Government fiscal decentralization and haze and carbon reduction: Evidence from the fiscal Province-Managing-County reform.

Government governance reform is not only a vital motivation for high economic quality but also an important factor in stimulating the government's environmental governance responsibility. The article empirically examines the fiscal Province-Managing-County (PMC) pilot reform on the synergic governance of haze and carbon reduction and its mechanism. The results show that the policy helps to realize the synergic governance of haze and carbon reduction, and the reform of fiscal Province-Managing-County promotes regional haze and carbon reduction mainly through structural effect, innovation effect, and fiscal expenditure responsibility effect. The heterogeneity analysis shows that the policy has an asymmetric effect on haze and carbon reduction under different administrative structures, economic structures and levels of government intervention. Further analysis shows a policy linkage effect between this policy and the Green Fiscal Policy. The policy has the situation of blood-sucking in the provincial capital city and leads to an increase in financial funds. The above results prove that the policy can help to realize haze and carbon reduction and provide practical ideas for the further expansion of the policy. At the same time, it provides the direction for the local government to realize the double-carbon goal.

Understanding health system resilience in responding to COVID-19 pandemic: experiences and lessons from an evolving context of federalization in Nepal.

INTRODUCTION: The COVID-19 pandemic has tested the resilience capacities of health systems worldwide and highlighted the need to understand the concept, pathways, and elements of resilience in different country contexts. In this study, we assessed the health system response to COVID-19 in Nepal and examined the processes of policy formulation, communication, and implementation at the three tiers of government, including the dynamic interactions between tiers. Nepal was experiencing the early stages of federalization reform when COVID-19 pandemic hit the country, and clarity in roles and capacity to implement functions were the prevailing challenges, especially among the subnational governments. METHODS: We adopted a cross-sectional exploratory design, using mixed methods. We conducted a desk-based review of all policy documents introduced in response to COVID-19 from January to December 2020, and collected qualitative data through 22 key informant interviews at three tiers of government, during January-March 2021. Two municipalities were purposively selected for data collection in Lumbini province. Our analysis is based on a resilience framework that has been developed by our research project, ReBUILD for Resilience, which helps to understand pathways to health system resilience through absorption, adaptation and transformation. RESULTS: In the newly established federal structure, the existing emergency response structure and plans were utilized, which were yet to be tested in the decentralized system. The federal government effectively led the policy formulation process, but with minimal engagement of sub-national governments. Local governments could not demonstrate resilience capacities due to the novelty of the federal system and their consequent lack of experience, confusion on roles, insufficient management capacity and governance structures at local level, which was further aggravated by the limited availability of human, technical and financial resources. CONCLUSIONS: The study findings emphasize the importance of strong and flexible governance structures and strengthened capacity of subnational governments to effectively manage pandemics. The study elaborates on the key areas and pathways that contribute to the resilience capacities of health systems from the experience of Nepal. We draw out lessons that can be applied to other fragile and shock-prone settings.

Nurturing transformative local structures of multisectoral collaboration for primary health care: qualitative insights from select states in India.

