The Prevention and Public Health initiative in the African Countries - Research Paper Example

and number Final Research Paper submitted Introduction The burden of different types of epidemics and diseases in the African countries continue to present challenging conditions for the development of these regions. The promotion of health and suitable interventions for disease prevention are being made in a cost effective and impactful manner. Both the governments and private enterprises are spending heavily on disease prevention, health promotion and health relief provisions for improving the health outcomes in these countries. The Prevention and Public Health initiative (PPH) in the African countries has emerged as one of the most critical aspects of investment in the global healthcare relief and assistance providing sector. This report is aimed at conducting a study and presenting a paper to the board of directors of a large nonprofit based health relief company regarding the issues about solving the health needs of a poorly developed African Country, Ghana. This report is prepared by keeping in mind the available organizational resources and capabilities , the funding required for the project initiatives , the need for obtaining subsidized medicines from, the major international pharmaceutical organizations functioning across the globe, the need for collecting non generic medication sources, non USDA approved medications and alternate stem cell based medication from different foreign sources. The research is conducted with the ultimate objective of proposing the most suitable and practically feasible expenditure plan including the budgetary propositions, financial controls, funds accounting perspectives, management of public expenditure, analysis of the relevant budgets and financial statements related to the healthcare industry in the country, the financial reporting requirements as per the regulatory requirements of the state government and the management and control of public expenditures. Additionally, these financial management components are critically delved into and evaluated for the purpose of providing sufficient information to the decision making authorities to take key administrative decisions and also apply the financial structures like expenditure plans and budgets as significant financial disciplinary processes and tools. Thesis statement and objectives The healthcare segment has become a booming as well as a crucial sector in terms of importance and effectiveness. The recent focus of the healthcare industry has remained constant on the provision of healthcare and medical aids to the lesser developed or under developed nations in the world like Africa. Many of the regions in South Africa and North Africa have very less convenience of accessing basic medical needs. As such, the access to the advanced medical aids remain a distant dream in these nations. In this respect, both the profit oriented and charitable organizations and institutions are taking up different kinds of initiatives for investing in the poorly developed nations of the world and provide basic to advanced levels of medical services and products to the people in these countries. The thesis statement for this report is “to conduct an analysis of the internal conditions of the nonprofit based healthcare relief providing organization and the external conditions of the selected African country, Ghana with the aim of preparing a report that is to be presented to the board of directors of the organization regarding the financial and strategic ways of solving the problems and challenges and meeting the health needs of the people of Ghana”. The report also includes a comprehensive expenditure plan and budget designed for the organization while considering the funding limitations and prioritizing the key investment requirements and health care service provisions need to deliver a commendable level of healthcare service and medical aids to the people of the Ghana. Discussion and Analysis Suitable information for the report is collected from the secondary data sources including journals, articles, reports and publications related to the healthcare segment, operations of the nonprofit base healthcare organizations and the healthcare sector. The collected data for the research appear is analyzed and interpreted in the most suitable manner so that the specific primary and secondary research objectives are appropriately attained. Both the primary and the secondary data relevant to the research are assessed, studied , analyzed and interpreted through the use of different statistical, quantifiable, non-quantifiable and behavior analyses techniques so as to ensure that all the required formation and interpretations can be gathered. The findings of the study are also presented in the form of an expenditure plan for the nonprofit health relief organization. The expenditure plan and budgetary plans for the company are devised by considering the basic underlying factors like the needs that are to be fulfilled by the organization in the process of providing adequate levels of healthcare and health services to the African country, Ghana and the limitations in the resource and capabilities of the health relief company. This expenditure plan and budget would act as important financial management mechanisms and discipline processes that would support the managing entities of the health relief providing organization to solve the health related issues in the underdeveloped regions of Africa. It is found out that to cater to the primary need of providing large scale health relief and medical services and aid to the people of Ghana, the company has to focus on sourcing the medical aids from a reliable supplier who would provide the products at a low wholesale cost and also have the capability of supplying the medical aids like medicines and medical support systems etc. to the