Resource allocation in public hospitals: is it effective?

The allocative inefficiency is a fundamental flaw in the public hospitals of the developing countries. The inefficiencies drain the limited public resources allotted for healthcare. Sri Lanka's public health system faces worsening budget constraints. The resource allocation practices of the Ministry of Health focus on increasing the cadre of hospital staff, consequently crowding out the investments on facility development. The purpose of the study is to assess the impact of resource allocation in the tertiary-care public hospitals that are under the central Ministry of Health. The model is based on the assumption that the hospital managers and other agents of a public hospital pursue the objective of quality maximization (in the absence of a profit motive). The inpatient mortality rate is selected as the indicator of quality. With the use of panel data fixed-effects, and first-differencing estimation methods, we study the impact of the resource allocation on the hospital mortality rates. The selected models are statistically significant at 0.1% level. The elasticity effect of the capital is considerably larger than the effects of the human resources, in servicing the patients. The results suggest that the human resource utilization is suboptimal, due to the inadequacy of the capital (i.e. medical equipment, etc.). The reorientation of the resource allocation towards the capital investments may save more lives.     

Strategic market planning in hospitals: is it done? Does it work?

A nationwide survey of strategic market planning within hospitals was conducted. The level of strategic market planning activity performed by hospitals is reported. Level of planning maturity also is determined. Levels of activity and maturity are related to satisfaction with strategic market planning. Results and implications are presented.     

Disinfection: is it time to reconsider Spaulding?

The Spaulding classification, originally proposed in 1957, is a widely used system for matching the disinfection and sterilization of surfaces, particularly those of re-usable medical/surgical devices, with available processes. It presents a ranking, from simple disinfection through to sterilization, that should be considered in the reprocessing of devices, based on the risks associated with their use, ranging from 'critical' (presenting a high risk), through 'semi-critical' to 'non-critical' (presenting a low risk). The different levels of disinfection are based on demonstrating antimicrobial activity against established marker micro-organisms representing a range of pathogens. Although this classification system is probably as valid today as it was in 1957, the understanding of microbiology and micro-organisms has changed. This article discusses some examples of disinfection studies with viruses, bacteria, protozoa and prions that challenge the current definitions and expectations of high-, intermediate- and low-level disinfection. In many of these examples, the test micro-organisms demonstrate atypical tolerance or resistance profiles to disinfection processes. In addition to laboratory-based studies, there is now clinical evidence for at least some of these micro-organisms that biocide resistance can lead to infection outbreaks due to unexpected disinfection failure. These reports should encourage the reader to challenge current dogma, and reconsider the expectations of disinfection and sterilization practices.     

Medical futility in pediatrics: is it time for a public policy?

For the past decade, there has been a debate raging within the medical, ethical, and legal communities focusing on the issue of medical futility. What has fueled the fires of this multi-faceted debate is the patient rights movement and the perception that the right to self-determination extends not only to the refusal of medical treatments but to demands for overtreatment. The medical specialities of Pediatrics and Neonatology further complicate this issue because despite the dramatic technological advances in these areas, diagnostic and prognostic certainty for many medical conditions remains illusive. As a result, surrogates have to decide whether children with various congenital anomalies, diseases, and genetic defects should be treated aggressively if at all. This uncertainty has led to conflicts between physicians and families about whether certain medical treatments are futile and thus not in the best interest of the child. From a legal and ethical perspective, one way to resolve these conflicts would be a specific process-based public policy approach to futility determinations on a case-by-case basis. The medical futility policy proposed as a public policy protects the patient's right to self-determination; the physician's right of professional integrity; society's concern for the just allocation of scarce medical resources; and is securely rooted in the ethical tradition of promoting and defending human dignity.     

The sector-wide approach in health: what is it? Where is it leading?

This paper describes early experience with the Sector-Wide Approach (SWAp), an emerging trend in development practice in low-income countries. The paper describes what a SWAp is, and why it is now being pursued. The SWAp is characterized as a sustained government-led partnership with donor agencies and other groups. By applying sector-wide policies to an expenditure framework and national implementation systems, explicit health sector reforms are undertaken to meet sectoral and national development objectives. The approach has changed the dynamic between governments and donor agencies, requiring systemic changes in policy-making and management in both governments and donor agencies. With the SWAp, ongoing joint assessment and negotiations around sectoral plans and review of performance replaces the old way of preparing and supervising projects. Early experiences in countries undergoing SWAps are discussed, including the problem of reconciling priority programs and old practices with broader health sector reforms and new ways of managing development assistance. The paper concludes by identifying some of the key challenges for the future of SWAps.     

Now is it time to implement spacers in cervical cancer brachytherapy?

Although the international study on MRI-guided brachytherapy in cervical cancer (EMBRACE-I) demonstrated excellent local control regardless of the T stage, up to 14.6% of grade 3–5 late radiation-related toxicities were observed, which is unacceptable. While the efficacy of hydrogel spacers has been established in prostate radiotherapy, its implementation speed in cervical cancer brachytherapy is relatively slow, despite the fact that several articles have reported its efficacy in cervical cancer brachytherapy. The authors believe that using a spacer in cervical cancer brachytherapy and brachytherapy for other gynecologic malignancies will reduce late radiation-related toxicity and improve patients’ quality of life; therefore, its rapid implementation is required.