One of the most interesting water management case studies in Iran is the case of Zayandehrud River, the main river that supplies water to Isfahan Province which is located in Gavkhuni River Basin (GRB). This paper examines the present and future demands for water and determines the extent to which water will be available for agricultural use by the year 2020. Although demand and supply conditions in 2000 were more or less in balance, there was an increase in the supply of some 28% by 2010 due to the completion of the third trans-basin diversion and the development of other local water sources. However, the demand exceeded its supply in 2010 and the basin fell into severe deficit. In this condition, the only way to keep supply and demand in balance is to reduce allocations to agriculture. By 2020, agriculture would only have 5% more water than the present and water supply is only 90% that of the normal, and this would then shrink from 2025 onwards. In other words, agriculture would have to be sacrificed in order to ensure full supplies of water for the other sectors. The scenarios examined reveal that a sustainable agriculture can only be accomplished by water saving practices and management measures, which may further lead to reduced demand, control supplies, and improve the efficiency of water use.
This paper describes how an acute tertiary referral hospital moved away from a "culture of blame", using change management principles aligned with the concept of the learning organisation. I outline the process of change, and describe its outcomes. The result is summarised as an improvement in desired attributes of the organisation's culture, as evidenced by consistent improvement in the results of a proprietary staff survey. I conclude that the concept of the learning organisation is a useful one for hospitals that seek to improve the organisational culture.
One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges.The WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population, and the Malaysian National Health Accounts (2008) provided the latest Malaysian data on health spending. Measuring against the four target indicators outlined, Malaysia fared credibly with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, and a tax-based financing system that fundamentally poses as a national risk-pooled scheme for the population.Nonetheless, within a holistic systems framework, the financing component interacts synergistically with other health system spheres. In Malaysia, outmigration of public health workers particularly specialist doctors remains an issue and financing strategies critically needs to incorporate a comprehensive workforce compensation strategy to improve the health workforce skill mix. Health expenditure information is systematically collated, but feedback from the private sector remains a challenge. Service delivery-wise, there is a need to enhance financing capacity to expand preventive care, in better managing escalating healthcare costs associated with the increasing trend of non-communicable diseases. In tandem, health financing policies need to infuse the element of cost-effectiveness to better manage the purchasing of new medical supplies and equipment. Ultimately, good governance and leadership are needed to ensure adequate public spending on health and maintain the focus on the attainment of universal coverage, as well as making healthcare financing more accountable to the public, particularly in regards to inefficiencies and better utilisation of public funds and resources.
Co-management is now established as a mainstream approach to small-scale fisheries management across the developing world. A comprehensive review of 204 potential cases reveals a lack of impact assessments of fisheries co-management. This study reports on a meta-analysis of the impact of fisheries co-management in developing countries in 90 sites across 29 case-studies. The top five most frequently measured process indicators are participation, influence, rule compliance, control over resources, and conflict. The top five most frequently measured outcome indicators are access to resources, resource well-being, fishery yield, household well-being, and household income. To deal with the diversity of the 52 indicators measured and the different ways these data are collected and analysed, we apply a coding system to capture change over time. The results of the meta-analysis suggest that, overall fisheries co-management delivers benefits to end-users through improvements in key process and outcome indicators. However, the dataset as a whole is constituted primarily of data from the Philippines. When we exclude this body of work, few generalisations can be made about the impact of fisheries co-management. The lack of comparative data suitable for impact assessment and the difficulties in comparing data and generalising across countries and regions reiterates calls in other fields for more systematic approaches to understanding and evaluating governance frameworks.
Findings of a study of the impact of professional learning on Malaysian registered nurses are reported. The offshore delivery post-registration nursing degree programme is a formal aspect of professional learning, which enables Malaysian registered nurses to upgrade their hospital-based training or diploma of nursing qualification to a degree. Using a qualitative case study approach, data were collected from twelve programme graduates, through individual and focus group interviews. The programme promoted their personal professional growth and enhanced their professional development. It increased self-confidence, knowledge, self-fulfillment, critical thinking ability, interpersonal skills, interest in research and research utilisation, and life-long learning. There was evidence of career mobility and a raised awareness of their professional role and responsibility.
