Service Budget Research Articles

Cumulative prospect theory under different types of input data for public health resilience assessment during natural disasters

Despite the significance of health and the threats natural disasters pose to public health and the well-being of the affected communities, comprehensive research that explores critical factors and indicators that measure health implications brought about by disasters is underdeveloped in the literature. The primary objective of this study is twofold: (1) to develop a list of indicators that assess health-related impacts during disasters through a literature survey, and (2) to create a “public health resilience index” that measures the resilience of affected communities with a case study in Southern Cebu, Philippines. A hybrid model based on the fuzzy stepwise weight assessment ratio analysis and the extended cumulative prospect theory was deployed to advance these objectives. The proposed model considers subjective judgment and cognitive biases while exhibiting high scalability and flexibility and accommodating diverse data input formats. Results revealed that the promptness of response, the allocated budget for humanitarian aid and services, the availability of drinking water per household, the number of personnel assigned for humanitarian aid, and the location of water distribution points are highly prioritized during natural disasters. On the other hand, among the 21 municipalities under consideration, 10 demonstrated strong performance, while the other 10 exhibited poor performance, leaving one municipality in the middle of both extremes. Sensitivity and comparative analyses show that the proposed hybrid model is not sensitive to model parameter changes. The findings of this study would aid decision-makers in developing initiatives aimed at optimizing resources and efforts, mitigating risks, and enhancing the overall health resilience of local communities in the onslaught of natural disasters.

Centralised Development and Inactive Business Sector: The Case of Nakhon Si Thammarat City Municipality

This article examines the relationship between the business sector and the policymaking of Nakhon Si Thammarat City Municipality in Southern Thailand. We find that business influence on local policy remains highly limited. We argue that this is primarily due to two factors: political and economic centralisation which limits the capacity of the municipal government, and the limited economic opportunities for medium and large businesses within the municipal borders. The result is that medium and large firms tend to focus their attention on and cultivate links with officials at the provincial and national level. At the same time, small businesses have expanded in the municipality. However, their inability to coordinate to make collective demands limits their influence on municipal policymaking. Instead, small entrepreneurs individually lobby the local government through the same channels as the general public, appealing for allocations from the government's limited community service budget.

Upaya Preventif: Edukasi dari Pemerintahan untuk Mencegah Gelandangan dan Pengemis

The government has an important role in carrying out preventive efforts to prevent homelessness and beggars, one of which is in the Yogyakarta area through the Social Service. This study uses a phenomenological method with a qualitative approach to explore phenomena related to the preventive efforts of DIY social services to prevent homelessness and beggars through counseling and education. The aim of this article is to provide an overview of the activities of the DIY Social Service in implementing education to prevent homelessness and beggars by examining three things, namely planning, implementation and obstacles in implementing counseling and education as a form of preventive effort. In planning, the social service makes a plan by first identifying its objectives, analyzing its targets, preparing materials, planning scheduling, preparing presenters to deliver outreach and public education. Counseling and education to the community is carried out by the DIY social service through various media such as print media, electronic media, and through cultural media. DIY social services face several obstacles, budget constraints and lack of human resources. However, the DIY social service has a solution to face these obstacles by inviting and collaborating with other institutions and community leaders to help spread outreach and education to the community.

Variability in public health programming and priorities to address health inequities across public health units in Ontario, Canada.

In 2018, Ontario Public Health Standards were updated to include the foundational Health Equity Standard to guide planning, implementation, and evaluation of public health programs and services. Public health units (PHUs), the regional public health bodies, are now required to address health equity through four requirements: (a) Assessing and Reporting; (b) Modifying and Orienting Public Health Interventions; (c) Engaging in Multi-sectoral Collaboration; and (d) Health Equity Analysis, Policy Development, and Advancing Healthy Public Policies. This qualitative descriptive study explored how the 27 participating PHUs (out of 34) serving urban (N = 10), mixed urban-rural (N = 15), and rural (N = 9) populations addressed the Health Equity Standard. Using document analysis, we inductively and deductively coded the content of 68 PHU Annual Service Plan and Budget Submissions from a 3-year period (2018-2020) received from the 27 PHUs. Emergent categories were organized into the four requirements and one additional emergent theme: Organizational Implementation of Health Equity. The approaches of embedding health equity into PHUs' activities varied across groups. Urban PHUs presented more diverse strategies, including working with a larger number of organizations, and participating in academic research projects. We found more process standardization and greater discussion of capacity building in urban and mixed urban-rural PHUs. Rural PHUs strategically addressed the needs of their diverse populations through relationship building with Indigenous communities. Findings suggest broad implementation of health equity approaches in public health independent of PHUs' geographic size and population dispersion, though strategies and key challenges differ across units.