people of Ghana in high volumes and at a consistent manner. Financial forecasting in the healthcare segment is characterized by a high degree of uncertainty. However, any types of healthcare expenditure plans and budgets should be developed by considering all types of positive outcomes, objectives, financial resources and constraints as well as the external situations existing in the country in which Medical aid is to be provided. Additionally, the internal strengths and weaknesses as well as the resources and capabilities of the healthcare service provider should also be considered while forecasting the financial aspects of the organization through the presentation of the expenditure plan and budgets. Apart from these, factors like global influences and social changes, health inequality, cost of Medical aid and medical service system, advancements in the technological and innovative aspects of medicines and medical support systems should also be refereed to while developing the expenditure plan. The expenditure plans of the organization should ideally also taken into account any kind of contingencies or unforeseen circumstances that may arise in the future in the process of the functioning of the organization. Proposed expenditure plan assessing It is identified that the funding capacity of the health care relief providing company is limited to USD 100,000. It is also be pointed out that to provide suitable healthcare aids to a country like Ghana, which has minimum access to medical aids, the organization needs to invest heavily into the various aspects of healthcare service provision. The fact that the country is much underdeveloped and has poor infrastructure is another factor that is to be kept into mind while assessing the existing constraints and challenges in the healthcare service provision sector in this nation. Additionally, the presence of a number of epidemics and diseases and the widespread cases of infections and diseases like malaria, tuberculosis, typhoid, dengue, HIV/AIDS etc., make it clear that the health care relief providing company will have to provide services in much challenging conditions and thus, would need a high funding capability for conducting its operations in a value adding manner (Olden, 2008). The expenditure plan or budget forecast for the organization in its new project is to be developed by noting the regulatory and political requirements of the pharmaceutical industry, the needs of the selected country and the capabilities of the case organization. As such, the expenditure plan of the organization takes into account a number of diverse expense items including medicines, medical services, setting up of the necessary infrastructure for providing medical aid, sourcing of medicines, cost of providing the medical aids to the low income groups of people, cost of the health camps set up by the organization, fund raising and donation initiatives etc. The expenditure plan for the health relief organization is designed for a period of 1 year in which all the probable and certain expense items that would have to be incurred in the project are included. The proposed expenditure plan developed for the health relief providing organization, as prepared under the above discussed guidelines is given as follows: Expenditure plan for the nonprofit based healthcare relief providing organization. Total fund available in the organization   100,000 All expenditures are given in USD (millions)     Expenditure items Percentage Amount HIV, malaria, TB, and reproductive health 14% 14000 Curative care services 5% 5000 Fees of the medical personnel including doctors and nurses 11% 11000 Costs of setting up health camps 10% 10000 Cost of promoting health awareness mechanisms 7% 7000 Health information systems 8% 8000 Disease prevention activities 6% 6000 Health promotion activities 8% 8000 Other miscellaneous public health services 8% 8000 Medical personnel transportation costs 8% 8000 Sourcing of medicines and medical equipment 15% 15000 Total expenses incurred by the organization 100% 100000 The expenditure plan is developed on a standard framework by considering the main items of expense in any kind of health financing activity or project. This expenditure plan is develop by considering the financial resource that already flow into e health care sector at the global level with apaprprite modifications based on the macro and micro economic and healthcare sector specific situations in the selected country, Ghana. The expenditure plan takes into consideration the sources of funding in the organization, the allocation of funding to different types of health services and initiatives, prioritization of funding activities as well as the healthcare reliefs that are to be provided in the country. The expenditure plan is developed by accounting for the financial and funding sources accessed by the healthcare organization, the health providing entity sources like clinics, hospitals, nursing homes, pharmacies, dispensaries and traditional healing service provisions. Additionally, the health care functions like curative care, rehabilitative care, medical products and services, medical administration are also accounted for. The expenditure plan also takes into consideration a number of internal and external factors that may impact the attainment of the project initiatives. These external factors include the external situations of the broad environment, the requirements of the health relief sector in Ghana., the urgency of some health care services and medical aids in the region, the level of health care services and facilities already available in the region, the availability of infrastructural and others support systems that are mandatory to support the successful operation of the project and the acceptance and resistance levels of access to the health relief and medical aids provided to the people in the region . Additionally, the political constructs, the access of external funding sources like the World bank, the International Monetary fund (IMF) and the World Health Organization (WHO) etc., the existing healthcare facilities and the government interventions in the healthcare sector are also accounted for to ensure higher practical feasibility and viability of the health care relief providing schemes and plans taken up by the organization. In addition to these, the internal factors that may impact the success level of the health relief services provided to the people of Ghana are also to be referred to in the designing of the expenditure plan. The internal factors like the availability of physical and financial resources, funds and other support systems are major factors that would help the organization to design the most value adding expenditure plan for the project. Fund accounting and financial controls The fund accounting processes and financial control management aspects are integrated into the expenditure plan or budget forecasts made for the healthcare relief organization. The different types of expenditures are accounted for by considering the weightage of each of the expense variables. Also, the variables and expenditure items are given a percentage weight based on the priority or urgency level of each of the variables for providing health care services in the nation of Ghana. The expenses linked with any kind of operational contingencies and unforeseen demands in the process of porovidng health relief to the people in the country are included in the miscellaneous expenses of the public healthcare services which has been given a weightage of 8%, The provision for sourcing the general medical equipment and medicines are included in the sourcing and procurement expense item in which the organization has to access and source medicines, medical support systems and other varieties of medical aids from different foreign pharmaceutical companies at the best possible prices so that the organization can provide the required level of health relief to the people in Ghana at the most cost effective and time effective manner. In addition to these, the financial management controls and review mechanisms are included in the expenditure plan, the expenses of which are included in the healthcare awareness and promotion cost items in the expenditure or budgetary plan. Management of public expenditures The management of the public expenditures would be a main criteria that should be taken into consideration while developing the expenditure plan and the budgets that would decide the allocation of funds of the non-profit organization to various types of medial aids and health services. There are two main kinds of payments that should be taken into account in the perspective of the management of public expenditures in the healthcare segment. These are the direct payments and the indirect payments. The direct payments include the taxes that are paid by the citizens and households of the country, a part of which then is used by the state government for financing the healthcare system. Since, till date there is no such system that has been incorporated in Ghana, therefore, the payment of personal taxes remain a nullified account in the public expenditure management. However, the payment of taxes to the government would be a consideration for the nonprofit based healthcare organization in its home country of existence and thus, would be a key expenditure item for the organization (Panayiotis and Roupas, 2009). The direct payments for healthcare services also include the monetary contributions that people make towards the culinary and mandatory health insurance schemes or other types of health related prepayment schemes. Thus, if the company wants to set up any kind of health care service provision system in the country, then, either it has to tie up with some health insurance providing company or would have to allocate sufficient amounts of resources towards the development of health insurance service provisions. Some amount of funding can also be allocated towards the contributions or payments made to the local health service providing cooperatives with whom the organization can work together for providing suitable healthcare aids to the people of Ghana. The direct payments would include the user payments which occur in direct relation to the services provided to the common people and which are paid by the users directly to the healthcare relief providing companies. These include the disbursement of money and includes all types of costs and expenses that any individual bears for the purpose of getting the medical aid. A second type of direct user payment include the payments that is made by the individuals for the purpose of transportation to and from the medical aid provider. Figure 1: Key payments made in the healthcare industry (Source: Cleverley, Song and Cleverley, 2011) In the case of Ghana, these kinds of costs would have to be managed very carefully and kept at the minimum possoble level because of the fact that the economic condition of Ghana is not sound enough for the low income groups of residents to bear the burdens of the expenditures for any kinds of medical aids. Thus, the cost of medicne, the costs of accessing health care, lodging for medical care, purchase of medicines, medical drugs and other types of medical supplies would have to be primarily borne by the company so that it can create a profitable position for the people of the chosen country. The fact that the healthcare relief organization is a nonprofit based organization makes it necessary that it has to try to reduce the public expenditure level for the people of the country in which it is providing its service and at the same time ensure that it is able to procure the necessary medical aids and products at the lowest possible prices so that the organization can continue to