BACKGROUND: Multisectoral collaboration is essential for advancing primary health care (PHC). In low- and middle-income countries (LMICs), limited institutional capacities, governance issues, and inadequate stakeholder engagement impede multisectoral collaboration. India faces similar challenges, especially at the meso-level (districts and subdistricts). Owing to its dependence on context, and insufficient evidence, understanding "How" to improve multisectoral collaboration remains challenging. This study aims to elicit specific recommendations to strengthen meso-level stewardship in India for multisectoral collaboration. The findings from this study may offer lessons for other LMICs. METHODS: Using purposive, maximum variation sampling, the study team conducted semi-structured interviews with 20 diverse participants, including policymakers, implementers, development agency representatives, and academics experienced in multisectoral initiatives. The interviews delved into participants' experiences, the current situation, enablers, and recommendations for enhancing stakeholder engagement and capacities at the meso-level for multisectoral collaboration. RESULTS: Context and power are critical elements to consider in fostering effective collaboration. Multisectoral collaboration was particularly successful in three distinct governance contexts: the social-democratic context as in Kerala, the social governance context in Chhattisgarh, and the public health governance context in Tamil Nadu. Adequate health system input and timely guidance instil confidence among local implementers to collaborate. While power plays a role through local leadership's influence in setting agendas, convening stakeholders, and ensuring accountability. To nurture transformative local leaders for collaboration, holistic, equity-driven, community-informed approaches are essential. The study participants proposed several concrete steps: at the state level, establish "central management units" for supervising local implementers and ensuring bottom-up feedback; at the district level, rationalise committees and assign deliverables to stakeholders; and at the block level, expand convergence structures and involve local self-governments. Development partners can support data-driven priority setting, but local implementers with contextual familiarity should develop decentralised plans collaboratively, articulating rationales, activities, and resources. Finally, innovative training programs are required at all levels, fostering humility, motivation, equity awareness, leadership, problem- solving, and data use proficiency. CONCLUSION: This study offers multiple solutions to enhance local implementers' engagement in multisectoral efforts, advocating for the development, piloting, and evaluation of innovative approaches such as the block convergence model, locally-led collaboration efforts, and novel training methods for local implementers.

Healthcare workers' views on decentralized primary health care management in Lesotho: a qualitative study.

BACKGROUND: Lesotho experienced high rates of maternal (566/100,000 live births) and under-five mortality (72.9/1000 live births). A 2013 national assessment found centralized healthcare management in Ministry of Health led to fragmented, ineffective district health team management. Launched in 2014 through collaboration between the Ministry of Health and Partners In Health, Lesotho's Primary Health Care Reform (LPHCR) aimed to improve service quality and quantity by decentralizing healthcare management to the district level. We conducted a qualitative study to explore health workers' perceptions regarding the effectiveness of LPHCR in enhancing the primary health care system. METHODS: We conducted 21 semi-structured key informant interviews (KII) with healthcare workers and Ministry of Health officials purposively sampled from various levels of Lesotho's health system, including the central Ministry of Health, district health management teams, health centers, and community health worker programs in four pilot districts of the LPHCR initiative. The World Health Organization's health systems building blocks framework was used to guide data collection and analysis. Interviews assessed health care workers' perspectives on the impact of the LPHCR initiative on the six-health system building blocks: service delivery, health information systems, access to essential medicines, health workforce, financing, and leadership/governance. Data were analyzed using directed content analysis. RESULTS: Participants described benefits of decentralization, including improved efficiency in service delivery, enhanced accountability and responsiveness, increased community participation, improved data availability, and better resource allocation. Participants highlighted how the reform resulted in more efficient procurement and distribution processes and increased recognition and status in part due to the empowerment of district health management teams. However, participants also identified limited decentralization of financial decision-making and encountered barriers to successful implementation, such as staff shortages, inadequate management of the village health worker program, and a lack of clear communication regarding autonomy in utilizing and mobilizing donor funds. CONCLUSION: Our study findings indicate that the implementation of decentralized primary health care management in Lesotho was associated a positive impact on health system building blocks related to primary health care. However, it is crucial to address the implementation challenges identified by healthcare workers to optimize the benefits of decentralized healthcare management.

The determinants of legislation for radiofrequency electromagnetic fields (RF-EMFs) with the onset of 5G: An empirical analysis with a worldwide cross-sectional dataset.

