Contracting retail pharmacies as a source of essential medicines for public sector clients in low- and middle-income countries: a scoping review of key considerations, challenges, and opportunities.

BACKGROUND: Insurances in high-income countries (HIC) often contract with private community pharmacies to dispense medicines to outpatients. In contrast, dispensing of medicines in low- and middle-income countries (LMICs) often lacks such contractual arrangements. Furthermore, many LMICs lack sufficient investment in supply chains and financial and human resources to guarantee stock levels and services at public medicine-dispensing institutions. Countries striving to achieve universal health coverage (UHC) can, in principle, incorporate retail pharmacies into their supply chains to expand access to essential medicines (EMs). The objectives of this paper are (a) to identify and analyze key considerations, opportunities and challenges for public payers when contracting out the supply and dispensing of medicines to retail pharmacies and (b) to provide examples of strategies and policies to address these challenges. METHODS: A targeted literature strategy was used to conduct this scoping review. We created an analytical framework of key dimensions: (1) governance (including medicine and pharmacy regulation); (2) contracting (3) reimbursement; (4) medicine affordability (5) equitable access; and (6) quality of care (including 'patient-centered' pharmaceutical care). Using this framework, we selected a mix of three HIC and four LMIC case studies and analyzed the opportunities and challenges encountered when contracting retail pharmacies. RESULTS: From this analysis, we identified a set of opportunities and challenges that should be considered by public payers considering public-private contracting: (1) balancing business viability with medicine affordability; (2) incentivizing equitable access to medicines; (3) ensuring quality of care and delivery of services; (4) ensuring product quality; (5) task-sharing from primary care providers to pharmacies and (6) securing human resources and related capacity constraints to ensure sustainability of the contract. CONCLUSION: Public-private partnerships offer opportunities to improve access to EMs. Nonetheless, managing these agreements is complex and is influenced by a variety of factors. For effective contractual partnerships, a systems approach is needed in which business, industry and regulatory contexts are considered in tandem with the health system. Special attention should be devoted to rapidly changing health contexts and systems, such as changes in patient preferences and market developments brought about by the COVID-19 pandemic.

Introduction

The distribution of the first funds of the European recovery plan, the progressive lifting of Covid restrictions, the work of the Conference on the Future of Europe and the geopolitical tension caused by Russia's invasion of Ukraine have marked European news in the first months of 2022. In this uncertain and worrying context, the European Union (EU) is striving to address the important challenges it confronts, such as the climate transition, digitalisation, security at its external borders and strategic autonomy, among others. The response given to these challenges will determine not only the position of the EU on the world stage, but also the sustainability of the European project itself in the coming years.

Research Paper: Investigating the Role of Empathy in Psychological Capital Impact on Stress Caused by Contracting COVID-19 in Nurses: A Case Study of Nurses of Tehran Oil Hospital

Background: Rapid transmission and sudden outbreak of new coronavirus have caused widespread stress among the community and treatment staff. Regarding the consecutive peaks of the disease, its persistence stress, in the long run, creates destructive effects and leads to physical weakness and psychological complications. Hence, the present study seeks to find proper ways to promote psychological capital and reduce the stress of contracting COVID-19 with the mediating role of empathy. Materials and Methods: The present research was an applied and analytical study. It is a cross-sectional study conducted in 2020. The study's statistical population comprised 510 nurses working in Tehran Oil Industry Hospital. Using a simple random sampling method and Krejcie and Morgan table, a sample of 160 was selected. The data collection tool was a standard questionnaire whose validity and reliability have been confirmed. For data analysis, we used the structural equation modeling method and the Pearson correlation test to examine the relationship between variables. Results: The findings showed the significant and direct effect of psychological capital on empathy and a significant inverse impact of both empathy and psychological capital on the stress of contracting COVID-19 in nurses. The mediating role of empathy in the relationship between psychological capital and contracting COVID-19 stress was also confirmed. Conclusion: Accordingly, by promoting the components of psychological capital in nurses, the hospital managers can prepare them for daily stress during the coronavirus epidemic. Also, by strengthening the empathy indicators in employees along with psychological capital, the tensions related to this disease can be overcome more than ever. © 2022, Negah Institute for Scientific Communication. All rights reserved.

