develop infrastructure and human resources in PHC facil- ities. Secondly, mechanisms for bidirectional referral be- tween PHC facilities and upper-level hospitals would be established to separate their different roles in health care . Finally, PHC system would change the state of dependent on sales of drugs, and governmental subsid- ies and service charges would become their major income . These policies offered health workforces material guarantee, clarified their job responsibilities and effectively promoted the development of PHC facil- ities. However, although the number of nurses was ris- ing over the study period, the measures of inequality of nurses worsen in 2012. Similar results have also been concluded in other studies. Isabel and Paula , ana- lyzing the equality in geographic distribution of physi- cians and its evolution in Portugal, concluded that the impact of the growing number of physicians on geographic distribution during the period studies was small. In a study from Japan, Toyabe  found that the total number of physicians increased every year in the period from 1996 to 2006, but all three measures of mal-distribution of physi- cians worsened after 2004. These results implied that a sig- nificant increase in the supply of health workforces does not necessarily lead to improvement of the inequality in the distribution of health workforces. On the contrary, the distribution of health workforces may be worsen, because new health workforces may prefer large health facilities ra- ther than small and remote facilities. Further research is needed to determine true reasons for these results.
Figure 2 shows a map of the actors in the supply and distribution of Pharmaceutical Products in Morocco: The Procurement Division (PD) of the Ministry of Health launches tenders for procurement of pharmaceuticals (drugs and devices medical) with pharmaceutical laboratories which are 40 in number and supplier of medical devices and reagents which number 20 .These suppliers deliver directly to the storage point 1, consisting of 4 central depots (Central Pharmacy in Casablanca ,Service Management of FP in Berrachid, Beauséjour warehouse for thermolabile products and contraceptives, and Derb Ghallef Site for solid solutes) that distribute pharmaceuticals from side to regional warehouses of 8 including 4 completed (Meknes, Agadir, Oujda and Al Hoceima ) and 4 under construction or at the planning stage (Tetouan, Marrakech and Guelmim Laayoune), the start of work started in 2005 currently play no role in the procurement cycle or are used as provincial and pharmacies On the other hand the hospital pharmacies provincial and regional hospitals that supply State Services Managed Autonomously (SSMA) hospitals and provincial pharmacies provincial delegations that deliver basic health care facilities (BHCF) to the end provide the end customer who is the patient.
Therefore, in this study, bivariate probit regression ana- lysis was employed to account for the endogenous nature of insurance enrollment. The model provides a convenient set- ting for estimating the effect of an endogenous binary regressor on a binary outcome variable in non- experimental empirical studies. 23,24 In the case of bivariate probit regression, two binary response variables are varying jointly, and we want estimated coefficients to account for the joint distribution. In this analysis, insurance enrollment and healthcare visits were an endogenous binary regressor and outcome variables, respectively. So, applying classical logis- tic/probit regression analysis may provide biased estimates and will end up with the wrong conclusion. In the case of continuous outcome and predictor variable: instrumental (IV) variable and regression discontinuity (RD) methods can be applied to deal with endogeneity problems. 25 However, a regression with a binary outcome and binary regressor presents particular difficulties and instrumental variables solution may not be apparent, mainly when the endogenous regressor is binary. 25 The bivariate probit model is recommended in health economics studies when one wants to estimate the effect of treatment on a binary health- care use 23,26-32 Therefore, in this study, we applied the bivariate probit model to predict the effect of CBHI enroll- ment on child health services utilization. First, the model assessed the households' CBHI enrollment status and self- rated health and socioeconomic predictor variables used as a control. Second, the conditional probability of the enrol- ment to CBH and different supply and demand-side factors that affect CBHI enrolment, and finally, the model deter- mined the marginal effect of the binary endogenous regres- sor after bivariate-probit regression using margins in Stata. The percent of marginal effects as an average treatment effect with a 95% CI and a p-value of less than 0.05 were used to determine statistically significant association between healthcare utilization and the independent variables.
In most major economies fraction of Service sector in GDP is growing everywhere. Specific Skills are required for production of services (unlike capital which is mostly homogeneous). Usually, individual agents decide which skills to acquire, government has no control over it. But skills’ compo- sition is crucial for economy, government should take an aggressive approach to determine which skills its agents acquire (by investing/ providing subsidies etc.)