The unprecedented exposure of radiofrequency electromagnetic field (RF-EMF) to humans from mobile communications raises serious public concern about the possibility of unexpected adverse health effects and has stimulated authorities to adopt precautionary exposure limits. These limits are distinctly different across countries, and the causes of these differences are unclear from the literature. This article is the first empirical analysis on the determinants of RF-EMF exposure legislation, using a novel cross-sectional database of 164 countries worldwide. The analysis shows that decentralization and mobile competition in countries with low mobile network deployment tend to promote more stringent RF-EMF exposure limits across the dataset with 164 countries. In more decentralized countries, the regions had a greater influence on national legislation and could accommodate local demands with the advent of mobile technology in the 2000s. In contrast, decentralization and mobile competition in countries with high levels of mobile network deployment tend to relax RF-EMF exposure limits in the sample of 61 countries with fifth-generation (5G) technology. Indeed, restrictive RF-EMF exposure limits are constraining 5G deployment in a context of the widespread adoption of mobile-broadband technologies. These results should be useful for policymakers and mobile operators alike to anticipate the outcome of legislation in countries that have yet to introduce 5G technology. The results should also be useful when reviewing policies and strategies for the implementation of the upcoming 6G technology in frequency bands that will be increasingly higher (above 6 GHz up to THz for very local usage), and hence where the health effects on humans are less well studied.

Decentralization of the health system - experiences from Pakistan, Portugal and Brazil.

BACKGROUND: Decentralization of a health system is a complex and multidimensional phenomenon that demands thorough investigation of its process logistics, predisposing factors and implementation mechanisms, within the broader socio-political environment of each nation. Despite its wide adoption across both high-income countries (HICs) and low-and-middle-income countries (LMICs), empirical evidence of whether decentralization actually translates into improved health system performance remains inconclusive and controversial. This paper aims to provide a comprehensive description of the decentralization processes in three countries at different stages of their decentralization strategies - Pakistan, Brazil and Portugal. MAIN BODY: This study employed a systematic analysis of peer-reviewed academic journals, official government reports, policy documents and publications from international organizations related to health system decentralization. A comprehensive search was conducted using reputable databases such as PubMed, Google Scholar, the WHO repository and other relevant databases, covering the period up to the knowledge cutoff date in June 2023. Information was systematically extracted and organized into the determinants, process mechanics and challenges encountered during the planning, implementation and post-decentralization phases. Although decentralization reforms have achieved some success, challenges persist in their implementation. Comparing all three countries, it was evident that all three have prioritized health in their decentralization reforms and aimed to enhance local decision-making power. Brazil has made significant progress in implementing decentralization reforms, while Portugal and Pakistan are still in the process. Pakistan has faced significant implementation challenges, including capacity-building, resource allocation, resistance to change and inequity in access to care. Brazil and Portugal have also faced challenges, but to a lesser extent. The extent, progress and challenges in the decentralization processes vary among the three countries, each requiring ongoing evaluation and improvement to achieve the desired outcomes. CONCLUSION: Notable differences exist in the extent of decentralization, the challenges faced during implementation and inequality in access to care between the three countries. It is important for Portugal, Brazil and Pakistan to address these through reinforcing implementation strategies, tackling inequalities in access to care and enhancing monitoring and evaluation mechanism. Additionally, fostering knowledge sharing among these different countries will be instrumental in facilitating mutual learning.

Blockchain Based Decentralized and Proactive Caching Strategy in Mobile Edge Computing Environment.

In the mobile edge computing (MEC) environment, the edge caching can provide the timely data response service for the intelligent scenarios. However, due to the limited storage capacity of edge nodes and the malicious node behavior, the question of how to select the cached contents and realize the decentralized security data caching faces challenges. In this paper, a blockchain-based decentralized and proactive caching strategy is proposed in an MEC environment to address this problem. The novelty is that the blockchain was adopted in an MEC environment with a proactive caching strategy based on node utility, and the corresponding optimization problem was built. The blockchain was adopted to build a secure and reliable service environment. The employed methodology is that the optimal caching strategy was achieved based on the linear relaxation technology and the interior point method. Additionally, in a content caching system, there is a trade-off between cache space and node utility, and the caching strategy was proposed to solve this problem. There was also a trade-off between the consensus process delay of blockchain and the caching latency of content. An offline consensus authentication method was adopted to reduce the influence of the consensus process delay on the content caching. The key finding was that the proposed algorithm can reduce latency and can ensure the security data caching in an IoT environment. Finally, the simulation experiment showed that the proposed algorithm can achieve up to 49.32%, 43.11%, and 34.85% improvements on the cache hit rate, the average content response latency, and the average system utility, respectively, compared to the random content caching algorithm, and it achieved up to 9.67%, 8.11%, and 5.95% increases, successively, compared to the greedy content caching algorithm.