ESG performance and loan contracting in an emerging market

In this paper, we find that better environmental, social and governmental (ESG) performance is associated with a greater magnitude of bank loans and a lower ratio of guaranteed loans in China. The relation is mainly driven by social and governmental factors while the environmental factor plays an insignificant role. Our main findings are robust to a battery of sensitivity tests, including alternative measures of ESG performance and bank-loan contracting, as well as different approaches to address potential endogeneity. Additional analysis indicates that reduced risk and increased information environment might be channels by which ESG performance affects bank-loan contracting while state ownership and the COVID-19 outbreak moderate that impact. Overall, this paper reveals that in emerging markets, the sub-dimensional ESG factors have heterogeneous impacts on loan contracting that are quite different from those found in developed markets.

Race, ethnicity, psychological factors, and COVID-19 vaccine hesitancy during the COVID-19 pandemic.

We examined the associations between perceived risk, perceived severity, and fear of contracting COVID-19 and vaccine acceptance among different ethnic groups in San José, California. We surveyed 3,797 adults living in San José using a multi-stage, clustered sampling design in which we randomly selected census tracts in San José followed by households within each census tract. We estimated the odds ratio (ORs) for perceived risk, perceived general severity, fear of contracting COVID-19, and vaccine acceptance using regression models. Finally, we assessed the differential impacts of perceived risk, perceived severity, and fear of contracting the COVID-19 on vaccine acceptance by controlling for social-demographic variables. Hispanic/Latino respondents reported higher levels of perceived risk and lower fear of contracting COVID-19 than Asians. Hispanic/Latinos (odds ratio [OR] = 0.48, P < 0.05), Whites (OR = 0.61, P < 0.05), and African Americans (OR = 0.28, P < 0.05) were less likely to report intentions to be vaccinated than Asians. Finally, perceived risk and perceived personal severity were not associated with intentions to be vaccinated, while perceived general severity and fear of contracting COVID-19 were stronger predictors of vaccination intentions. The study highlights the importance of psychological factors in understanding vaccine acceptance across race/ethnicity groups.

CISG and Proactive Contracting: Suspending Performance Under Article 71 CISG in the Time of a Global Pandemic

The profound economic and social impact of the global COVID-19 pandemic put to the test the resilience of commercial relationships, pushing legal academia and practice to consider questions beyond the mere impact of certain institutes of civil or common law tradition: the role of contract law in supporting the survival of affected trading relationships. The discussion under CISG has focused mostly on the interpretation and application of its provisions – notably Art. 79 – but did not go significantly further than that. This paper aims to contribute to the existing discussion in two ways. First is to bring to the table a discussion around a remedy embedded in Art. 71 (1) and (3) CISG: the right of suspending performance. Second is to put such remedy in the context of proactive contracting, demonstrating the potential for its use in structuring and managing the pandemic (or any other event) going forward. The discussion will, therefore, focus on the current interpretation and application of Art. 71 (1) and (3) CISG and will then move to clarify the ideas behind proactive contracting and the ways in which participants in international sales contracts can use Art. 71 (1) and (3) CISG to address performance and adaptability risks within their relationship. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Feasibility of Using Energy Performance Contracting for the Retrofit of Apartment Buildings in Slovakia

This study is focused on the feasibility of using energy performance contracting (EPC) for the retrofit of two apartment buildings constructed using precast concrete technologies in Slovakia decades ago. The retrofit packages were defined, and their suitability for EPC was evaluated through discounted payback. The uncertainties in the profitability calculations were covered by designing five possible economic developments and defining input ranges instead of just single inputs. The measures in the technical systems were shown to be more feasible than the retrofit of the building envelopes. The potential to finance the selected measures for technical systems through EPC was further evaluated. It was shown that, for at least one of the two buildings studied, the EPC was recommended only for the economic developments with a notable increase in energy prices compared to the baseline that referred to the situation before the Covid-19 pandemic. In the best case, the payback was four years for one building and seven years for the other;thus, both were potentially suitable for EPC. However, for a complex retrofit, the EPC must be combined with a different funding source to also finance other retrofit measures.

Public Procurement of Innovative and Technological Solutions in the EU

Smart cities should identify and procure the best technical solutions for their communities and companies while at the same time demonstrating the local economic benefits of public procurement. Whenever possible, the procurement process should increase innovation in sustainability. Public procurement of innovative solutions can contribute to the economic recovery of the EU, especially after the crisis caused by COVID-19 with the help of better and more technologically accessible public investments. It is a means of stimulating the transformation of European economies into digital economies. This paper seeks to explain the use and advantages of public procurement of innovative solutions. The contracting authority acts as the first customer (launch customer) of innovative goods or services that are not yet widely available commercially and are technologically acceptable. Instead of buying a finished product, service or process, the contracting authority acts as the first user and buys a product, service or process that is new to the market and has significant new features in terms of innovation and technological achievements. Therefore, this paper will try to identify how various stakeholders can use innovative and technology-aware public procurement systems procedures and contribute to the accelerated development of digitalization mandated by the European Commission. © 2022 Croatian Society MIPRO.