농촌지역 기초자치단체의 자살분야 지역안전지수 향상 방안

This study aimed to examine the reality of local safety index with detailed result of analysis on the suicide sector which is shown as the most vulnerable indicator out of local safety index of Goesan-gun that is considered a representative local governments in rural area in Chungcheongbuk-do, and seek for solution to improve the foregoing. This study also intended to suggest a political measure to secure safety of the residents of Goesan-gun and improve the quality of life of local communities against suicide in the future by suggesting basic direction for spreading safety culture in local communities and promoting safety consciousness of local residents that need to be carried out for improvement of local safety index in suicide sector through the contents of research. Research result shows that it is necessary to revise the 「Ordinance on Prevention of Prevention of Suicide and Creation of Culture of Respect for Life」and expand support system for reducing suicide of the elderly to improve suicide sector local safety index and specific vulnerable indicators of Goesan-gun, Chungcheongbuk-do. As for specific measures, enhancement of economic support system such as expansion of support system for cashable welfare for the elderly and discover of subsidy support by Goesan-gun are also considered necessary. In addition, support system for independence of the elderly for supplementation of elderly employment and social activities must be enhanced by expanding resident participatory protection system for disadvantaged elderly and vulnerable social groups, and psychological support system for local residents shall also be reorganized by installing a suicide prevention as an affiliated institution. Additionally, the budget must be increased to the average level of local governments across the country by expanding social welfare and health service budget of Goesan-gun, and improvement of infrastructure and system for establishing a social safety net which is indispensible for preventing suicide of the elderly must also be carried out positively through the aforementioned.

An analysis of financial hardship faced by patients with First Episode Psychosis, and their families, in an Indian setting

BackgroundThe economic burden of psychotic disorders is not well documented in LMICs like India, due to several bottlenecks present in Indian healthcare system like lack of adequate resources, low budget for mental health services and inequity in accessibility of treatment. Hence, a large proportion of health expenditure is paid out of pocket by the households. ObjectiveTo evaluate the direct and indirect costs incurred by patients with First Episode Psychosis and their families in a North Indian setting. MethodDirect and Indirect costs were estimated for 87 patients diagnosed at AIIMS, New Delhi with first-episode psychosis (nonaffective) in the first- and sixth month following diagnosis, and the six months before diagnosis, using a bespoke questionnaire. Indirect costs were valued using the Human Capital Approach. ResultsMean total costs in month one were INR 7991 ($107.5). Indirect costs were 78.3% of this total. Productivity losses was a major component of the indirect cost. Transportation was a key component of direct costs. Costs fell substantially at six months (INR 2732, Indirect Costs 61%). Respondents incurred substantial costs pre-diagnosis, related to formal and informal care seeking and loss of income. ConclusionFamilies suffered substantial productivity loss. Care models and financial protection that address this could substantially reduce the financial burden of mental illness. Measures to address disruption to work and education during FEP are likely to have significant long-term benefits. Families also suffered prolonged income loss pre-diagnosis, highlighting the benefits of early and effective diagnosis.

Payment Innovation in Emergency Care: A Case for Global Clinician Budgets

The fee-for-service funding model for U.S. emergency department (ED) clinician groups is increasingly fragile. Traditional FFS payment systems offer no financial incentives to improve quality, address population health, or make value-based clinical decisions. FFS also does not support maintaining ED capacity to handle peak demand periods. In FFS, clinicians rely heavily on cross subsidization where high reimbursement from commercial payors offsets low reimbursement from government payors and the uninsured. While FFS survived decades of steady cuts in government reimbursement rates, it is increasingly strained due to visit volatility and the effects of the No Surprises Act, which is driving down commercial reimbursement. Financial pressures on ED clinician groups, combined with higher hospital boarding and clinical workloads are increasing workforce attrition. Here we propose an alternative model to address some of these fundamental issues: an all-payer-funded, voluntary global budget for ED clinician services. If designed and implemented effectively, the model could effectively support robust clinician staffing over the long-term, ensure stability in clinical workload, and potentially improve the equity in payments. The model could also be combined with population health programs (e.g., pre- and post-ED telehealth, frequent ED use programs, and other innovations) which offer significant payer returns and address both quality and value. A linked program could also change hospital incentives that contribute to boarding. Strategies exist to test and refine ED clinician global budgets through existing government programs in Maryland and potentially through state-level legislation, as a precursor to broader adoption.