Toward Verification of DAG-Based Distributed Ledger Technologies through Discrete-Event Simulation.

As the potential of directed acyclic graph (DAG)-based distributed ledgers in IoT systems unfolds, a need arises to understand their intricate dynamics in real-world scenarios. It is well known that discrete event simulations can provide high-fidelity evaluations of protocols. However, there is a lack of public discrete event simulators capable of assessing DAG-based distributed ledgers. In this paper, a discrete-event-based distributed ledger simulator is introduced, with which we investigate a custom Python-based implementation of IOTA's Tangle DAG protocol. The study reveals the dynamics of Tangle (particularly Poisson processes in transaction dynamics), the efficiency and intricacies of the random walk in Tangle, and the quantitative assessment of node convergence. Furthermore, the research underscores the significance of weight updates without depth limitations and provides insights into the role, challenges, and implications of the coordinator/validator in DAG architectures. The results are striking, and although the findings are reported only for Tangle, they demonstrate the need for adaptable and versatile discrete event simulators for DAG architectures and tip selection methodologies in general.

Fiscal decentralization, leader localization, and reduction of pollution and carbon emissions -empirical evidence from China's fiscal "province-managing-county" reform.

The fiscal system plays an important role in the government's environmental governance efforts. There is currently no consensus on how fiscal structure adjustments impact pollution and carbon reduction. This paper uses China's fiscal "province-managing-county" reform (FPMCR) implemented in 2004 as a quasi-natural experiment, utilizing panel data from 1670 counties in China from 2000 to 2020 to investigate the impact of fiscal decentralization on reduction pollution and carbon emissions (RPCE), as well as its underlying mechanisms. The results show that (1) from 2000 to 2020, China's RPCE shows an overall trend of fluctuating increase, with its value turning positive after 2013. China's RPCE exhibits a spatial pattern characterized by "lower in the north, higher in the south; higher in the east, lower in the west". (2) After implementing FPMCR, the RPCE levels in reformed counties decreased by -1.44%, showing that reformed county-level governments prioritize economic development over environmental protection. (3) The mechanism analysis found that after implementing FPMCR, reformed counties experienced a 9.16% increase in nighttime light intensity (NLI), and a 3.99% and 4.34% increase in the number of large-scale industrial enterprises (NLIE) and industrial agglomeration (IA), respectively. This suggests that FPMCR leads to radical urbanization and rapid industrialization in counties, which is detrimental to the improvement of RPCE levels. (4) The spatial heterogeneity analysis found that FPMCR's impact coefficient on RPCE levels in the eastern regions is -1.96%, while in the western regions it is -1.16%. This indicates that reformed counties in the eastern regions are more likely to invest expanded fiscal resources in economic development projects, leading to a decrease in RPCE levels. (5) The temporal heterogeneity analysis found that after the promulgation of the "Three-Year Action Plan to Win the Blue Sky Defense Battle" in 2018, the adverse impact of FPMCR on RPCE is completely reversed, leading to a 1.76% increase in RPCE levels. (6) Further analysis reveals that localizing leaders can slow down the promotion of county-level urbanization and industrialization by the FPMCR, benefiting the improvement of RPCE levels. In other words, "the outsider monk will not recite scriptures as well as a local one". This study has clarified the causal relationship and underlying mechanisms between fiscal decentralization and environmental governance, providing reliable theoretical support for optimizing grassroots fiscal systems and reducing environmental pollution in other transitional economies. It enriches the field of environmental economics related to fiscal decentralization.

Experiences of patients on cancer treatment regarding decentralization of oncology services at a tertiary hospital in the Eastern Cape.