The Use of Comic Musical Skits to Overcome Fear and Anxiety during the Outbreak of Covid-19 in Nigeria

Nigeria experienced its first index case on 27th February 2020, when an Italian was diagnosed as having contracted Coronavirus. With the rise of Covid cases, social media was agog with myths, fables, information (both true and false), and fake drugs that could be used to cure Coronavirus. This research examines three indigenous-oriented comic musical skits that were aimed at allayed the fear of contracting Covid-19. The theory applied to this study is psychoanalytic. It is argued that comic musical skits were forceful tools used to alleviate the fear of contracting Covid-19.

Strategic purchasing and health systems resilience: Lessons from COVID-19 in selected European countries.

Strategic purchasing is a popular and frequently proposed policy for improving the efficiency and adaptiveness of health systems. The COVID-19 pandemic shocked health systems, creating a test of the adaptability and resiliency of their key features. This research study explores (i) what role purchasing systems and agents played in the COVID-19 pandemic, (ii) if it was strategic, and (iii) how it has contributed to a resilient health system. We conducted a qualitative, comparative study of six countries in the European Union-focusing on three as in-depth case studies-to understand how and when strategic purchasers responded to seven clearly defined health system "shocks" that they all experienced during the pandemic. We found that every case country relied on the federal government to fund and respond to the pandemic. Purchasers often had very limited, and if any then only passive, roles.

COVID-19 in Prisons: State Health Care Contracting and the Pandemic Behind Bars.

The COVID-19 pandemic has had far-reaching consequences, resulting in millions of infections and deaths worldwide. Given the vast impact of the virus and how it has highlighted health care access/treatment concerns within the general public, this study examined how these issues specifically impacted COVID-19 cases and deaths among incarcerated individuals. In particular, we examined how the method of medical care delivery (i.e., provided by correctional versus contracted practitioners) impacted the reported rates of COVID-19 cases/deaths within correctional institutions. Findings indicated that COVID-19 diagnosis and mortality rates were significantly lower in states where at least some health care for incarcerated individuals was directly provided by correctional employees. We offer various explanations for these findings while also highlighting potential key reporting differences between these two forms of correctional health care delivery.

Price Effects Of Vertical Integration And Joint Contracting Between Physicians And Hospitals In Massachusetts

Vertical integration in health care has recently garnered scrutiny by antitrust authorities and state regulators. We examined trends, geographic variation, and price effects of vertical integration and joint contracting between physicians and hospitals, using physician affiliations and all-payer claims data from Massachusetts from the period 2013-17. Vertical integration and joint contracting with small and medium health systems rose from 19.5 percent in 2013 to 32.8 percent in 2017 for primary care physicians and from 26.1 percent to 37.8 percent for specialists. Vertical integration and joint contracting with large health systems slightly declined, whereas geographic variation in these physician affiliations rose. We found that vertical integration and joint contracting led to price increases from 2013 to 2017, from 2.1 percent to 12.0 percent for primary care physicians and from 0.7 percent to 6.0 percent for specialists, with the greatest increases seen in large health systems. These findings can inform policy makers seeking to limit growth in health care prices.

Partnering with Agents: How the Covid-19 Pandemic changed Relations between the UK Government and Public Service Contractors.

The contracting out of public goods and services has become a central feature of the UK's state machinery, with more than £350 billion spent annually on services ranging from rubbish collection to building submarines. In response to the Covid-19 pandemic, the UK government took the unprecedented step of incorporating private providers at a national scale to deliver emergency services which were previously the purview of the state. To achieve this, the government used emergency legislation temporarily to remove competitive tenders and reduced reporting processes. In doing so, it substantially re-orientated its relationship with private providers, moving from a position of a principal granting its authority to deliver services to something more akin to a partner organisation leveraging private resources. This shift in power dynamics, coupled with an ongoing government ambition to expand the UK's public service markets, risks a permanent change in government-provider relations, to the detriment of the UK's contracting out framework.

African Americans views of COVID-19 contact tracing and testing.

