purchasing approaches such as capitation and performance-based financing.

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria.

The availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states. We collected primary data from 50 health facilities (25 per state), including PHC facilities-health posts, health clinics, health centers-and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider's perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state. We found that average actual PHC costs per capita at PHC facilities-where most PHC services should be provided according to government guidelines-ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals-where approximately a third of PHC services are delivered in both states-the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano. Bridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.

A Kano model-based demand analysis and perceived barriers of pulmonary rehabilitation interventions for patients with chronic obstructive pulmonary disease in China.

Pulmonary rehabilitation (PR) has been recognized to be an effective therapy for chronic obstructive pulmonary disease (COPD). However, in China, the application of PR interventions is still less promoted. Therefore, this cross-sectional study aimed to understand COPD patients' intention to receive PR, capture the potential personal, social and environmental barriers preventing their willingness of receiving PR, and eventually identify demanding PR services with the highest priority from patients' point of view. In total 237 COPD patients were recruited from 8 health care facilities in Zhejiang, China. A self-designed questionnaire was applied to investigate patients' intention to participate in PR and potentially associated factors, including personal dimension such as personal awareness, demographic factors, COPD status and health-related literacy/behaviors, as well as social policies and perceived environmental barriers. The demand questionnaire of PR interventions based on the Kano model was further adopted. Among the 237 COPD patients, 75.1% of COPD patients were willing to participate in PR interventions, while only 62.9% of the investigated patients had heard of PR interventions. Over 90% of patients believed that the cost of PR services and the ratio of medical insurance reimbursement were potential obstacles hindering them from accepting PR services. The multiple linear regression analysis indicated that the PR skills of medical staff, knowledge promotion and public education levels of PR in the community, patients' transportation concerns and degree of support from family and friends were significantly associated with willingness of participation in PR interventions. By using the Kano model, the top 9 most-requisite PR services (i.e., one-dimensional qualities) were identified from patients' point of view, which are mainly diet guidance, education interventions, psychological interventions and lower limb exercise interventions. Subgroup analysis also revealed that patients' demographics, such as breathlessness level, age, education and income levels, could influence their choice of priorities for PR services, especially services related to exercise interventions, respiratory muscle training, oxygen therapy and expectoration. This study suggested that PR-related knowledge education among patients and their family, as well as providing basic package of PR services with the most-requisite PR items to COPD patients, were considerable approaches to promote PR attendance in the future.

Expectations of clients, insurers, and providers: a qualitative responsiveness assessment among private health insurance sector in Kampala-Uganda

BackgroundThere is less attention to assessing how health services meet the expectations of private health insurance (PHI) actors, clients, insurers, and providers in developing countries. Interdependently, the expectations of each actor are stipulated during contract negotiations (duties, obligations, and privileges) in a PHI arrangement. Complementary service roles performed by each actor significantly contribute to achieving their expectations. This study assessed the role of PHI in meeting the expectations of clients, insurers, and providers in Kampala. Lessons from this study may inform possible reviews and improvements in Uganda’s proposed National Health Insurance Scheme (NHIS) to ensure NHIS service responsiveness.MethodsThis study employed a qualitative case-study design. Eight (8) focus group discussions (FGDs) with insured clients and nine (9) key informant interviews (KIIs) with insurer and provider liaison officers between October 2020 and February 2021 were conducted. Participants were purposively selected from eligible institutions. Thematic analysis was employed, and findings were presented using themes with corresponding anonymized narratives and quotes.ResultsClient-Provider, Client-Insurer, and Provider-Insurer expectations were generally not met. Client-provider expectations: Although most facilities were clean with a conducive care environment, clients experienced low service care responsiveness characterized by long waiting times. Both clients and providers received inadequate feedback about services they received and delivered respectively, in addition to prompt care being received by a few clients. For client-insurer expectations, under unclear service packages, clients received low-quality medicines. Lastly, for provider-insurer expectations, delayed payments, selective periodic assessments, and inadequate orientation of clients on insurance plans were most reported. Weak coordination between the client-provider and insurer did not support delivery processes for responsive service.ConclusionHealth care service responsiveness was generally low. There is a need to commit resources to support the setting up of clearer service package orientation programs, and efficient monitoring and feedback platforms. Uganda’s proposed National Health Insurance Act may use these findings to: Inform its design initiatives focusing on operating under realistic expectations, investment in quality improvement systems and coordination, and efficient and accountable client care relationships.