BACKGROUND: The cancer burden is a global public health concern associated with high morbidities and mortalities. Low and middle-income countries are more affected including South Africa. Limited access to oncology services contributes to the late presentation, late diagnosis, and treatment of cancer. In the Eastern Cape, oncology services were previously centralized with negative effects on the quality of life of the already compromised health status of the oncology patients. To mitigate the situation, a new oncology unit was opened to decentralize oncology services in the province. Little is known about the experiences of patients after this transformation. That prompted this inquiry. AIM: This study aims to explore the experiences of cancer patients regarding the decentralization of oncology services at a tertiary hospital in the Eastern Cape. METHODOLOGY: A qualitative approach with a descriptive, explorative, and contextual design was undertaken, to obtain the perspective of oncology recipients following the decentralization of oncology services at a selected public tertiary hospital in the Eastern Cape. After obtaining ethical clearance and permission to conduct the study, interviews were conducted with 19 participants. All interviews were transcribed verbatim against their audio recordings. Field notes were taken by the primary researcher. The concept of trustworthiness was used to ensure rigour throughout this study. Thematic analysis was done using Tesch's approach to open coding in qualitative research. RESULTS: Three themes emerged from the data analysis: 1) Access to oncology services; 2) Oncology services provided; and 3) Need for improved infrastructural facilities. CONCLUSION: The majority of patients had positive experiences with the unit. The waiting time was acceptable, and medication was available. Access to services was improved. The staff had a positive attitude towards patients receiving cancer treatment.

Telehealth utilization in gynecologic oncology clinical trials.

OBJECTIVE: Prior to the COVID-19 pandemic, telehealth visits and remote clinical trial operations (such as local collection of laboratory tests or imaging studies) were underutilized in gynecologic oncology clinical trials. Current literature on these operational changes provides anecdotal experience and expert opinion with few studies describing patient-level safety data. We aimed to evaluate the safety and feasibility of telehealth and remote clinical trial operations during the COVID-19 Pandemic. METHODS: Gynecologic oncology patients enrolled and actively receiving treatment on a clinical trial at a single, academic institution during the designated pre-Telehealth and Telehealth periods were identified. Patients with at least 1 provider or research coordinator telehealth visit were included. Patient demographics, health system encounters, adverse events, and protocol deviations were collected. Pairwise comparisons were performed between the pre-Telehealth and Telehealth period with each patient serving as their own control. RESULTS: Thirty-one patients met inclusion criteria. Virtual provider visits and off-site laboratory testing increased during the Telehealth period. Delays in provider visits, imaging, and laboratory testing did not differ between time periods. Total and minor protocol deviations increased in incidence during the Telehealth period and were due to documentation of telehealth and deferment of non-therapeutic testing. Major protocol deviations, emergency department visits, admissions, and severe adverse events were of low incidence and did not differ between time periods. CONCLUSIONS: Telehealth and remote clinical trial operations appeared safe and did not compromise clinical trial protocols in a small, single institutional study. Larger scale evaluations of such trial adaptations should be performed to determine continued utility following the Pandemic.

Evaluation of a decentralized investigational drug service pharmacist in a cancer clinical trial infusion unit.

INTRODUCTION: Investigational drug service (IDS) oversees and manages use of investigational products. There is limited data on utility of pharmacy services in clinical trial conduct and outcomes, specifically on the value of a decentralized IDS pharmacist. METHODS: This is a quasi-experimental study conducted in an oncology clinical trial infusion unit. A retrospective chart review was done to reflect current practice from January through June 2022. A decentralized IDS pharmacist was piloted in December 2022. Data collected included number and types of consults, personnel requesting the consult, and intervention performed. A satisfaction questionnaire was conducted after the pilot program. RESULTS: A total of 16.3% (173 of 1062 patient visits) of pharmacy consults were completed in the centralized IDS pharmacy model, while 44.5% (81 of 182 patient visits) of pharmacy consults were completed during the decentralized IDS pharmacist pilot, p < .001. Decentralized IDS pharmacist completed 77% (62/81) of the consults during the pilot period. Most common types of consults were toxicity management (20%), electronic medical record issues (17%), and tubing and drug administration issues (16%). More than 80% of respondents to the satisfaction questionnaire responded that implementation of a decentralized IDS pharmacist is acceptable, appropriate, and feasible. CONCLUSION: This pilot study demonstrated that a decentralized IDS pharmacist in an oncology clinical trial infusion unit improved accessibility to an IDS pharmacist, increased pharmacy consults relevant to patient care and optimized centralized pharmacists medication distribution workflow. Further studies are needed to evaluate patient benefits from implementing decentralized IDS pharmacist in direct patient care activities.