function in a sustainable manner. The user fees that are generally charged by the healthcare relief providing organization would not be applicable in the case organization because of its charitable nature of composition and it has to ensure that it is managing the pubic expenditures in the most appropriate manner when considering the delicate financial and economic state of the selected African country. Adherence to the state government financial reporting requirements The healthcare relief providing company also has to abide by the national and international regulatory requirements related to the healthcare service provision as well as adhere to the local government specified financial reporting procedures and international financial reporting standards. In a sub-Saharan African country like Ghana, the expenditures done by the government in health care products and services are extremely low (CBS News, 2014). Therefore the importance of donor funding is more profound in these types of economies. Donor funding remains one of the most crucial sources of revenue for the healthcare segment in Ghana and this involves both public and private sources of revenues. Since, the private spending in the healthcare sector is more than the public spending levels, therefore, the healthcare organization should focus on leveraging on these factors in the external environment and create an all-inclusive and controlled expenditure plan for investing in the healthcare sector of Ghana. While developing the expenditure plan, the organization should consider the fact that the out of pocket payments made in the healthcare sector in Ghana account for a total of 80% of the private spending in the healthcare services and approximately 50% of the total health spending in the country (Rauscher, 2008). The main challenges of providing suitable healthcare services and medical aids to the people of Ghana lies in a wide variety of factors including the low per capita income in the country, lack of suitable infrastructures that would help in service delivery, the constrained potential of the economy for mobilizing the domestic revenues, highly restrictive growth prospects, severe lack of available labor resources and the highest burden of diseases in the world. As such, making financing decisions related to healthcare in these regions and economies are difficult for both the organizations functioning in this segment as well as the governments of these ccountreis. The focus of the government on increasing the probability of using additional resources for having desired outcomes in health benefits and strictly monitoring and adhering to the poverty minimization strategies in the economy would at as key criteria in the formulation of the government reporting standards in these kinds of economies. Other than that the healthcare organization also has to show adequate degree of compliance to the local norms and external regulatory policies governing the healthcare segments in the region. The organization also has to integrate required levels of compliance and conformance to the USDA rules, the rules set by the Food and Drug Administration (FDA) Authority of the United States of America, other key rules related to the patents of medicinal drugs and the trade activity governing regulations like export and import laws as applicable in the country specific and global healthcare segment. Analyzing budgets for making appropriate administrative decisions The official and detailed budget and expenditure plan prepared for the health relief investments that are to be made in the chosen country would be prepared on the basis of the consideration of a period of 1 year. As such, the budget plan prepared for the organization should be analyzed adequately for making all possible corporate decisions related to the project taken up by the health relief organization. These decisions would also encompass any types of plans related to project contingencies and emergencies that may pose as challenges or obstructions to the successful implementation of the project plan. The analysis of the administrative budget prepared by the organization should include all the cotst of running the operation. These costs would encompass both the direct and indirect costs incurred by the organization in the process of implementing the health relief project plan. The analysis of a comprehensive budget would enable the management of the organization to exercise suitable level of control in the day to day activities included in the project. The analysis of the expenditure plan or budget for the organization would also help the management to make accurate estimations and review and measure the progress of the initiative in a timely and useful manner. The budget would act as a key financial management system that would help the organization to have a fair idea about eh requirements of the project and the resources available in the organization. Also, it will help the organization to track resource utilization and thus, make the most effective and optimal allocation of the resources. The budget analysis would support the health relief organization to effectively plan and control the financial aspects of the project and ensure the most effective and efficient use of resources, demonstrate higher levels of accountability, make the most suitable business and corporate decisions, make suitable remedial decisions and take proper control and remedial actions as and when necessary in the course of the project. The low income nations of the world like Ghana are expensing high government expenditures in the arena of health care service provision. All types of low income countries including Ghana are attempting to achieve the Millennium Development Goals for healthcare service provision. But the budget constraints in these economies and the high degree of lag in the economic and financial conditions would continue to