A regulatory gap analysis of midwifery to deliver essential reproductive, maternal, newborn, child and adolescent health services in Lao People’s Democratic Republic

In Lao Peoples Democratic Republic, midwives are the main providers of primary reproductive, maternal, newborn, child and adolescent (RMNCAH) services. We analyzed to what extent practice regulations allow midwives to provide nationally defined essential RMNCAH services. Stakeholder consultations and document reviews were conducted to identify the essential RMNCAH interventions and care tasks midwives are expected to provide without physicians. These were defined in: 1) the Essential Health Service Package (EHSP) and 2) 18 national standards and guidelines. We then mapped whether midwifery regulations, which provide the legal framework for clinical service provision, supported delivery of these standards to identify regulatory gaps. Data were used to update regulations. Midwives were expected to provide 39 RMNCAH interventions without physicians, representing 1100 care tasks. Midwifery practice regulations allowed eight of 39 interventions (20.5%) and 705 of 1100 care tasks (64.1%) at baseline. Of the 31 interventions not allowed for provision by midwives, 83.9% (26) required prescribing and giving medicines, 51.6% (16) ordering and conducting diagnostics, 38.7% (12) making a clinical diagnosis, and 22.6% (7) use of non-pharmacological interventions. The Ministry of Health convened a multi-stakeholder group to revise the midwifery practice regulations, which increased the legally supported interventions and care tasks to 37 (94.9%) and 1081 (98.3%), respectively. This novel methodology enabled systematic identification and quantification of regulatory gaps in midwifery practice and data-driven revisions. Consequently, regulatory support for delivery of primary RMNCAH interventions vastly improved. The approach can be applied to other clinical cadres, service areas and countries. Korea Foundation for International Health Care (KOFIH) supported research operation.

A gap analysis of midwifery competency, pre- and in-service education for reproductive, maternal, newborn, child and, adolescent health in Lao People's Democratic Republic

Ensuring midwives deliver quality essential services requires systematic and timely updates to midwifery education based on constantly evolving global evidence and local needs. However, midwifery curricula are often not updated to incorporate new evidence, consistent with national standards. This study supported the Ministry of Health of Lao People's Democratic Republic to identify gaps in the midwifery competency framework and training packages. Stakeholder consultations and a document review were conducted to define a core package of RMNCAH interventions and care tasks that midwives should provide based on the national Essential Health Service Package (EHSP). Nationally defined midwifery competencies, the higher diploma midwifery curriculum, and in-service training packages were mapped against required interventions and care tasks. Data were used to revise midwifery education standards. Midwives were expected to provide 47 RMNCAH interventions based on the EHSP. At baseline, 7 (14.9%), 11 (23.4%) and 35 (74.5%) of the 47 interventions were included in the midwifery competency, higher diploma in midwifery curriculum, and in-service training materials, respectively. After revision, the midwifery competency framework included 42 of 47 interventions (89.4%). The data are currently being used to review and update the national midwifery pre-service diploma curriculum. This analysis enabled the Ministry to identify RMNCAH content gaps in national midwifery education standards and align them with the EHSP. Regular use of a quantitative approach to review educational content is essential to ensure standards are consistent with changing evidence. The approach has potential application to other service areas, cadres, and countries. Korea Foundation for International Healthcare (KOFIH) supported research operation.