Addressing health inequalities in times of austerity: implementation of a place-based approach in multitiered local government.

This article focuses on how local authorities in England are tackling wider determinants of health and inequalities in their population's outcomes while budgets for public services are diminishing. It reports the experience from one case study engaged in rolling out a devolved, place- and asset-based strategy over multiple tiers of local government. Relating these findings to relevant social theory, we draw out aspects of context and mechanisms of change. We offer plausible hypotheses for the experiences observed, which supports transferability and implementation of place-based strategies in other local authority areas struggling with similar challenges. Findings highlight the importance of high-level and political buy-in, as well as the role of the COVID-19 pandemic as a potential catalyst to rollout. Creating the foundations for a new, place-based working was important for achieving coherence among partners around what local government was trying to achieve. These included investment in infrastructure, both relational and tangible inputs such as organisational and human resources, to establish the conditions for systemic change towards early intervention and prevention. This study identified clear foundations for place-based action, plus enablers and barriers to significant transformation of practice towards asset-based approaches between local authorities, partners and the public.

Implementation of Minimum Antenatal Care Service Standards in North Lampung Regency

Maternal Mortality Rate (MMR) in North Lampung is high. Coverage of antenatal care visits in 2021 (88.7%) has yet to reach the target (100%), even though the number of midwives and integrated health post (Posyandu) services increases every year. The Minimum Service Standard report also indicates that the budget for maternal care services is around 17% of the total budget allocation. This study aims to provide an overview of implementing the 10 Antenatal Care (ANC) services in North Lampung. The research design employs a quantitative method with a documentation study using Maternal and Child Health (MCH) books and questionnaires to measure midwives' knowledge in North Lampung. The sample size was determined using the open-source calculator SSPropor (OpenEpi, version 3), resulting in 595 collected samples for this study. Data were analyzed using univariate and bivariate analyses. None (0%) of the pregnant women received all 10 ANC services. Almost all pregnant women (>90%) received blood pressure examinations, counseling, and referral services. Meanwhile, the ANC service received least frequently (<50%) was the provision of Iron and Folic Acid (IFA) tablets. There is a significant difference in the mean coverage based on the three clusters, and there is a weak relationship between Midwives' Knowledge and the implementation of 10 ANC services. Recommendations: There is a need for programs to comprehensively improve knowledge about ANC standards among health workers and volunteers. Discipline in recording needs to be enhanced. Further qualitative studies are needed to gain a broader perspective.

Significant healthcare resource utilisation in the management of skin and soft tissue infections in the Torres Strait, Australia.

Aboriginal and Torres Strait Islander Peoples (First Nations Australians) living in remote communities are hospitalised with skin and soft tissue infections (SSTIs) at three times the rate of non-First Nations Australians. The Torres Strait in tropical northern Australia has a highly dispersed population mainly comprising First Nations Australians. This study aimed to define the health service utilisation and health system costs associated with SSTIs in the Torres Strait and to improve the quality of regional healthcare delivery. The research team conducted a retrospective, de-identified audit of health records for a 2-year period, 2018-2019. The aim was to define health service utilisation, episodes of outpatient care, emergency department care, inpatient care and aeromedical retrieval services for SSTIs. Across 2018 - 2019, there were 3509 outpatient episodes of care for SSTIs as well as 507 emergency department visits and 100 hospitalisations. For individuals with an SSTI, the mean outpatient clinic episode cost $240; the mean emergency department episode cost $400.85, the mean inpatient episode cost $8403.05 while an aeromedical retrieval service cost $18,670. The total costs to the health system for all services accessed for SSTI management was $6,169,881 per year, 3% of the total annual health service budget. Healthcare costs associated with SSTIs in the Torres Strait are substantial. The implementation of effective preventative and primary care interventions may enable resources to be reallocated to address other health priorities in the Torres Strait.