Decentralized Policy-Hidden Fine-Grained Redaction in Blockchain-Based IoT Systems.

Currently, decentralized redactable blockchains have been widely applied in IoT systems for secure and controllable data management. Unfortunately, existing works ignore policy privacy (i.e., the content of users' redaction policies), causing severe privacy leakage threats to users since users' policies usually contain large amounts of private information (e.g., health conditions and geographical locations) and limiting the applications in IoT systems. To bridge this research gap, we propose PFRB, a policy-hidden fine-grained redactable blockchain in decentralized blockchain-based IoT systems. PFRB follows the decentralized settings and fine-grained chameleon hash-based redaction in existing redactable blockchains. In addition, PFRB hides users' policies during policy matching such that apart from successful policy matching, users' policy contents cannot be inferred and valid redactions cannot be executed. Some main technical challenges include determining how to hide policy contents and support policy matching. Inspired by Newton's interpolation formula-based secret sharing, PFRB converts policy contents into polynomial parameters and utilizes multi-authority attribute-based encryption to further hide these parameters. Theoretical analysis proves the correctness and security against the chosen-plaintext attack. Extensive experiments on the FISCO blockchain platform and IoT devices show that PFRB achieves competitive efficiency over current redactable blockchains.

Relating fiscal decentralization and financial inclusion to environmental sustainability: Criticality of natural resources.

This study deals with a novel perspective on how natural resource dependence (NRD) and natural resource abundance (NRA) moderate the effects of fiscal decentralization and financial inclusion on energy and carbon intensity. Our work develops on the Stochastic Impacts by Regression on Population, Affluence, and Technology framework, considering the selected seven Organization for Economic Co-operation and Development members as the investigative laboratory from 1995 through 2018. Employing a panel Method of Moments Quantile Regression with fixed effects, we find that fiscal decentralization is beneficial for environmental sustainability, especially across the countries with a higher level of energy and carbon intensity; however, enhanced financial inclusivity is detrimental to the environmental quality, with more visible effects in more energy-efficient economies. As per the direct effects, NRD and NRA mitigate energy and carbon efficiency, with more substantial contributions in less energy- and carbon-intensive countries. Concerning the indirect effects, NRD and NRA positively moderate the influence of fiscal decentralization and financial inclusion on energy and carbon intensities, displaying more substantial effects in more energy-efficient economies. Among other control variables, environmental innovation, renewable electricity, employment to population ratio, and economic progress enhance environmental sustainability. We suggest fiscal decentralization should be built on a more transparent and accountable subnational governmental setup to prevent rent-seeking and fragile environmental protection. We also recommend inclusive finance should enhance the access to and affordability of financial services to economic agents for green consumption and investment ventures to achieve environmental sustainability, among other Sustainable Development Goals.

Assessing the impact of economic growth target constraints on environmental pollution: Does environmental decentralization matter?