Multifunctional barrier coating systems created by multilayer curtain coating

Functional coatings are applied to paper and paperboard substrates to provide resistance, or a barrier, against media such as oil and grease, water, water vapor, and oxygen, for applications such as food packaging, food service, and other non-food packaging. Today, there is increasing interest in developing recyclable and more sustainable approaches for producing these types of packages. This paper focuses on water-based barrier coatings (WBBC) for oil and grease resistance (OGR), water, moisture vapor transmission rate (MVTR), and oxygen barrier performance. The main goal is to create coated systems that can achieve more than one barrier property using multilayer curtain coating (MLCC) in a single application step. One advantage is in optimizing coating material cost with the use of functional chemistry in confined layers where performance is balanced within the coating layered structure. This allows simultaneous application of layers of different polymer types in one step to achieve the appropriate performance needs for a given barrier application. This paper provides working examples of using MLCC to create coating structures with multiple barrier properties in a single application pass. Barrier polymers studied include styrene butadiene, styrene acrylate, starch-containing emulsions, and polyvinyl alcohol. The paper also shows the effect of increasing the pigment volume concentration with platy clay or fine ground calcium carbonate on MVTR and OGR barrier properties.

The Effect of the New Service Package of Integrated Healthy Child Care on the Health Indicators of Children in Tuiserkan City

The Effect of the New Service Package of Integrated Healthy Child Care on the Health Indicators of Children in Tuiserkan City

Revision of Malawi’s Health Benefits Package: A Critical Analysis of Policy Formulation and Implementation

ObjectivesHealth benefits packages (HBPs), which define specific health services that can be offered for free or at a reduced cost to fit within public revenues, have been recommended for over 30 years to maximize population health in resource-limited settings. However, there remain gaps in defining and operationalizing HBPs. We propose a combination of design and prioritization methods along with practical strategies to improve the implementation of future iterations of the HBP in Malawi. MethodsFor HBP development for Malawi’s Third Health Sector Strategic Plan, we combined cost-effectiveness analysis with a quantitative, consultative multicriteria decision analysis. Throughout the process of development, we documented challenges and opportunities to improve HBP design and application. ResultsThe primary and secondary HBP included 115 interventions. However, the definition of an HBP is just one step toward focusing limited resources, with functional operationalization as the most critical component. Full implementation of previous HBPs has been limited by challenges in aid coordination with the misalignment of nonfungible vertical donor funding for the HBP without accounting for the complexity and interconnectedness of the health system. Opportunities for improved application include creation of a complementary minimum health service package to guide overall resource inputs through an integrative approach. ConclusionsWe believe that expanded participatory HBP methods that consider value, equity, and social considerations, along with a shift to providing integrated health service packages at all levels of care, will improve the efficiency of using scarce resources along the journey to universal health coverage.

Optimizing New Power Switch Technology

Power switches are critical components in power conversion for a wide variety of applications, including DC-AC inverters for electric vehicles (EVs), solid state breakers, and energy storage devices. Improving the efficiency and performance of semiconductor power switch components can have wide benefits, improving the efficiency and accelerating deployment of these applications. Compared to conventional power switches, such as insulated-gate bipolar transistors (IGBTs), the B-TRAN™ bidirectional power switch from Ideal Power offers significant improvements in efficiency, reducing power losses by 50% or more depending on the application. With its higher efficiency, B-TRAN results in less heat being generated and thus has significantly lower thermal management requirements. In addition, a single B-TRAN™ replaces multiple conventional power switches for bidirectional applications. Beginning in mid-2020, Ideal Power teamed with QP Technologies, a leading provider of microelectronic packaging and assembly services, to package their B-TRAN switches in various TO packages (a wide range of small-pin-count packages often used for discrete parts such as transistors or diodes). The development work started with TO-247, then moved TO-264 packages, and finally transitioned to a custom direct-bond copper (DBC) solution. To achieve a high-reliability design, QP Technologies and Ideal Power focused on developing die and packaging designs based on flip-chip technology in lieu of wirebonding to maximize the life cycle of the product. This paper investigates the challenges, solutions and finally the fabrication of the first double-sided B-TRAN device.

