Financial sustainability strategies of public primary health care centres in the Republic of Srpska, Bosnia and Herzegovina

BACKGROUND

The literature on the functioning of public health facilities in health systems with significant arrears is limited. The growing liabilities of health facilities and the accumulating arrears have been a challenge in the Republic of Srpska. Most public primary healthcare (PHC) centres generated a gross loss in 2018.

METHOD

Guided by the 'positive deviance' approach, we used an exploratory case study design to identify strategies used by managers to achieve financial sustainability in eight top-performing PHC centres. Qualitative data were collected through face-to-face in-depth semistructured interviews with key informants from the PHC centres that reported positive financial results in 2018.

RESULTS

Seven organisational goals, comprising 34 financial sustainability strategies, were recognised during the data analysis and were used to build an organisational-level model for a PHC centre.

CONCLUSION

Managers concurrently used multiple strategies to ensure financial sustainability. Each centre tailored its range of strategies to the organisational context, local context, and wider environment of the health system. The strategies were conceived and implemented by managers operating at different organisational levels under the leadership of top-level managers. Managers of indebted health facilities can learn from the positively deviant peers who manage facilities that achieved satisfactory financial performance.

Bioethics in China's Biosecurity Law: forms, effects, and unsettled issues

The Biosecurity Law has laid down a regulatory framework on bioethics in China, from raising awareness through education, requiring researchers to conform to ethical principles and conduct ethical reviews on biomedical research, to giving special attention to human genetic resources. The law constructively leaves a wide range of discretion to medical institutions and professionals in ethical decision-making, adaptive to the biotechnology-ethics-regulation dynamics. This regulatory strategy poses crucial institutional challenges in its implementation, particularly on how to safeguard institutional review boards (IRB), a core mechanism in the governance, to effectively protect human subjects but not unnecessarily hinder the progress of biomedical research. Further measures need to clarify important issues on the IRB-based governance, including legal status of the IRB review decision, potential liabilities, and protections of the IRB members.

Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae) on the "Offensive" in Africa: Prospects for Integrated Management Initiatives

The South American tomato pinworm Tuta absoluta (Meyrick) has aggressively invaded the African continent. Since its first detection in North Africa in Morocco and Tunisia in 2008, it has successfully invaded the entire southern, eastern and western Africa, where it has been on the offensive, causing significant damage to Solanaceous food crops. While control of this prolific invader is primarily based on conventional synthetic pesticides, this form of control is consistently losing societal approval owing to (1) pesticide resistance development and consequential loss of field efficacy; (2) growing public health concerns; (3) environmental contamination and loss of biological diversity and its associated ecological services; and (4) unsustainable costs, particularly for resource-poor African farmers. As such, more ecologically sound pest management strategies, e.g., the use of natural substances (NSs), may offer a more sustainable approach to tackling this offensive. A systematic literature search through digital libraries and online databases (JSTOR, PubMed, Web of Science, SCOPUS and Google Scholar) was conducted using predetermined keywords on T. absoluta, e.g., South American tomato pinworm. We use this to explain the invasion of T. absoluta in Africa, citing mechanisms facilitating African invasion and exploring the potential of its control using diverse biological control agents, natural and low-risk substances. Specifically, we explore how botanicals, entomopathogens, semiochemicals, predators, parasitoids, host plant resistance, sterile insect technique and others have been spatially employed to control T. absoluta and discuss the potential of these control agents in African landscapes using more integrated approaches. We discuss the use of NSs as assets to general insect pest control, some potential associated liabilities and explain the potential use and barriers to adoption in African systems from a legislative, economic, ecological and social standpoint.

Financial Performance of Public Hospitals: A Cross-Sectional Study among Polish Providers

There is growing evidence of a positive association between health care providers’ financial standing and the quality of care. In Poland, the instable financial situation and growing debt of public hospitals has been a source of concern for more than two decades now. The objectives of this paper were to compare the financial performance of public hospitals in Poland, depending on the ownership and organizational form; and analyze whether there is an association between financial performance and the chosen variables. We conducted a cross sectional study covering the whole population of public hospitals operating in 2018. The total number of included units was 805. The hospitals’ financial outcomes were measured by several variables; Spearman’s rank correlation was calculated, and a multivariable logistic regression model was performed. In 2018, the majority of public hospitals in Poland (52%) generated a gross loss, while 40% hospitals had overdue liabilities. There were statistically significant differences between hospital groups, with university hospitals and those owned by counties (local hospitals) being in the most disadvantageous situation. Additionally, corporatized public hospitals performed worse than those functioning in the classic legal form of independent health care units. Urgent actions are needed to measure and monitor the potential impact of financial performance on the quality of care.