Modelling the factors affecting Nigerian medical tourism sector using an interpretive structural modelling approach

Modeling and analysis of barriers in controlling TB: developing countries' perspective

Purpose

Tuberculosis (TB) continues to c-exist with humans despite many TB control programs and elimination strategies. This depicts that some barriers are not allowing achieving the desired results. The current study aims to focus on identification and ranking of such barriers to facilitate TB control programs in developing countries.

Design/methodology/approach

In the present study, 13 barriers that can influence success rate of TB elimination strategies have been recognized with an in-depth assessment of related literature and opinions of specialists from medical industry and academic world. The interpretive structural modeling (ISM) and decision-making trial and evaluation laboratory (DEMATEL) techniques have been employed for the ranking of barriers.

Findings

Based on driving power of barriers, the study coined that underinvestment is a major barrier followed by poor implementation of government policies and programs, poverty and poor primary health care infrastructure.

Research limitations/implications

The findings may guide healthcare service providers and researchers in analyzing the barriers and understanding the necessity of further advancements to decrease the count of already existing and incident cases.

Practical implications

Policy- and decision-makers may utilize the information on dependence and driving power of barriers for better planning and effective execution of TB control strategies.

Originality/value

Although a lot of literature is available on different barriers that are affecting success of TB strategies, the current study analyzes all the key barriers collectively for the prioritization of barriers.

Ranking of Sustainable Medical Tourism Destinations in Iran: An Integrated Approach Using Fuzzy SWARA-PROMETHEE

Today, medical tourism is one of the fastest growing sectors of the tourism industry around the world. Medical tourism can contribute to the sustainable development and economic dynamism of countries. Therefore, in this study, we prioritize the world’s leading countries in medical tourism for Iranians. First, five main criteria and 20 sub-criteria were selected, which are the reasons for choosing a country as a medical tourism destination. In this paper a combined fuzzy SWARA-PROMETHEE approach was used to prioritize tourism destinations. The acronym PROMETHEE stands for Preference Ranking Organization Method for Enrichment Evaluation method and represents an useful MCDA (Multi-Criteria Decision Analysis) tool. On the other hand, SWARA acronym means Step-wise Weight Assessment Ratio Analysis. The criteria were weighted using the fuzzy SWARA approach. In the following, using the PROMETHEE approach, we prioritized eight countries as tourism destinations, then we identified criteria related to sustainability of medical tourism destinations and prioritized medical tourism destinations using these criteria as the contributions of this paper. The weights obtained for criteria “Abilities of skilled staff,” “Applied medical equipment,” “Marketing capability,” “Type of service provided,” and “Application of information and communications technology” were 0.176, 0.232, 0.108, 0.395, and 0.089, respectively. The results show that medical tourism destination priorities for Iranians are India (Phi = 0.1396), Malaysia (Phi = 0.1128), Panama (Phi = 0.0976), Mexico (Phi = 0.0790), Singapore (Phi = 0.0096), Taiwan (Phi = −0.0442), Brazil (Phi = −0.1747), and Costa Rica (Phi = −0.2196), respectively. Negative Phi values indicate below average performance of those countries and positive Phi values indicate above average performance of those criteria. The results indicate that countries with negative Phi values should be strengthened relative to the improvement of some criteria.

What can we learn from previous pandemics to reduce the frequency of emerging infectious diseases like COVID-19?

The global risks report of 2020 stated, climate-related issues dominate all of the top-five long-term critical global risks burning the planet and according to the report, "as existing health risks resurge and new ones emerge, humanity's past successes in overcoming health challenges are no guarantee of future results." Over the last few decades, the world has experienced several pandemic outbreaks of various pathogens and the frequency of the emergence of novel strains of infectious organisms has increased in recent decades. As per expert opinion, rapidly mutating viruses, emergence and re-emergence of epidemics with increasing frequencies, climate-sensitive vector-borne diseases are likely to be increasing over the years and the trends will continue and intensify. Susceptible disease hosts, anthropogenic activities and environmental changes contribute and trigger the 'adaptive evolution' of infectious agents to thrive and spread into different ecological niches and to adapt to new hosts. The overarching objective of this paper is to provide insight into the human actions which should be strictly regulated to help to sustain life on earth. To identify and categorize the triggering factors that contribute to disease ecology, especially repeated emergence of disease pandemics, a theory building approach, 'Total Interpretive Structural Modeling' (TISM) was used; also the tool, 'Impact Matrix Cross-Reference Multiplication Applied to a Classification' analysis (MICMAC) was applied to rank the risk factors based on their impacts on other factors and on the interdependence among them. This mathematical modeling tool clearly explains the strength, position and interconnectedness of each anthropogenic factor that contributes to the evolution of pathogens and to the frequent emergence of pandemics which needs to be addressed with immediate priority. As we are least prepared for another pandemic outbreak, significant policy attention must be focused on the causative factors to limit emerging outbreaks like COVID 19 in the future.