Increasing COVID-testing and contact tracing is necessary to control the COVID-19 pandemic considering suboptimal vaccine rates. We conducted semi-structured interviews to explore views towards contact tracing and testing among 62 African Americans. Based on our findings, participants identified COVID-19 testing and contact tracing as beneficial, yet medical and governmental mistrust, stigma associated with SARS-CoV-2, lack of access, poor communication, and costs as major barriers. This study also highlights intervention targets to improve COVID-testing and contact tracing.

Service contracting as a policy response for public transport recovery during the Covid-19 Pandemic: A preliminary evaluation.

We examine and assess the service contracting (SC) program implemented for the first time in Metro Manila, Philippines as a response to the impact of the pandemic on road-based public transport sector. We develop an evaluation framework, consisting of three indicators: social amelioration, increase in transport supply and performance improvement. These indicators are the purported objectives of SC. Using a mix of qualitative and quantitative methods, our evaluation suggests that although SC has brought positive impact in terms of the first two indicators, there is no robust evidence so far that may suggest that SC has improved the performance of public transport service delivery. We also find that while the primary objective of providing social amelioration to affected operators is appropriate during the time of the pandemic, this has also brought challenges in financially sustaining the program and in effecting improvements to public transport services. Our work aims to contribute as an empirical case study on the upsides and downsides of service contracting implemented as a business model for public transport provision during the pandemic.

Investigating students' E-Learning attitudes in times of crisis (COVID-19 pandemic).

With the COVID-19 pandemic affecting the world, the vast majority of students in various educational institutions around the world have changed their learning styles from the physical classroom to digital learning education. Especially the fact that university students take their lessons with e-learning in times of crisis (COVID-19 pandemic) has forced them to spend more time with the computer. This situation will also affect their academic motivation. This research aimed to test whether the fear of contracting COVID-19 (CoVFC) had a moderating effect on the prediction of preservice teachers' academic motivation (AMOTV) with their computer self-efficacy perceptions (CSE). With a combined approach, a single model was employed to test the moderating role of CoVFC and the mediating role of Attitudes towards E-Learning (ATEL) in the prediction of preservice teachers' AMOTV with their CSE. 522 preservice teachers from 21 different branches participated in this research. As a result of the research, the CSE of preservice teachers were determined to predict their AMOTV significantly and positively. The increase in CoVFC was found to have a negative moderating effect on the prediction of AMOTV with the CSE of preservice teachers. Also, ATEL was found to have a partial mediating effect in the relationship between the CSE and AMOTV of preservice teachers.

Fear of Contracting COVID-19: A validation study of the Fear of Contracting COVID-19 Scale in Portuguese adolescents

Introduction: Given the pandemic circumstances, fear may emerge due to uncertainty, the possibility of being infected by SARS-Cov 2 or infecting others. It may also be associated with psychopathological symptoms and impact quality of life resulting from the COVID-19 pandemic. Objective: The current study aimed to examine the factor structure and psychometric properties of the Fear of Contracting COVID-19 Scale (FCCS) in Portuguese adolescents and analyze the relationship between fear of contracting COVID-19 and depression, anxiety and stress symptoms, and with the quality of life of this age group. Method: The sample comprised 269 adolescents (137 boys and 132 girls), aged between 11 and 16 years old, attending the 3rd cycle of basic education. Participants completed a sociodemographic questionnaire, the FCCS, the Depression, Anxiety and Stress Scales (DASS-21), and the KIDSCREEN-10, as a measure of the quality of life in adolescents. Results: The FCCS revealed, as in its original version for adults, a one-dimensional structure, with good adjustment indicators and good reliability. The fear of contracting COVID-19 was associated with anxiety, depression, and stress symptoms, but it did not show a relationship with the adolescents' quality of life. Gender differences showed that the girls present higher levels of fear of contracting COVID-19, more anxiety, depression and stress symptoms, and a worse perception of their quality of life. Conclusions: The Fear of Contracting COVID-19 Scale showed to be suitable for use with adolescents. The fear of contracting COVID-19, although associated with psychopathological symptoms of anxiety, depression and stress, does not seem to be related to the quality of life of adolescents.

Does the Profit Motive Matter? COVID-19 Prevention and Management in Ontario Long-Term-Care Homes.