Analyzing AI-Generated Packaging's Impact on Consumer Satisfaction With Three Types of Datasets

The study quantitatively examines how AI-generated cosmetic packaging design impact consumer satisfaction, offering strategies for database-driven development and design based on this evaluation. A comprehensive evaluation system consisting of 18 indicators in five dimensions was constructed by combining literature review and user interviews with expert opinions. On this basis, a questionnaire survey on AI-generated packaging design was conducted based on three types of datasets. In addition, importance-performance analysis was used to analyze the satisfaction of AI-generated packaging design indicators. The study found that while consumers are highly satisfied with the information transmission and creative attraction of AI-generated packaging design, the design's functional availability and user experience still have to be improved. It is suggested that the public model be combined into the data warehouse to build an AI packaging service platform. Focusing on the interpretability and controllability of the design process will also help increase consumer satisfaction and trust.

Costing Interventions for Developing an Essential Package of Health Services: Application of a Rapid Method and Results From Pakistan.

The Federal Ministry of National Health Services, Regulations and Coordination (MNHSR&C) in Pakistan has committed to progress towards universal health coverage (UHC) by 2030 by providing an Essential Package of Health Services (EPHS). Starting in 2019, the Disease Control Priorities 3rd edition (DCP3) evidence framework was used to guide the development of Pakistan's EPHS. In this paper, we describe the methods and results of a rapid costing approach used to inform the EPHS design process. A total of 167 unit costs were calculated through a context-specific, normative, ingredients-based, and bottom-up economic costing approach. Costs were constructed by determining resource use from descriptions provided by MNHSR&C and validated by technical experts. Price data from publicly available sources were used. Deterministic univariate sensitivity analyses were carried out. Unit costs ranged from 2019 US$ 0.27 to 2019 US$ 1478. Interventions in the cancer package of services had the highest average cost (2019 US$ 837) while interventions in the environmental package of services had the lowest (2019 US$ 0.68). Cost drivers varied by platform; the two largest drivers were drug regimens and surgery-related costs. Sensitivity analyses suggest our results are not sensitive to changes in staff salary but are sensitive to changes in medicine pricing. We estimated a large number of context-specific unit costs, over a six-month period, demonstrating a rapid costing method suitable for EPHS design.

Improving access and quality of maternal and newborn care through the newly established Ayaan Specialist Hospital in Bosaso City, Puntland State of Somalia

Somalia has one of the highest maternal mortality ratios globally, constituting an important public health issue for the country. The availability of free and quality obstetric and newborn care services is critical for reducing maternal and newborn deaths. The Ayaan Foundation for humanitarian assistance has established a specialized hospital in Bosaso, Puntland, Somalia and created a cost-free service for normal deliveries and caesarean sections with assistance from the UN Population Fund. The Ayaan Specialist Hospital aims to provide better health and free basic and emergency obstetric and neonatal services to reduce maternal and neonatal morbidity and mortality. The hospital has high standard facilities, equipment, and supplies and is run by a highly specialized medical team implementing advanced quality services and supported by well-trained midwives and nurses that are available around the clock. The hospital has a clinical diagnostic laboratory, medical imaging facilities and provides quality drugs. Services were initially paid out-of-pocket, which was a problem for low-income clients. Pregnant women now have access to a comprehensive package of services at the hospital regardless of their socioeconomic status. During the initial period of January 2020 to June 2021, only 223 pregnant women attended the hospital; however upon easing the requirement for payment between July 2021 and June 2022, a total of 1,213 women of childbearing age attended the hospital. Among the full-term mothers, 218 had a normal vaginal delivery (36%), while 386 (63%) underwent caesarean section. The majority (84%) of these were treated as situations of emergencies. This approach has successfully increased facility-based births among poor women in the city and its surrounding rural districts. The initiative to establish the hospital was taken in view of the need to promote a free maternal health care policy to effectively realize universal access to and the full utilization of facility-based delivery across the country.