THE BURGEONING BURDEN OF PERINATAL MENTAL HEALTH IN LOWER MIDDLE-INCOME COUNTRIES

THE BURGEONING BURDEN OF PERINATAL MENTAL HEALTH IN LOWER MIDDLE-INCOME COUNTRIES

A national mental health cascade training programme for practitioners supporting unaccompanied minors in Greece.

Practitioners who support unaccompanied minors (UAMs) come from different professional backgrounds and often are not appropriately trained to address children's complex mental health needs. This gap informed a training programme across all accommodation centres in Greece. The aim of the Train-of-Trainer (ToT) national programme was to upskill trainers from 17 organisations to cascade knowledge. Training was interprofessional, trauma-informed and culturally sensitive. A pilot implementation involved 199 practitioners from all disciplines. A sub-sample of 33 practitioners, nine managers and six trainers shared their experiences in focus group discussions, which were analysed through a thematic framework. Participants found that the programme was useful in generating knowledge relevant to children's needs and their roles, addressing the emotional impact of trauma on staff, sharing learning across professional disciplines and being interactive, but systemic support should be put in place for benefits to be sustained. Train-of-Trainer is a resource-effective approach to upskill mixed staff groups across many organisations. This should involve caregivers and staff with limited educational opportunities, while accommodating for different professional needs. Training should be integrated to service budgets, specifications and structures.

Measuring the digital behavior for health purposes of the Garifuna community in Atlántida, Honduras

Historically, the Garifuna community has been relegated to northern Honduras. The access indicators for the behavior in telecommunications services of this ethnic group are not known in depth. A sample has been chosen to study variables such as hours of use of computers and mobiles, the monthly budget for telecommunications services, and characterization of complementary final services, especially the behavior and digital knowledge from the intersection of technology together with an aspect of common knowledge among the Garifuna, which in this case is proposed to carry out the analysis to be able to encourage and promote health in terms of the prevention of sexually transmitted diseases (STD). Data were collected electronically using an instrument between January and May 2022. In the behavior and knowledge of digital technologies, basic statistics have been used to analyze quantitative data, but an unstructured text analysis algorithm has been used, together with graph theory, to find the relationships between the terms used by the participants. The result has been widespread access to telecommunications services, but there is also low knowledge of the basic concepts associated with these technologies. Keywords: Digital behavior; Garifuna; algorithm; ICT; mobile services

Empirical analysis of factors affecting industrial maintenance services selection

The process of selecting industrial maintenance services needs careful consideration of various factors to ensure that the chosen provider can effectively meet the specific needs of the organization/facility. This research paper examines the key factors that play a significant role in the decision-making process for selecting industrial maintenance services. These factors encompass the nature of services required, the expertise and experience of the service provider, cost and budget constraints, availability and responsiveness, establishment of service level agreements, evaluation of reputation and references, compliance with safety regulations, assessment of technological capabilities, flexibility and scalability of services, and sustainability practices. Through a thorough examination of these factors, industrial facilities can make well-informed decisions that align with their unique requirements and priorities.

Efficiency of Public Expenditure in Sumatera before Covid-19 Pandemic Era

This study will analyze the efficiency of local government expenditure towards the Human Development Index (HDI) indicators achievement. To see the realization, this study will conduct an efficiency analysis of local government expenditures in Indonesian’s 34 provinces at 2015-2018 periods. Furthermore, this study tries to find out which sectors are affect efficiency, and conducts a descriptive analysis of the effect of the covid 19 pandemic on these sectors. Based on the study result, it can be suggested to the local government as follows; Provinces that have reached maximum efficiency levels must be able to maintain government performance by maintaining a large portion of inputs, and continue to work to increase output. So that the level of community welfare can be maintained, or even increased in the following year. In general, its necessary to optimize in terms of the effectiveness of the budget for education, health and public services on the input side for all provinces. Meanwhile, from the output side, the target Life expectancy and Expected Years of Schooling need to be improved.