The main purpose of the study has been to shed light on primary and lower secondary pupils' everyday experience with ecology and health in connection with the public organic school food programmes in the municipality of Copenhagen. Moreover the aim has been to investigate to which degree the pupils experience a connection between the organic food program and the underlying organic supply chain and classroom initiatives in subjects related to ecology and health. In February 2008, we approached a public school which proved willing to participate in our study. Subsequently, over a four week period, we designed an interview guide used to conduct the focus group interviews which were then
Several papers in the literature propose different methodologies in evaluating the impact of DGs on network reliability and service restoration. An interesting approach based on Analytical Simulation (AS) was presented in (Neto et al., 2006). The impact was assessed by comparing the isolated to the interconnected operation of DGs. The study showed that DGs can effectively reduce interruption duration, improve load point reliability in distribution systems, and eliminate network constraints violations. Many researchers have studied the effect of load management (LM) on the evaluation of reliability from different points of view. Reference (Dange Huang) examined the effect of selected load management techniques on the individual load point and system reliability indices of a bulk electric power system. The authors concluded that the system becomes more reliable and secure when applying effective DSM measures. Although several papers have studied the impact of RE and DSM separately on the reliability and restoration, the literature still lacks studies including both DSM and RE. In this paper, the impact of integrating wind and solar energies and the application of LM on the reliability and restoration process of the grid is examined. Actual RE data have been used. Also, two LM programs are considered and modeled, load shifting and peak clipping. The system under study is a part of RBTS Bus 2, and SAIDI, SAIFI, and ENS system reliability indices are computed. The simulation study covers an entire year.
Another key finding from the analysis in Table 2 show that while the nurse to population ratio is 1:2,067 (from 2015 projected population of 5,272,029 and growth rate of 3.5%), the TBA to population ratio is 1:1,883. Also, in terms of spread and coverage, the TBAs are readily available and in large numbers to deliver home services compared to nurses and midwives who in most cases are not readily available especially in the rural areas. From Figure 2 above, apart from Etinan, Abak, Uruan and Uyo that the number of nurses/midwives are above TBAs, all the other LGAs apart from Ikot Ekpene and Mkpt Enin where data for TBAs was not available, the spread of TBAs is far higher than nurses/midwives. The non-availability of nurses/midwives to match the population needs can be attributed to several factors among which are challenges of lack of residential quarters within the health facilities and where these are available, issues of security and absence of power supply and other infrastructure poses huge challenge as well. Besides infrastructural deficits, another major challenge in meeting up with increasing demands for professional and skilled birth attendants is the poor remuneration and poor motivation that has increased the high rate of attrition and brain drain among the healthcare workers. The mal-distribution of available medical manpower that is urban-biased has also severely constrained efforts to increase access to healthcare services including PMTCT across the state.
Although ANC service users mentioned that they ex- perienced inappropriate behavior of health providers, both supply and demand sides might not be aware of the full potential of the negative effect of that problem. A study in Hong Kong demonstrated that emotional or psychological abuse during pregnancy resulted in a greater risk of postnatal depression, higher risk of think- ing of harming themselves, and significantly poorer mental health-related quality of life . Therefore, the feedback system in addition to the medical ethics course would probably also help to increase awareness of harm- ful practices and to improve inadequate behavior and negative attitudes of health providers. However, the feed- back system should be available and accessible every- where, as suggested by our respondents. Also, the skills of giving and receiving constructive feedback may not yet be common among the leaders and providers, so that would require training and advocacy as well.
During disaster, various organizations such as Red Cross or Red Crescent are often engaged with significant problems regarding to supply chain management. Sustainable supply chain management is defined as a collaboration between partners along supply chain to manage materials, information and capital flow for an achievement of sustainability along with environmental, economic and social dimensions. The aim of this paper is to develop a new framework for identifying the effect of sustainability concept on supply chain during emergency condition. Having a meticulous and thorough approach in this stage during the system averts technical and financial issues during the engagement with emergency condition and operational stages. In this paper, a VIKOR approach is utilized to find the best compromise solution. The most appropriate path way to improve the supply chain management towards sustainability regarding to ICS in emergency management was identified.
WATER SUPPLY, USE, MANAGEMENT, POLLUTION AND TREATMENT: The importance of water and they hydrologic cycle to ecosystem, human health, and economic pursuits, distribution of fresh water on Earth, major types of freshwater ecosystems, problems of water supply and propose solutions to address depletion of fresh water, problems of water quality and propose solution to address water pollution, explain how waste water is treated
The scientific literature and policy discourse (at both national and international levels) have given much attention to issues around action to reduce domestic carbon emissions vs. risk of carbon leakage, and increasingly linking the latter to issues around spatial relocation of production activity (see Section 2 above). However, it is only more recently that the policy debate in the EU has shifted to focus specifically on the ‘just transition’ element of the Paris agreement, and in particular what the implications of industrial decarbonisation in EU nations may be in terms of the level and quality of employment at a domestic level (e.g. see ZEP, 2018). The previous section demonstrates that IRIO multiplier analysis may prove useful in highlighting potential patterns of spatial displacement of value-added and jobs at different geographical levels. In this section we consider how further decomposition of the type of multiplier results derived using the system in equations  to  may provide further insight in to potential domestic patterns of impacts if an industry like cement production is even partially displaced. Focussing again on the case of cement production in Germany, we extend this focus to consider wider supply chain impacts on GDP in other EU member states. This is motivated by the result reflected in Figure 3 above, where, of the five nations we report for, the biggest external supply chain content of the ‘Cement etc.’ GDP multipliers is observed in the case of value-added content across the EU for the German industry.