We introduce evidence that for-profit long-term-care providers are associated with less successful outcomes in coronavirus disease 2019 outbreak management. We introduce two sets of theoretical arguments that predict variation in service quality by provider type: those that deal with the institution of contracting (innovative competition vs. erosive competition) and those that address organizational features of for-profit, non-profit, and government actors (profit seeking, cross-subsidization, and future investment). We contextualize these arguments through a discussion of how contracting operates in Ontario long-term care. That discussion leads us to exclude the institutional arguments while retaining the arguments about organizational features as our three hypotheses. Using outbreak data as of February 2021, we find that government-run long-term-care homes surpassed for-profit and non-profit homes in outbreak management, consistent with an earlier finding from Stall et al. (2020). Non-profit homes outperform for-profit homes but are outperformed by government-run homes. These results are consistent with the expectations derived from two theoretical arguments-profit seeking and cross-subsidization-and inconsistent with a third-capacity for future investment.

Dans cet article, nous présentons quelques éléments de preuve que les fournisseurs de soins de longue durée à but lucratif ont eu de moins bons résultats dans la gestion de la pandémie de la COVID-19. Nous avançons deux séries d'arguments théoriques qui prédisent la variation dans la qualité du service selon le type de fournisseur : ceux qui ont trait à l'institution contractante (concurrence novatrice versus concurrence érosive) et ceux qui s'intéressent aux caractéristiques organisationnelles des acteurs à but lucratif, sans but lucratif et gouvernementaux (recherche de profit, interfinancement et investissement futur). Nous mettons ces arguments en contexte en discutant les façons dont les contrats sont attribués dans le cas des soins de longue durée en Ontario. Cette analyse nous pousse à exclure les arguments institutionnels et à conserver, comme nos trois hypothèses, les arguments sur les caractéristiques organisationnelles. En utilisant les données relatives à l'épidémie à partir de février 2021, nous constatons que les établissements de soins de longue durée gouvernementaux ont surpassé les établissements à but lucratif et sans but lucratif dans la gestion de l'épidémie, ce qui concorde avec une conclusion antérieure par Stall et ses collègues (2020). Ces résultats concordent avec les attentes dérivées de deux arguments théoriques ­ la recherche du profit et l'interfinancement ­ mais pas avec le troisième, celui de l'investissement futur.

Social distancing decreases an individual's likelihood of contracting COVID-19.

Past research has established the value of social distancing as a means of deterring the spread of COVID-19 largely by examining aggregate level data. Locales in which efforts were undertaken to encourage distancing experienced reductions in their rate of transmission. However, these aggregate results tell us little about the effectiveness of social distancing at the level of the individual, which is the question addressed by the current research. Four months after participating in a study assessing their social distancing behavior, 2,120 participants indicated whether they had contracted COVID-19. Importantly, the assessment of social distancing involved not only a self-report measure of how strictly participants had followed social distancing recommendations but also a series of virtual behavior measures of social distancing. These simulations presented participants with graphical depictions mirroring specific real-world scenarios, asking them to position themselves in relation to others in the scene. Individuals' social distancing behavior, particularly as assessed by the virtual behavior measure, predicted whether they contracted COVID-19 during the intervening 4 mo. This was true when considering only participants who reported having tested positively for the virus and when considering additional participants who, although untested, believed that they had contracted the virus. The findings offer a unique form of additional evidence as to why individuals should practice social distancing. What the individual does matters, not only for the health of the collective, but also for the specific individual.

Risk of Contracting COVID-19, Personal Resources and Subjective Well-Being among Healthcare Workers: The Mediating Role of Stress and Meaning-Making.

The latest research suggests that the relationships between the risk of contracting COVID-19, personal resources and subjective well-being have rather an indirect character and can include the occurrence of mediating factors related to meaning-making processes and stress experiences. Protection motivation theory offers a theoretical paradigm that enables these associations to be thoroughly investigated and understood. The current study aimed to examine the mediating roles of meaning-making and stress in the relationship of risk of contracting COVID-19 and personal resources (self-efficacy and meaning in life) with subjective well-being among healthcare workers. A total of 225 healthcare workers from hospitals, medical centres and diagnostic units completed a set of questionnaires during the first few months of the COVID-19 lockdown period (March-May 2020). The results revealed that greater self-efficacy and meaning in life were associated with higher cognitive and affective dimensions of subjective well-being, whereas a lesser risk of contracting COVID-19 was only associated with the higher affective dimension. The central finding demonstrated different mediating roles of stress and meaning-making in the relationship of risk of contracting COVID-19 and personal resources with the cognitive and affective dimensions of subjective well-being. This confirmed the applicability of meaning-oriented and stress management processes for understanding how healthcare workers' well-being is affected during the COVID-19 pandemic.