Pengaruh SiLPA terhadap Belanja Barang dan Jasa dan Efek Moderasi Financial Distress pada Pemerintah Daerah

Objectives: This study seeks to investigate the impact of SiLPA budget changes on adjustments in the goods and services budget, with financial distress serving as a moderator in Indonesian district/city governments. Design/method/approach: Employing a quantitative methodology, the sample comprises 42 district/city governments in Indonesia that encountered financial distress and underwent budget changes during the 2019 fiscal year. Hypothesis testing involved multiple linear regression models and Moderated Analysis Regression (MRA), utilizing historical documents data from the Regional Revenue and Expenditure Budget (RREB) -Year Change of 2019, and the Regional Government Financial Report (RGFR) from 2016 to 2018.Results/findings: The multiple linear regression model outcomes indicate that alterations in the SiLPA budget and financial distress collectively influence adjustments in the goods and services budget. Furthermore, MRA results demonstrate that financial distress moderates the impact of SiLPA budget changes on adjustments in the goods and services budget. Theoretical contribution: The application of punctuated equilibrium theory (PET) is proposed as a valuable reference in comprehending regional budget changes. Practical contribution: The study employs a relatively small sample size, as the data is sourced from the 2019 LKPD, considering regional governments with a deficit in the LO for three consecutive years. Additionally, limited secondary data spans only one budget year, and the regression model features only one independent variable, despite previous studies highlighting the multifaceted influences on changes in regional budgets (Abdullah, 2013; Marzalita, et al., 2014; Martunis, et al., 2014; Junita, 2015; Abdullah, et al., 2020).Limitations: The use of small samples occurred because the data used was sourced from LKPD in 2019, with the criteria of local governments experiencing deficits in LO for three consecutive years. Limited secondary data, which is only one budget year. The use of regression models with only one independent variable, while in previous studies it was shown that changes in regional budgets were influenced by many factors (Abdullah, 2013; Marzalita, et al., 2014; Martunis, et al., 2014; Junita, 2015; Abdullah, et al., 2020).

Managerial factors influencing the implementation of NIMART services in the mobile health clinics of eThekwini municipality in KwaZulu-Natal

BackgroundThe mobile health clinics (MHCs) have been instrumental in rolling out Human Immunodeficiency Virus (HIV) care since they are an extension of Primary Health Care (PHC) services. The integration of HIV care into PHC services is reported as a structural facilitative factor for implementing nurse-initiated antiretroviral therapy (NIMART). The success of any health program relies heavily on management and support structure, hence managers’ perspectives on the implementation of NIMART services in MHCs are deemed crucial. AimThe study aimed to explore and describe the managerial factors influencing the implementation of NIMART services in the MHCs of eThekwini municipality in KwaZulu Natal. MethodsA generic qualitative research approach was used applying Qualitative Exploratory Descriptive (QED) design, on twelve MHC managers who were purposefully selected and managing MHCs operated by local and provincial health authorities. The study was approved by the North-West University Human Research Ethics Committee (NWU 00934–19-A1), provincial (KZ_202002_017) and local health (30/1/1/6/3/1) authorities. Online semi-structured interviews were conducted to collect data and were transcribed. Atlas-TI was used for data analysis while demographic data was descriptively analysed. ResultsThree themes and twelve subthemes emerged from the study: theme 1: Challenges in implementing NIMART services in MHCs, theme 2: Positive factors influencing implementation of NIMART services in MHCs, and theme 3: Suggestions to strengthen implementation of NIMART services. Subthemes were shortage of staff, shortage of medical equipment for NIMART services, challenges with infrastructure, lack of budget for NIMART services, nurses are trained in NIMART, continuous meetings, Proper planning, more nurses should be trained on NIMART, employment of more nursing personnel, collaboration with relevant stakeholders, proper infrastructure for NIMART and need for allowances. ConclusionThe involvement of managers is key to the successful implementation of NIMART services in the MHCs and improvement is more desirable.

Addressing the gap in health economics data to support national cancer control plans in low- and middle-income countries: The Childhood Cancers Budgeting Rapidly to Incorporate Disadvantaged Groups for Equity (CC-BRIDGE) tool.