In the context of the goal of "carbon neutrality", an economic development model that achieves emission reduction goals and ensures stable economic growth is currently being advocated by China. Based on provincial panel data in China from 2005 to 2016, we analyse the impact of economic growth target (EGT) constraints on environmental pollution using a spatial econometric method. The results indicate that EGT constraints significantly exacerbate environmental pollution in local regions and adjacent areas. Local governments are motivated to achieve economic growth goals at the expense of the ecological environment. The positive effects are attributed to a reduction in environmental regulation (ER), industrial structure upgrading and technological innovation and an increase in foreign direct investment (FDI). Moreover, environmental decentralization (ED) plays a positive regulatory role and can weaken the adverse influences of EGT constraints on environmental pollution. Interestingly, the nonlinear impact of EGT constraints on environmental pollution relies on different types of ED. Environmental administration decentralization (EDA) and environmental supervision decentralization (EDS) can reduce the positive effect of EGT constraints on environmental pollution, while an improvement in environmental monitoring decentralization (EDM) can increase the promoting influences of the constraints of economic growth goals on environmental pollution. The above conclusions still hold under a series of robustness tests. Based on the above findings, we suggest that local governments set scientific growth targets, establish scientific assessment indicators for officials, and optimize the ED management institution.

Feasibility, effectiveness and cost of a decentralized HCV care model among the general population in Delhi, India.

BACKGROUND AND AIMS: India has a significant burden of hepatitis C virus (HCV) infection and has committed to achieving national elimination by 2030. This will require a substantial scale-up in testing and treatment. The "HEAD-Start Project Delhi" aimed to enhance HCV diagnosis and treatment pathways among the general population. METHODS: A prospective study was conducted at 5 district hospitals (Arm 1: one-stop shop), 15 polyclinics (Arm 2: referral for viral load (VL) testing and treatment) and 62 screening camps (Arm 3: referral for treatment). HCV prevalence, retention in the HCV care cascade, and turn-around time were measured. RESULTS: Between January and September 2019, 37 425 participants were screened for HCV. The median (IQR) age of participants was 35 (26-48) years, with 50.4% male and 49.6% female. A significantly higher proportion of participants in Arm 1 (93.7%) and Arm 3 (90.3%) received a VL test compared with Arm 2 (52.5%, P < .001). Of those confirmed positive, treatment was initiated at significantly higher rates for participants in both Arms 1 (85.6%) and 2 (73.7%) compared to Arm 3 (41.8%, P < .001). Arm 1 was found to be a cost-saving strategy compared to Arm 2, Arm 3, and no action. CONCLUSIONS: Delivery of all services at a single site (district hospitals) resulted in a higher yield of HCV seropositive cases and retention compared with sites where participants were referred elsewhere for VL testing and/or treatment. The highest level of retention in the care cascade was also associated with the shortest turn-around times.

Assessing engagement of scheduled tribe communities in the functioning of Village Health Sanitation & Nutrition Committees in India.

India is home to the largest population of indigenous tribes in the world. Despite initiative of the National Rural Health Mission, now National Health Mission (NHM) and various tribal development programmes since India's Independence, disparity in healthcare for Scheduled Tribes (STs) prevails. The constitution of Village Health Sanitation and Nutrition Committees (VHSNCs) in 2007 by the NHM is a step towards decentralized planning and community engagement to improve health, nutrition and sanitation services. VHSNCs are now present in almost all States of the country. However, several reports including the 12th Common Review Mission report have highlighted that these committees are not uniformly following guidelines and lack clarity about their mandates, with no clear visibility of their functioning in tribal areas. Therefore, this review was conducted to assess the participation of the VHSNCs in tribal dominated States in order to know in detail about their functioning and gaps if any that require intervention. Several deviations from the existing guidelines of NHM were identified and we concluded that in order to sustain and perform well, VHSNCs not only require, mobilization and strict monitoring but also motivation and willingness of its members to bring in a radical change at the grassroot level. With continuous supervision and support from both the Government and various non-governmental organizations, handholding, strategic deployment of workforce, community participation and sustained financial support, VHSNCs would be able to facilitate delivery of better healthcare to the indigenous population.

HIV-related stigma and discrimination among health care workers during early program decentralization in rural district Gunungkidul, Indonesia: a cross-sectional study.