The epidemiology of sporadic (non-outbreak associated) cases is poorly understood. Infection varies spatially, with C. parvum more prevalent in rural areas, reflecting contact with farm animals. In the United Kingdom, socioeco- nomic status was found to be associated with risk factors for infection such as foreign travel and swimming pool use . Type of water supply  and water treatment methods are important risk factors. In humans both spe- cies are associated with acute diarrhoea with or without additional gastrointestinal symptoms following an incu- bation period of 7 to 14 days [6,7]. The condition is self- limiting in otherwise healthy people, but can cause intrac- table diarrhoea in patients with impaired immune func- tion. The infection is transmitted by the faecal-oral route, either by direct person-to-person contact or indirectly through contamination of food or water. Several large outbreaks of human cryptosporidiosis have been reported, often associated with contaminated water sup- plies. The prevention and control of waterborne outbreaks of cryptosporidiosis is difficult because the oocysts of the protozoan cryptosporidium are not inactivated by chlo- rination at levels used in drinking water. As chlorination is not effective in destroying the oocysts, the protection of drinking water from contamination is dependent on source protection (limiting animal and human faecal con- tamination of water sources) and on removal or inactiva- tion of cryptosporidium oocysts in the water treatment process. Water that is fully compliant with accepted bacte- riological standards (absence of E. coli, general coliform bacteria, enterococci and C. perfringens) may contain via- ble cryptosporidia. Conventional water treatment proc- esses including chemical coagulation, flocculation, sedimentation, filtration and disinfection successfully remove the majority of microorganisms in raw water which are a concern to public health , but these meth- ods do not always remove cryptosporidium. Advances in water treatment that successfully remove cryptosporidium when the systems components are intact and operating correctly include microfiltration and ultrafiltration, and the most effective method to inactivate any cryptosporid- ium remaining after filtration is ultraviolet treatment , which requires that the treated water is of low turbidity. However, treatment methods alone cannot solve the problem; protecting water supplies and monitoring water quality are crucial.
The objective of this paper is to develop a model of tax evasion to suit institutional set up in which corruption is endemic. Corrupt intermediation in general is motivated by two reasons (Rose-Ackerman 1997); (i) to obtain government benefits; and (ii) to avoid costs. In line with Rose-Ackerman, we assume that taxpayers, due to the dominance of the informal law in practice, need to use some resources to buy informal/corrupt intermediation (CI) in their attempt to reduce their tax payment. A model to describe taxpayer demand for CI services is developed in section 2. Like the theoretical model developed by Allingham and Sandmo and its refinements, our model also is stylised in nature. The supply CI is outlined in section 3. The model is designed to be flexible enough to include both constant and non-constant returns to scale properties. This way, it can readily be incorporated into a larger economy-wide economic model which usually have constant returns to scale properties. A standard closure of the model and a qualitative partial equilibrium analysis of tax policy change are set out in section 4. Section 5 illustrates how the model can be used in examining the reactions of representative taxpayers, whose productivity in use of corrupt intermediation (CI) activity differs, to a change in the tax policy. This reveals a mechanism for the operation of a type of Laffer curve. Section 6 offers a brief concluding remarks.
DOI: 10.4236/jss.2018.64022 257 Open Journal of Social Sciences system. Despite the abundant research on unidimensional supply chain rela- tionships, the SCI construct is a relatively new as an area of research . Supply chain integration is defined as “the degree to which a firm can strategically col- laborate with its supply chain partners and collaboratively manage the intra- and inter-organization processes to achieve effective and efficient flows of product and services, information, money and decisions with the objective of providing maximum value to customers at low cost and high speed” . Vickery et al. state that the challenge of supply chain integration is the managerial capacity for combining resources and competencies from various supply chain members and business units, and directing all relevant parties towards an expanded resource base and competitive advantage , which means that it should be strategically managed as an integrated system as opposed to individually optimized frag- mented subsystems. Maloni and Benton report that in order to provide custom- ers with greater value and gain competitive advantage, a higher level of coopera- tion is required for supply chain partners, which leads to integration of the supply chain .
involved in the programs passed the comprehensive and the national license examination and they had better clinical competencies than graduates with a normal track.  Imbalanced distribution of health workers is an international issue. The WHO has issued a global strategy on human resources for health to ensure the equitable access to health workers within strengthened health systems.  One of the objectives of the global strategy is to align investment in human resources for health to address shortages and improve distribution of health workers. For Indonesia, as the fourth largest country by population in the world, regulation to manage workforce maldistribution may be more appropriate. Graduates of health professions may be in over-supply on Java Island, but not in other rural areas of Indonesia. For example, there were 22,263 graduate nurses in 2014 but only 13,528 (39%) had been employed.  East Java province has the highest numbers of nursing schools, 55 Diploma of Nursing and 53 Bachelor of Nursing schools, producing around 12,000 nurses every year, with only 10% employed.  On the other hand, the 2015 annual report of the Indonesian Ministry of Health shows that the ratio of nurses to population was 87.65 per 100,000 population which was below the target, 180 per 100,000 population.  This demonstrates a need for regulation of graduates’ education so that all health professional graduates, mainly from Java Island, can be well distributed to all areas of Indonesia.
Global interest and investment in community health ser- vices has been building to address these gaps and as a pathway to Universal Health Coverage (UHC), with sub- stantial commitment to Community Health Worker (CHW) programmes (see key definitions) in resource- constrained health systems [7–9]. Work of CHWs has been shown to improve equitable child survival, health and nutrition [1, 10] by bringing services closer to the homes of hard-to-reach and underserved populations [6, 11, 12]. The effectiveness of using CHWs to promote im- munisation and initiation of breastfeeding and to reduce maternal and child morbidity and mortality, compared with usual care has been demonstrated . However, new health interventions typically reach those with higher socio-economic position first, only benefiting the poor later, in what is known as the ‘inverse equity hypothesis’  and so introducing CHWs within a health system should not be assumed to automatically result in equitable coverage of health services . A wide range of interven- tion design factors that may be inequitably applied influ- ence CHW performance, such as a mix of incentives, frequent supervision, continuous training, community in- volvement and strong coordination between CHWs and health workers [11, 16]. Community, economic, socio- cultural factors and education status of the target group (among other factors) have also been demonstrated to in- fluence CHW performance and service coverage . There is a need to better understand the design and con- textual factors of CHW programmes which impact health equity within populations.
The differing cultural, social, political and demographic backgrounds of Kenya and Mala LDUHOLNHO\WRHQULFKWKHXQGHUVWDQGLQJRIWKHDSSURSULDWHQHVVDQGHIIHFWLYHQHVV of reproductive health initiatives for men in different contexts. Due to its strategic importance in the East African Region, the openness of its politicians on population issues and the size of its population, Kenya has received substantial international aid and support for its population program since the 1960s. Kenya has transformed from being labelled the country with the highest fertility level in the late 1970s to one that has exhibited one of the fastest fertility transitions in human history. The Mala LDQ Government, on the other hand, adopted an anti-natalist strategy that culminated in banning of family planning services between the 1960s and the mid-1980s. The family planning program appears to have gained momentum very rapidly, as evidenced by the notable decline in fertility and sharp increase in contraceptive use over the past decade. As with many other countries in the East-Southern Africa region, the two countries have been devastated by the HIV/AIDS epidemic. In 1997, approximately 15 per cent of Mala ians were estimated to be infected with the HIV virus and nearly half a million people had died of AIDS since the start of the epidemic (World Health Organisation 1998).
social services provision within their area of responsibility...The key area of overlap between health and social services is in the provision of care for the elderly. There is a national plan for the elderly aimed to improving older people’s standard of living. This plan includes a component on health care which focuses on health promotion, the prevention of illness and accidents, and healthy lifestyle. Social services are responsible for elderly residential care.” The total number of places amounted to 188,913 in 3,689 elderly homes in 1998. Additionally, more places are purchased through contracts with private institutions. For every 1000 people over 65 there were 2.8 places in 1998. The issue of the elderly requiring continuing medical care has not been resolved satisfactorily and there is no uniform, national/cross-sectional approach. Home care is being expanded and within most municipalities an infrastructure exists to deliver basic support to those being cared for or caring for others at home. Yet, accessibility to these services is severely restricted and coordination with medical care is still lacking in many aspects (EOHCS, 2000b, p. 85). The report can be summarised as follows: long-term care for the elderly and handicapped is still considerably underdeveloped and managed by different organisational structures. In addition, long-term care places for palliative care of the chronically and terminally ill only absorb a marginal share of the total (p. 127). In view of the different organisational structures there is no global national database for long-term care services and no analyses can be carried out in this case. But it can be observed that the supply of long-term care services in nursing homes or by home care are far away from meeting the need of long-term care in Spain.