Hidden realities: Food waste from servings in mini size packaging

This paper provides data obtained from real-life measurement of the Food Waste (FW) associated with the services offering food in mini size (9–20 g) single-use packaging representing the impact of the difficulties in emptying the food from such packages and service characteristics. We collected discarded such food packages from commercial public eateries (a time-share thermal town, student canteen, and student refectory), quantified FW, and subjected data to statistical analysis regarding the eatery places, package characteristics, and food type. The results suggest that service style, packaging, and consumer wastefulness can cause 10–47 %, 3–11 %, and 5–37 % FW, respectively, indicating hidden part of the wastage iceberg from mini size food portions with vast implication on the food and relevant packaging sustainability. Regarding the packing, the dominant cause of FW is difficulties in emptying the food, such as the shape, size, depth, width, and material of the package. Concerning the consumer wastefulness, our measurements seem to imply that the groups with relatively higher affluency creates more FW. Our results will prove to be highly beneficial in both promoting efforts to raise awareness of not only consumers but also industry players and decision makers on the sustainability for food and relevant packaging material.

Water, sanitation and hygiene (WASH) practices and deworming improve nutritional status and anemia of unmarried adolescent girls in rural Bangladesh

BackgroundIn Bangladesh, undernutrition and anemia are more occurrent among adolescent girls. BRAC, the largest non-governmental organization (NGO), has been implementing a community-based nutrition education service package targeting adolescent girls for reducing their undernutrition and anemia.ObjectiveWe aimed to explore the underlying factors associated with nutritional status and anemia among adolescent girls under the BRAC nutrition program areas to improve their existing intervention package.MethodologyWe conducted a cross-sectional and comparative study in 2016, in 24 upazilas of Bogra, Barguna, Comilla, Dinajpur, Feni, Jessore, and Meherpur districts where the BRAC nutrition program was implemented while the remaining 27 upazilas of those districts were selected as comparison area. We followed a multistage cluster random sampling for selecting 1620 unmarried adolescent girls aged 10–19 years for interviewing in the intervention and comparison areas. Data were collected on socio-demographic information, dietary intake, morbidity, water, sanitation, and hygiene (WASH) practice, anthropometry, and serum hemoglobin (Hb) level by using a pre-structured questionnaire. The nutritional status of the adolescent girls was expressed as height-for-age Z (HAZ) and body mass index-for-age Z (BMIZ) score, while anemia referred to the serum Hb at the level of below 12 g/dl for adolescent girls. All statistical analyses were done in STATA version 17 (Chicago Inc.).FindingsThe prevalence of stunting (22.9% vs. 22.5%), thinness (12% vs. 14%), and anemia (34.5% vs. 37.3%) exhibited similarities between the intervention and comparison regions. Stunting and thinness were predictors for each other for this population group. Our findings indicated that adolescent girls who were not washing hands with soap after defecation were likely to be stunted [AOR 1.51 (95% CI 1.12–2.04)], and who did not utilize sanitary latrines had an increased likelihood of being thin [AOR 2.38 (95% CI 1.11–5.08)]. Conversely, those who did not watch television [AOR 1.69 (95% CI 1.12–2.56)] and did not have deworming tablets [AOR 1.33 (95% CI 1.07–1.64)] in the 6 months leading up to the interview had a 69% and 33% higher probability of being anemic, respectively.ConclusionFor sustainable improvement in the undernutrition and anemia of adolescent girls, integration of WASH, consistent administration of deworming tablets and broadcasting awareness programs through television are urgent to scale up the nutrition intervention programs in similar settings like Bangladesh.