BACKGROUND: Expanding HIV services by decentralizing provision to primary care raises a possible concern of HIV-related stigma and discrimination (SAD) from health care workers (HCWs) as new service points gain experience in HIV care delivery during early implementation. We surveyed indicators and examined the correlates of HIV-related SAD among HCWs in a decentralizing district of rural Gunungkidul, Indonesia. METHODS: We conducted a cross-sectional survey on a random stratified sample of 234 HCWs in 14 public health facilities (one district hospital, 13 primary health centers [PHC]) during the second year of decentralization roll-out in the district. We computed the prevalence of SAD indicators and used multivariable logistic regression to identify the correlates of these SAD indicators. RESULTS: The prevalence of SAD among HCWs was similarly high between hospital and PHC HCWs for fear of HIV transmission (~71%) and perceived negative image of PHIV (~75%). Hospital HCWs exhibited somewhat lower avoidance of service duties (52.6% vs. 63.7%; p = 0.088) with weak evidence of a difference and significantly higher levels of discriminatory practice (96.1% vs. 85.6%; p = 0.009) than those working in PHCs. Recent interactions with PLHIV and receipt of training lowered the odds of fear of HIV transmission (p <0.021). However, the odds of avoiding care duties increased with receipt of training (p =0.003) and decreased for hospital HCWs (p = 0.030). HIV knowledge lowered the odds of discriminatory practice (p = 0.002), but hospital facility and nurse/midwife cadres were associated with increased odds of discriminatory practices (p <0.021). No significant correlate was found for perceived negative image of PLHIV. CONCLUSION: HIV-related SAD among HCWs can be prevalent during early decentralization, highlighting the need for timely or preparatory interventions with a focus on building the capacity of hospital and non-physician workforce for positive patient-provider interactions when delivering HIV care.

Blockchain Private File Storage-Sharing Method Based on IPFS.

Under the current national network environment, anyone can participate in publishing. As an important information resource, knowledge files reflect the workload of publishers. Moreover, high-quality knowledge files can promote the progress of society. However, pirated inferior files have the opposite effect. At present, most organizations use centralized servers to centrally manage the knowledge files released by users. In addition, it is necessary to introduce an untrusted third party to examine and encrypt the contents of files, which leads to an opaque process of file storage transactions, tampering with intellectual copyright, and the inability to have consistent systems of file management among institutions due to the lack of uniform standards for the same intellectual files. The purpose of this paper is to ensure the safe storage of knowledge files on the one hand and to realize efficient sharing of copyrighted files on the other hand. Therefore, this paper combines NDN (Named Data Network) technology with a distributed blockchain and an Interplanetary File System (IPFS) and proposes a blockchain knowledge file storage and sharing method based on an NDN. The method uses the NDN itself for the file content signature and encryption, thereby separating the file security and transmission process. At the same time, the method uses a flexible NDN reverse path forwarding and routing strategy, combining an IPFS private storage network to improve the safety of the encrypted data storage security. Finally, the method takes advantage of all participating nodes consensus and shares files in the synchronized blockchain to ensure traceability. This paper introduces the structure and principles of the method and describes the process of file upload and transfer. Finally, the performance of the method is compared and evaluated, and the advantages and disadvantages of the method and the future research direction are summarized.

Blockchain-Cloud Integration: A Survey.

Over the last couple of years, Blockchain technology has emerged as a game-changer for various industry domains, ranging from FinTech and the supply chain to healthcare and education, thereby enabling them to meet the competitive market demands and end-user requirements. Blockchain technology gained its popularity after the massive success of Bitcoin, of which it constitutes the backbone technology. While blockchain is still emerging and finding its foothold across domains, Cloud computing is comparatively well defined and established. Organizations such as Amazon, IBM, Google, and Microsoft have extensively invested in Cloud and continue to provide a plethora of related services to a wide range of customers. The pay-per-use policy and easy access to resources are some of the biggest advantages of Cloud, but it continues to face challenges like data security, compliance, interoperability, and data management. In this article, we present the advantages of integrating Cloud and blockchain technology along with applications of Blockchain-as-a-Service. The article presents itself with a detailed survey illustrating recent works combining the amalgamation of both technologies. The survey also talks about blockchain-cloud services being offered by existing Cloud Service providers.