be matters of concern for both the government authorities and the private organizations functioning in this segment. Therefore, the allocative decisions related to both resources and capabilities would have key implications for the efficiency as well as equity in the healthcare segment of Ghana. So, the healthcare relief providing nonprofit based organization should focus on using the currently available national resources in a manner such that the use of these resources are directed towards key national interventions that would have the greatest amount of positive marginal impacts on the outcomes in the healthcare sector. The factors like political pressure, corruption and tradition would have to be used to create incentives that would help to increase the health resources in a poorly developed country like Ghana by creating the scopes of providing subsidies to the healthcare service providers, specialized diagnostic laboratories, sophisticated medical equipment and other advanced healthcare research institutions (Finkler, Purtell, Calabrese and Smith, 2013). Thus, the company would have to adequately account for sustainability and consider the impacts of different factors and variables in the process of designing its expenditure plan. The expenditure plan should encompass the focus on the future scenarios of healthcare segment expected in the country and the healthcare service goals that are set in the national and international domains of healthcare segments. The organization has to focus on considering the massive recurrent inputs and variables in the healthcare sector which creates the need for a large scale and scope of labor skills and the assurance of the continued availability of a wide variety of supplies of medicines, prescribed drugs and medical equipment like life support systems. Therefore, making the adequate and appropriate use of available resources, establishing clearly developed production functions and maximizing the impact of the healthcare sector on the future prospects of the country should remain a priority of the healthcare service providing organization. Additionally, the organization should considered that in Ghana., the richer segment of people are able to access all the basic to high levels of medical aid, but in contrast, the low income groups of the country do not have access to even the basic amenities related to medical aid and healthcare. For this purpose, overcoming the technical and allocative efficiency problems should be a major concern for the nonprofit based healthcare organization while designing the expenditure plan and budgets for providing Medical aid to the people of Ghana. Given the exactly specified budget constraints, the nonprofit based healthcare organization should embed carefully designed healthcare service provision systems in the health benefit and Medical aid plans (Milliken, 2010).   Restatement of thesis and conclusion The expenditure plan can be referred to as a key financial management tool for managerial decision making processes. Budgets can be used as a main financial management tool for forecasting the spending of an organization and also for taking key administrative decisions from the same. The budges prepared by the company can thus, be used as a main disciplinary process for taking crucial corporate and administrative decisions by the management of any profit based or nonprofit based organization. In the case of the selected health care relief providing organization, the expenditure plan is developed with the use of the proportional weightage method of budget forecasting which takes into account the possible expense items, the costs or values of which are decided on the basis of the priority of these variables or expense items. This expenditure plan can be used by the board of directors of the organization to make critical strategic management and administrative decisions regarding the planning and implementation of different stages of the project or initiative to solve the health issues in Ghana. The intensity of the health issues and challenges in the country makes it necessary for the organization to have a complete and in depth understanding of the possible financial expenditures, requirements of resources and capabilities as well as the challenges and constraints existing in the external environment of the project implementation. The expenditure plan or budget forecast for the coming year, as designed above would act as a key source for taking suitable decisions with relation to the funding initiatives and requirements, sourcing and allocation of funds and would also help the board of directors to assess the feasibility and viability of the project. References CBS News. (2014). Health Care Reform Bill Summary: A Look at what’s in the Bill.  Retrieved from http://www.cbsnews.com/8301-503544_162-20000846-503544.html. Cleverley, W., Song, P. & Cleverley, J. (2011).  Essentials of health care finance (7th Ed).  Sudbury, MA: Jones & Bartlett. Finkler, S. A., Purtell, R.M., Calabrese, T.D., & Smith, D.L. (2013). Financial management for public, health, and not-for-profit organizations (4th Ed.). Upper Saddle River, NJ: Pearson Prentice Hall. Milliken, A. (2010).  Use of volume variance– variance demand analysis in planning strategy formulation.  The Journal of Business Forecasting, Vol. 29(1), p.4.     Olden, P. (2008).  Hospitals, community health, and balanced scorecards.  Academy of Health Care Management Journal, Vol. 4(1), p. 39. Panayiotis, C. &, Roupas, T. (2009).  Health care finance, the performance of public hospitals and financial statement analysis. European Research Studies, Vol.12 (4), p.199.  Rauscher, S. (2008).  Effective hospital revenue cycle management: Is there a trade-off between the amount of patient revenue and the speed of revenue collection/practitioner application.  Journal of Health care Management, Vol.53 (6), p. 392.  Read More