Analysis of Hospital and INA-CBG’S Rates of JKN Outpatient in Genteng Regional Public Hospital in 2021

The Government's effort improves the health status of the Indonesian people by establishing a Jaminan Kesehatan Nasional (JKN). JKN’s program was formed by Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan). Payment of health costs by BPJS uses the Indonesian-Case Based Group (INA-CBG's) especially for advanced health care services. INA-CBG's is payment to the main health center for a predetermined service package according to the disease diagnosis category. This makes hospitals strive to continue providing quality health services to JKN patients while still controlling costs. The aim of this research is analyze the difference between the outpatient BPJS patient rates and INA-CBG's rates at the Genteng Regional General Hospital in 2021. The research method is a retrospective observational study with simple random sampling. The total sample was 400 obtained during the period January to December 2021. The results of the research showed that the hospital rates was IDR 105,995,056 and the INA-CBG's rates was IDR 89,484,300. It was known that there were three largest cost components including drugs (drugs and chronic drugs) was IDR 51,878,574 (48.70%); patient care costs was IDR 33,980,600 (24.65%); and consultation fee was IDR. 10,400,000 (9.40%). The three largest components of hospital rates included minor chronic disease procedures and dialysis procedures. The conclusion was hospital rates are greater than INA-CBG's rates.

Revising the essential package of health services through stakeholder alignment, Somalia.

The fragmented health sector in Somalia, burdened by financial challenges and an inadequate regulatory system, struggles to provide equitable essential health services to the entire population. To revise an essential package of health services that stakeholders could support and that aligned with stakeholders' financial and technical resources, the federal health ministry invited all key stakeholders in 2020 to participate in the revision process of the essential package. The ministry distributed a concept note to invited stakeholders, describing the scope and purpose of the revision process of the essential package. The note also contained a timeline and the expected contribution of each stakeholder. Stakeholders nominated representatives based on their technical expertise and knowledge of the health sector in Somalia. The health sector in Somalia involves multiple stakeholders, including the health ministry and many development partners. The private sector plays a substantial role in health-care provision. Public spending is an estimated 17% of the total health expenditure. After an 18-month revision process, the health ministry and development partners agreed to prioritize high-impact, cost-effective services and use a progressive realization of the package to improve access and coverage. The implementation strategy considers the health system and operational capacity of service providers, particularly in security-compromised areas. The approach showed that inclusivity, collaboration and transparency were of importance for a successful revision of the package. These achievements in consensus-building and priority alignment advance the government's pursuit of equitable and comprehensive health care for all.

Evolution of Requirements for Library Interior Design in the Context of Digitalisation, Reflecting Public Opinion

The purpose of the article is to determine the evolution of requirements for library interior design under the influence of digitalisation, taking into account the public’s attitude to the role and functions of libraries in the modern world. The research methods are based on a systematic approach to analysing the impact of innovative services on library interior design and public opinion about the role and status of libraries in the information society. It is shown that positive attitudes towards libraries are influenced by the quality of service and the relevance of the information services package, which, in turn, are associated with the functionality of the workspace planning and the library interior design. The survey revealed the public’s requirements for library interior design. The trends in the evolution of library interior design are analysed, taking into account the impact of digitalisation of information services on its requirements. Scientific novelty. The article demonstrates the relationship between the relevance of the package of information library services, the functionality of interior design, and the public positive attitude towards visiting libraries. The evolution of requirements for library interior design is characterised by a list of requirements generated by innovative services and refined by the results of a sociological survey on public attitudes to the functions of modern libraries. Conclusions. The study identified possible trajectories of sustainable development of libraries in the context of digitalisation, when libraries lose their monopoly on access to knowledge. The features of implementing the concept of «well-being of presence» in the design of library interiors using multisensory interaction of light, heat, acoustic, and olfactory environments are considered. It is shown that the implementation of this concept in the practice of managing the functioning of a modern library is based on a combination of architectural and design solutions with distributed «cloud» means of monitoring and managing the «well-being of the presence environment».

Cost-effectiveness of dental caries prevention strategies in South African schools

BackgroundIn South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children.MethodsThe study uses a hypothetical South African population of school aged learners aged 5–15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective.ResultsThe results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively.ConclusionBased on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.