The School of Health Sciences, Universiti Sains Malaysia (SHS) is planning to expand its contribution to produce more graduate nurses by offering a nursing degree through e-learning. After three years of using e-learning by four lecturers in seven nursing courses, we conducted a study to get the lecturers feedback and to compare the students' preference and their actual experiences in e-learning. Lecturers' feedback were collected based on six open-ended questions. Feedback from all the 36 final year nursing students were collected using Constructivist On-line Learning Environment Survey (COLLES)--the Student Experience/Preferred Form. Results show that lecturers and students have positive perception on e-learning. They perceive e-learning as a powerful and effective tool for expanding nursing education to meet the demand for a labour force that is knowledgeable, highly skilled and equipped with positive values. We believe blended learning is the most suitable approach to implement e-learning and social constructivism theory provides the dynamic view of learning. To increase success in e-learning implementation for the nursing programme, lecturers should be educated regarding proper instructional design so that their content delivery blends well with the technology and pedagogy.
Formulation of effective sustainability indicators for national assessment demands a comprehensive understanding of the utilisation, diffusion and dissemination of information in policy processes. To illustrate the dynamic of sustainability assessment within the context of policy processes, this paper uses a case study of national sustainability indicators development in Malaysia. Subsequently, this paper ascribes the limited achievement of national sustainability assessment in Malaysia to four types of constraints: meta-policy issues; technical capacities; communication concerns; and the inherent knowledge gaps within the indicator developer community vis-a-vis their theoretical limitations. It is proposed that such constraints will be encountered in many countries. Drawing from the literature on public policy, this paper outlines a framework for investigating indicator behaviour within policy processes based on well-established concepts such as knowledge utilisation and policy learning. I conclude this paper by elaborating on the corresponding future challenges that must be addressed before effective integration of sustainability indicators within policy systems can occur.
Performance measurement plays an important role in the successful design and reform of regional healthcare management systems. In this study, we propose a hybrid data envelopment analysis (DEA) and game theory model for measuring the performance and productivity in the healthcare centers. The input and output variables associated with the efficiency of the healthcare centers are identified by reviewing the relevant literature, and then used in conjunction with the internal organizational data. The selected indicators and collected data are then weighted and prioritized with the help of experts in the field. A case study is presented to demonstrate the applicability and efficacy of the proposed model. The results reveal useful information and insights on the efficiency levels of the regional healthcare centers in the case study.
Clinical information systems have long been used in intensive care units but reports on their adoption and benefits are limited. This study evaluated a Critical Care Information System implementation.
Studies related to healthcare ICT integration in Malaysia are relatively little, thus this paper provide a literature review of the integration of information and communication technologies (ICT) in the healthcare sector in Malaysia through the hospital information system (HIS). Our study emphasized on secondary data to investigate the factors related to ICT integration in healthcare through HIS. Therefore this paper aimed to gather an in depth understanding of issues related to HIS adoption, and contributing in fostering HIS adoption in Malaysia and other countries. This paper provides a direction for future research to study the correlation of factors affecting HIS adoption. Finally a research model is proposed using current adoption theories and external factors from human, technology, and organization perspectives.
There are numerous applications for Health Information Systems (HIS) that support specific tasks in the clinical workflow. The Lean method has been used increasingly to optimize clinical workflows, by removing waste and shortening the delivery cycle time. There are a limited number of studies on Lean applications related to HIS. Therefore, we applied the Lean method to evaluate the clinical processes related to HIS, in order to evaluate its efficiency in removing waste and optimizing the process flow. This paper presents the evaluation findings of these clinical processes, with regards to a critical care information system (CCIS), known as IntelliVue Clinical Information Portfolio (ICIP), and recommends solutions to the problems that were identified during the study.
Established 20 years ago with a single dialysis center assisting only 20 patients with 6 hemodialysis machines, Medicare has grown leaps and bounds to assist thousands of poor patients to obtain a highly subsidized rate for quality treatment. Millions of ringgit raised via various fundraising projects and events have been well utilized to serve the growing number of kidney patients in Malaysia who simply cannot bear the exorbitant cost of treatment. Staying true to its mission, Medicare extends its assistance to needy kidney patients and their families, who indirectly have become part of the Medicare family.