National cancer control plans (NCCPs) are complex public health programs that incorporate evidence-based cancer control strategies to improve health outcomes for all individuals in a country. Given the scope of NCCPs, small and vulnerable populations, such as patients with childhood cancer, are often missed. To support planning efforts, a rapid, modifiable tool was developed that estimates a context-specific national budget to fund pediatric cancer programs, provides 5-year scale-up scenarios, and calculates annual cost-effectiveness. The tool was codeveloped by teams of policymakers, clinicians, and public health advocates in Zimbabwe, Zambia, and Uganda. The 11 costing categories included real-world data, modeled data, and data from the literature. A base-case and three 5-year scale-up scenarios were created using modifiable inputs. The cost-effectiveness of the disability-adjusted life years averted was calculated. Results were compared with each country's projected gross domestic product per capita for 2022 through 2026. The number of patients/total budget for year 1 was 250/$1,109,366 for Zimbabwe, 280/$1,207,555 for Zambia, and 1000/$2,277,397 for Uganda. In year 5, these values were assumed to increase to 398/$5,545,445, 446/$4,926,150, and 1594/$9,059,331, respectively. Base-case cost per disability-adjusted life year averted/ratio to gross domestic product per capita for year 1, assuming 20% survival, was: $807/0.5 for Zimbabwe, $785/0.7 for Zambia, and $420/0.5 for Uganda. This costing tool provided a framework to forecast a budget for childhood-specific cancer services. By leveraging minimal primary data collection with existing secondary data, local teams obtained rapid results, ensuring that childhood cancer budgeting is not neglected once in every 5 to 6years of planning processes.

Is Remote Working Effective in the Public Utility Sector? The Perspective of Resource Allocation in Administrative and Civil Services

Abstract Objectives (1) assessing the effectiveness of resource allocation in the public utility sector groups during remote work, (2) examining the efficiency of remote work compared to stationary work from the entire public utility organization point of view. Methodology To operationalize the research aim, ten research questions (RQ1-RQ9) and a research hypothesis (H1) were prepared for the identification of the effectiveness of resource allocation (Table 1). H1. If remote work improves time management effectiveness for daily tasks, employees are willing to invest their resources to work remotely. Research question RQ10 was prepared to achieve this goal, and the second hypothesis (H2) was formulated. H2. Remote working reduces public utility sector institutions’ resource consumption (utility expenses). Findings (1) remote work requirements do not occupy a significant portion of annual budgets for public utility services, (2) remote work allows reducing the fixed costs of maintaining stationary working in the short term, (3) even if remote work is a cost-effective method for public utility services and decreases indirect employee costs, it has yet to be incorporated successfully. Value added: Consequently, remote work saves resources and is cost-effective for employers. It lowers indirect employee costs (real tax deductible costs) in terms of utility expenses because employees work out of their institutions’ premises in civil and administrative services. In addition, the employer does not finance the psychological and physiological needs of employees adapting to remote work in both services. Recommendations Future research will be essential to assess whether remote work applications have improved in the public utility sector in this regard. Additionally, it would be best practice to conduct a study with a similar research concept in the private sector to compare findings and implementation strategies and offer solutions to the challenges caused by remote work.

Evaluation of ecosystem services budget based on ecosystem services flow: A case study of Hangzhou Bay area

Ecosystem services (ESs) flow, the spatial transfer of ESs from supply to demand, is critical but remains underexplored. Traditional studies often quantify ESs flow by crudely overlaying supply-demand, which lacks authenticity. This work develops a simulative model based on the flow-medium-path agent to simulate and quantify ESs flow, and subsequently evaluate regional ESs budget by incorporating ESs flow, because ESs aren't static but could flow to remote area, thereby altering the supply-demand relationship. Three prominent ESs, crop production (CP), water yield (WY), and carbon sequestration (CS) in Hangzhou Bay area were selected as cases. The results show: (1) a noticeable mismatch between ESs supply and demand; (2) ESs flow appears diverse features, e.g., the WY flow is single-directional and can only deliver to the downstream, determined by the topography; (3) Traditional ESs budget reveals the number of towns as supply exceeding demand for CP, WY, and CS is 313, 411, and 171. Contrastively, regional final budget considering ESs flow suggests that is 202, 581, and 0 as supply-demand balanced, indicating the ecological state is altered by integrating ESs flow into ESs budget evaluation. This study contributes to the researches on ESs comprehensive evaluation, ESs flow quantification, and ecological strategies references.