Introduction: Medical schools increasingly offer curricula that specifically aim to prepare students for an international medical career. This is challenging as well as controversial: curriculum designers must balance specific local healthcare requirements with global health competencies doctors need in our globalised world. By investigating how international medical programme designers experience this balancing act, this study aims to contribute insights to the debate on local versus global medical education.Methods: We conducted a multi-centre instrumental case study across three universities with international medical programmes in three countries. The study involved 26 semi-structured interviews with key curriculum designers recruited through purposive sampling. Additionally, we performed a curriculum document analysis. Data were thematically analysed within a multidisciplinary team.Results: Participants described two profiles of international medical programme graduates: 'a global physician', equipped with specific competencies for international practice, and 'a universal professional', an overall high-level graduate fit for future practice anywhere. These perspectives presented different curriculum design challenges.Conclusions: International medical programmes teach us how we can rethink graduate profiles in a globalising world. Yet, educational standardisation poses risks and securing equity in global health education is challenging, as is preparing students to be adaptable to the requirements of a rapidly changing future local healthcare context.
Residents of disadvantaged neighbourhoods have poorer physical function than their advantaged counterparts, although the reasons for this remain largely unknown. We examined the moderating effects of walkability in the relationship between neighbourhood disadvantage and physical function using 2013 cross-sectional data from 5115 individuals aged 46-72 living in 200 neighbourhoods in Brisbane, Australia. The relationship between neighbourhood disadvantage and physical function differed by levels of walkability: positive associations as levels of walkability increased for those living in more disadvantaged neighbourhoods, and no difference for those living in more advantaged neighbourhoods. Further work is required to better understand the underlying mechanisms.
A survey was conducted to investigate the relationship between job satisfaction and job factors that affect work design in two automotives manufacturing companies in Malaysia. A set of multiple choices questionnaires was developed and data were collected by interviewing the employees at the production plant. Hundred and seventy male subjects between the ages of 18 to 40 years with the mean age of 26.8 and SD of 5.3 years and mean work experience of 6.5 and SD of 4.9 years took part in the survey. The survey focused on job factors, i.e. skill variety, task identity, task significance, autonomy and feedback. The results support the previous findings that job factors are significantly correlated to job satisfaction. Furthermore, it also highlights the significant influence of age, work experience and marital status.
Hospital mergers began in the UK in the late 1990s to deal with underperformance. Despite their prevalence, there is a lack of research on how such organizational changes affect the staff morale. This study aims to assess the impact of NHS hospital mergers between financial years 2009/10 and 2011/12 on staff job satisfaction and to identify factors contributing to satisfaction.
In the wake of the World Health Organization Framework Convention on Tobacco Control, corporate social responsibility (CSR) is among the few remaining mechanisms for tobacco corporations publicly to promote their interests. Health advocates may be unaware of the scale, nature and implications of tobacco industry CSR. This investigation aimed to construct a typology of tobacco industry CSR through a case study of the evolution and impact of CSR activities of a particular tobacco corporation in one country - British American Tobacco, Malaysia (BATM), the Malaysian market leader. Methods included searching, compiling and critically appraising publicly available materials from British American Tobacco, BATM, published literature and other sources. The study examined BATM's CSR strategy, the issues which it raises, consequences for tobacco control and potential responses by health advocates. The investigation found that BATM's CSR activities included assistance to tobacco growers, charitable donations, scholarships, involvement in anti-smuggling measures, 'youth smoking prevention' programs and annual Social Reports. BATM has stated that its model is predominantly motivated by social and stakeholder obligations. Its CSR activities have, however, had the additional benefits of contributing to a favourable image, deflecting criticism and establishing a modus vivendi with regulators that assists BATM's continued operations and profitability. It is imperative that health advocates highlight the potential conflicts inherent in such arrangements and develop strategies to address the concerns raised.
Theory-based evaluation (TBE) is an effectiveness assessment technique that critically analyses the theory underlying an intervention. Whilst its use has been widely reported in the area of social programmes, it is less applied in the field of energy and climate change policy evaluations. This paper reports a recent study that has evaluated the effectiveness of the national biofuel policy (NBP) for the transport sector in Malaysia by adapting a TBE approach. Three evaluation criteria were derived from the official goals of the NBP, those are (i) improve sustainability and environmental friendliness, (ii) reduce fossil fuel dependency, and (iii) enhance stakeholders' welfare. The policy theory underlying the NBP has been reconstructed through critical examination of the policy and regulatory documents followed by a rigorous appraisal of the causal link within the policy theory through the application of scientific knowledge. This study has identified several weaknesses in the policy framework that may engender the policy to be ineffective. Experiences with the use of a TBE approach for policy evaluations are also shared in this report.
Viral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost-effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence-gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints.