Search Results (412)

Although organizational resilience is well established, refining the systematic quantitative evaluation of health systems resilience (HSR) remains an ongoing opportunity for advancement. Research either focuses on individual HSR indicators, such as social welfare policy, public expenditure, health insurance, healthcare quality, and technology, or broadly examines socio-economic factors, highlighting the need for a more comprehensive methodological approach. This study employed the Slacks-Based Measure (SBM) within Data Envelopment Analysis (DEA) to analyze efficiency by maximizing outputs. It systematically examined key HSR factors across countries, providing insights for improved policymaking and resource allocation. Taking a five-year (2016–2020) dataset that covered 55 to 56 countries and evaluating 17 indicators across governance, health systems, and economic aspects, the paper presents that all sixteen top-ranked countries with a perfect efficiency score of 1 belonged to the high-income group, with ten in Europe, highlighting regional HSR differences. This paper concludes that adequate economic resources form the foundation of HSR and ensure stability and sustained progress. A properly supported healthcare workforce is essential for significantly enhancing health systems and delivering quality care. Last, effective governance and the equitable allocation of resources are crucial for fostering sustainable development and strengthening HSR. Full article

In 1961, Los Angeles experienced the disastrous Bel Air fire, which swept through an affluent neighborhood situated in a hilly, WUI (wildland–urban interface) location. In January 2025, the city was devastated again by a nearly-simultaneous series of wildfires, the most severe of which took place close to the 1961 fire location. Disastrous WUI fires are, unfortunately, an anticipatable occurrence in many U.S. cities. A number of issues identified earlier remained the same. Some were largely solved, while other new ones have emerged. The paper examines the Palisades Fire of January, 2025 in this context. In the intervening decades, the population of the city grew substantially. But firefighting resources did not keep pace. Very likely, the single-most-important factor in causing the 2025 disasters is that the Los Angeles Fire Department operational vehicle count shrank to 1/5 of what it was in 1961 (per capita). This is likely why critical delays were experienced in the initial attack on the Palisades Fire, leading to a runaway conflagration. Two other crucial issues were the management of vegetation and the adequacy of water supplies. On both these issues, the Palisades Fire revealed serious problems. A problem which arose after 1961 involves the unintended consequences of environmental legislation. Communities will continue to be devastated by wildfires unless adequate vegetation management is accomplished. Yet, environmental regulations are focused on maintaining the status quo, often making vegetation management difficult or ineffective. House survival during a wildfire is strongly affected by whether good vegetation management practices and good building practices (“ignition-resistant” construction features) have been implemented. The latter have not been mandatory for housing built prior to 2008, and the vast majority of houses in the area predated such building code requirements. California has also suffered from a highly counterproductive stance on insurance regulation. This has resulted in some residents not having property insurance, due to the inhospitable operating conditions for insurance firms in the state. Because of the historical precedent, the details in this paper focus on the Palisades Fire; however, many of the lessons learned apply to managing fires in all WUI areas. Policy recommendations are offered, which could help to reduce the potential for future conflagrations. Full article

As sustainability becomes a strategic priority across global financial services, its implementation in emerging insurance markets remains insufficiently understood. This study explores the integration of environmental, social, and governance (ESG) principles within Saudi Arabia’s insurance sector, combining content analysis of corporate disclosures with qualitative insights from industry stakeholders. The research investigates how insurers embed ESG principles into their operations, the development of sustainable insurance products, and their perceived financial and regulatory implications. The findings reveal gradual progress in ESG integration, primarily driven by governance reforms aligned with national development agendas, while social and environmental dimensions remain comparatively underdeveloped. Stakeholders identify regulatory ambiguity, data limitations, and technical capacity as persistent barriers, but also point to increasing investor and consumer interest in sustainability-aligned offerings. This study offers policy and managerial recommendations to advance ESG principle adoption, emphasizing standardized disclosures, capacity-building, and product innovation. It contributes to the limited empirical literature on ESG principles in Middle Eastern insurance markets and highlights the sector’s potential role in promoting inclusive and sustainable finance. Full article

Small-scale farms deserve attention and support because they play crucial and important roles. Apart from ensuring provision of food security, they also provide other economic, environmental, and social–cultural benefits. In the United States of America, these farms are agriculturally, culturally, and geographically different. They have varied needs that trigger an array of distinct biophysical, socioeconomic, and institutional challenges. The effects of these challenges are exacerbated by economic uncertainty, technological advancements, climate change, and other environmental concerns. To provide ideal services to the small-scale farm audience, it is necessary to understand these challenges and opportunities that can be leveraged to enhance their productivity and profitability. This article reviews the challenges faced by small-scale farming in the United States of America. It then reviews possible pathways to enhance their productivity and profitability. The review revealed that U.S. small-scale farms face several challenges. They include accessing farmland, credit and capital, lack of knowledge and skills, and technology adoption. Others are difficulties to insure, competition from corporations, and environmental uncertainties associated with climate change. The paper then reviews key pathways to enhance small-scale farmers’ capacities and resilience with a positive impact on their productivity and profitability. They are enhanced cooperative extension services, incentivization, strategic marketing, annexing technology, and government support, among others. Based on the diversity of farms and their needs, responses should be targeted towards individual needs. Since small-scale farm products have an effect on human health and dietary patterns, strategies to increase productivity should be linked to nutrition and health. Full article

Driven by climate change and stringent ecological conservation policies, arid and semi-arid pastoral areas face acute grassland degradation and forage–livestock imbalances. In Sunan County (Gansu Province, China), herders have increasingly turned to off-site grazing—leasing crop fields in adjacent oases during autumn and winter—to alleviate local grassland pressure and adapt their livelihoods. However, the interplay between the evolving land use system (L) and this emergent borrowed pasture system (B) remains under-explored. This study introduces a coupled analytical framework linking L and B. We employ multi-temporal remote sensing imagery (2018–2023) and official statistical data to derive land use dynamic degree (LUDD) metrics and 14 indicators for the borrowed pasture system. Through entropy weighting and a coupling coordination degree model (CCDM), we quantify subsystem performance, interaction intensity, and coordination over time. The results show that 2017 was a turning point in grassland–bare land dynamics: grassland trends shifted from positive to negative, whereas bare land trends turned from negative to positive; strong coupling but low early coordination (C > 0.95; D < 0.54) were present due to institutional lags, infrastructural gaps, and rising rental costs; resilient grassroots networks bolstered coordination during COVID-19 (D ≈ 0.78 in 2023); and institutional voids limited scalability, highlighting the need for integrated subsidy, insurance, and management frameworks. In addition, among those interviewed, 75% (15/20) observed significant grassland degradation before adopting off-site grazing, and 40% (8/20) perceived improvements afterward, indicating its potential role in ecological regulation under climate stress. By fusing remote sensing quantification with local stakeholder insights, this study advances social–ecological coupling theory and offers actionable guidance for optimizing cross-regional forage allocation and adaptive governance in arid pastoral zones. Full article

The Kingdom of Saudi Arabia (KSA) Personal Data Protection Law (PDPL) was enacted in 2021. In its brief three-year existence, the PDPL has attracted significant academic and legal practitioner attention. This critical analysis focuses on three key questions: (1) What are the key PDPL objectives? (2) How does this legislation compare with privacy–data protection approaches adopted in other jurisdictions (notably the European Union General Data Protection Regulation 2016 (GDPR))? and (3) Does the PDPL achieve a reasonable, workable balance between personal data protection (‘data subjects’ interests) and risks associated with personal data being shared with KSA insurers? The analysis confirms that these PDPL measures appear sound, but a definitive assessment of the ‘balance’ objectives highlighted here requires ongoing attention—three years of PDPL use is an insufficient basis to reach final conclusions regarding PDPL fitness for purpose. However, a tentative ‘soundness’ conclusion has reasonable support when the relevant authorities are collectively assessed, particularly regarding the treatment of personal data by KSA insurers in the context of personal insurance policies. Full article

The economic downturns in South Africa present a significant threat, with the potential to disrupt the nation’s notable advances in addressing the persistent challenges of high unemployment, widespread poverty and stark inequality. In the absence of substantial and extensive structural transformation, South Africa’s aspirations to achieve its ambitious development goals may remain unattainable. Building on the precedent of a blend of literature review, comprehensive ex post analysis, and applied general equilibrium modelling tailored for ex ante assessments, this paper assesses options and impacts of alternative ambitious developmental interventions. The results indicate that, despite implementing a variety of strategies, there remains a disheartening underperformance in economic indicators. However, ex ante evaluations indicate that with targeted interventions and supportive government policies, the country can achieve economic growth and job creation. Simulation results identify sectors of personal and social service activities, transport, finance, and insurance as having the most formidable potential to significantly reduce unemployment while simultaneously catalysing robust economic growth. These pivotal sectors, nestled within the broader services and industries, are uniquely poised to bolster overall productivity and diminish unemployment, while adeptly absorbing a considerable influx of highly educated and skilled labour. This suggests that South Africa can decisively accelerate its economic progress by embracing a dual-pronged approach: fostering structural shifts towards manufacturing and services, while steadfastly advancing the upskilling of its dynamic workforce. Full article

This study examines the decision-making processes that were used in the development of the National Disability Insurance Scheme (NDIS). It draws on research that highlights that decision-making can be improved if organisations follow specific decision-making processes. This study sought to examine whether formal decision-making rules and processes were used in the development of the NDIS. Semi-structured interviews were conducted with 58 senior public servants between 2016 and 2021 in the Commonwealth government departments that had policy oversight and responsibility for both the design and implementation of the NDIS. The data showed that there were examples of data-driven decisions and risk analysis used, but also considerable gaps in decision-making processes. These gaps potentially resulted in poorer decision-making quality, which may have negatively impacted the design of the NDIS and could potentially explain some of the current problems with the scheme. The paper concludes with recommendations for future research to improve decision-making processes within public administration. Full article

Amid the global drive to enhance public sector performance in the digital economy era, improving government spending efficiency has become a critical governance objective. This study investigates the impact of digital inclusive finance on government spending efficiency from a digital finance systems perspective using county-level panel data in China’s Yangtze River Delta for the period 2014–2022 and constructing the fixed-effects model and instrumental variable method to estimate the effect of digital inclusive finance and explore its underlying mechanisms. Heterogeneity across regions with varying economic development levels is analyzed, and fiscal pressure is examined as a potential mediating factor. The results indicate that (1) digital inclusive finance significantly enhances government spending efficiency, primarily through broad service coverage and deep usage of digital financial services such as mobile payments, digital credit, and insurance; (2) the positive effect is more pronounced in counties with lower government spending efficiency and economic development; and (3) fiscal pressure acts as a key transmission channel, with broader digital inclusive finance coverage helping to alleviate fiscal stress and improve government spending efficiency. These findings offer empirical insights into the role of digital finance in promoting effective and adaptive public financial governance. Full article

This study investigated the determinants of the Healthcare Quality Index (HQI) in Saudi Arabia over the period from 1990 to 2024. It specifically analyzed the impact of six key variables: Medical Insurance Penetration Rate (MIPR), Gross Domestic Product per Capita (GDP), Unemployment Rate (UR), Inflation Rate (IR), Government Healthcare Expenditure as a Percentage of GDP (GHE), and Foreign Direct Investment in the Healthcare Sector (FDI). Utilizing the Autoregressive Distributed Lag (ARDL) and Vector Error Correction Model (VECM) techniques, this research explored both the short-term dynamics and the long-term equilibrium relationships among these time-series variables, while also accounting for cointegration and potential endogeneity. This study contributes to the existing literature by applying the ARDL and VECM methodologies to comprehensively analyze the combined impact of these factors on HQI within the unique economic and social framework of Saudi Arabia, addressing a notable void in this specific context and exploring both transient fluctuations and sustained equilibrium relationships. The key findings revealed distinct influences across time horizons. In the short term, GDP and GHE significantly and positively affect HQI, whereas UR and IR demonstrate a significant negative impact. Short-term impacts of MIPR and FDI are found to be positive but not statistically significant. The long-term analysis indicates that MIPR, GHE, and FDI have a significant positive influence on HQI, while IR maintains a significant negative impact. GDP and UR effects are not statistically significant in the long term. Further analysis using Granger causality tests and VECM confirmed that MIPR, GDP, GHE, and FDI collectively Granger-cause HQI, with government healthcare expenditure playing a crucial role in correcting short-term deviations toward long-term equilibrium. This study concludes that long-term strategies focusing on expanding insurance coverage, increasing government healthcare investment, and attracting foreign direct investment are vital for significantly enhancing healthcare quality in Saudi Arabia. The sustained positive influence of these factors and the critical role of government spending in maintaining long-term stability underscore their importance for effective healthcare policy. While emphasizing these long-term drivers, policymakers should also remain cognizant of the significant negative short-term fluctuations caused by unemployment and inflation. Full article

The Black–Scholes model is a fundamental concept in modern financial theory. It is designed to estimate the theoretical value of derivatives, particularly option prices, by considering time and risk factors. In the context of agricultural insurance, this model can be applied to premium determination due to the similar characteristics shared with the option pricing mechanism. The primary challenge in its implementation is determining a fair premium by considering the potential financial losses due to crop failure. Therefore, this study aimed to analyze the determination of rainfall index-based agricultural insurance premiums using the standard and fractional Black–Scholes models. The results showed that a solution to the fractional model could be obtained through the Daftardar-Gejji Laplace method. The premium was subsequently calculated using the Black–Scholes model applied throughout the growing season and paid at the beginning of the season. Meanwhile, the fractional Black–Scholes model incorporated the fractional order parameter to provide greater flexibility in the premium payment mechanism. The novelty of this study was in the application of the fractional Black–Scholes model for agricultural insurance premium determination, with due consideration for the long-term effects to ensure more dynamism and flexibility. The results could serve as a reference for governments, agricultural departments, and insurance companies in designing agricultural insurance programs to mitigate risks caused by rainfall fluctuations. Full article

The coronavirus (COVID-19) pandemic has profoundly affected public health and socio-economic structures globally. This research conducted a post-COVID-19 analysis of the role of fiscal support interventions on COVID-19 health regulations such as mandatory non-pharmaceutical interventions like face masks, social distancing, periodic lockdowns which include restrictions on movement, and socio-economic dimensions. This quantitative research obtained 302 responses from different households in the Eastern Cape, Gauteng, Kwa-Zulu Natal, and Limpopo Provinces in South Africa. The results reveal that the relief fund (R350 unemployment grant, unemployment insurance fund claim, and food parcel distribution, among others) mediated the relationship between COVID-19 health regulations and poverty levels and the relationship between COVID-19 health regulations and health and well-being. The relief fund also mediated the relationship between COVID-19 health regulations and employment levels. Support packages from the R500 billion government support, which included loan guarantees, job support, tax and payment deferrals and holidays, social grants, wage guarantees, health interventions, and municipalities support, moderate the relationship between COVID-19 health regulations and the family and social support. These results validate the impact of the fiscal support intervention by the government in mitigating its emergency intervention with COVID-19 health regulations. This strengthens the theory of intervention, highlighting that multiple dynamics make interventions complex as shown by mediation and moderation results. Furthermore, this study highlights intervention being central to the management of the crisis. The study highlights the importance of comprehensive intervention for future preparedness, thus advancing the crisis–intervention perspective. Advances in these areas are critical to mitigate the impact of the next pandemic or similar major events in society. This can be achieved through improved pandemic timely response with effective economic stimulus, social relief, strong legal framework, and anti-corruption policies. Full article

Aligned with the worldwide shift towards promotional and preventative health care, the South African government has introduced a re-engineered primary health care plan, facilitated through a National Health Insurance (NHI) platform. Community health workers (CHWs) are key role-players in most universal health care systems. This article shares insider perspectives from 31 CHWs in one of the South African NHI pilot districts. Based on their perspectives, the authors share recommendations to strengthen the NHI plan. Recommendations comprise of the inclusion of a dedicated CHW team leader and reporting nurse, ongoing CHW education and training with an accompanying portfolio of evidence, and awareness campaigns on the role of CHWs within the South African re-engineered primary health care plan and NHI platform. Full article

This study investigated the dynamic factors influencing food security in Saudi Arabia, a critical concern for the nation’s stability and development. The purpose of this research was to analyze the impact of several key determinants on the Food Security Index and to distinguish between their short-term and long-term effects, thereby providing evidence-based policy recommendations. Using annual time-series data spanning 1990 to 2023, the research employs the Autoregressive Distributed Lag (ARDL) and Vector Error Correction Model (VECM) methods. We specifically examined the roles of agricultural GDP contribution, agricultural insurance coverage, food price stability, government policies related to agriculture, climate change impacts, agricultural productivity, and technology adoption. Short-run estimates reveal that agricultural GDP contribution, government policies, and agricultural productivity express a significant positive influence on food security. Importantly, climate change showed a counterintuitive positive association in the short term, potentially indicating immediate adaptive responses. Conversely, food price stability exhibited an unexpected negative association, which may indicate that the index captures high price levels rather than just volatility. The long-run analysis highlights the crucial importance of sustained factors for food security. Agricultural GDP contribution, agricultural insurance coverage, and agricultural productivity are identified as having significant positive impacts over the long term. In contrast, climate change demonstrates a significant negative long-run impact, underscoring its detrimental effect over time. Government policies, while impactful in the short term, become statistically insignificant in the long run, suggesting that sustained structural factors become dominant. Granger causality tests indicate short-term causal relationships flowing from climate change (positively), agricultural GDP contribution, government policies, and agricultural productivity towards food security. The significant error correction term confirms the existence of a stable long-run equilibrium relationship among the variables. On the basis of these findings, the study concludes that strengthening food security in Saudi Arabia requires a multifaceted approach. Short-term efforts should focus on enhancing agricultural productivity and implementing targeted measures to mitigate immediate climate impacts and refine food price stabilization strategies. For long-term resilience, priorities must include expanding agricultural insurance coverage, investing in sustainable agricultural practices, and continuing to boost agricultural productivity. The study contributes to the literature by providing a comprehensive dynamic analysis of food security determinants in Saudi Arabia using robust time-series methods, offering specific insights into the varying influences of economic, policy, environmental, and agricultural factors across different time horizons. Further research is recommended to explore the specific mechanisms behind the observed short-term relationship with climate change and optimize food price policies. Full article

(1) Background: Traumatic brain injury (TBI) is caused from rapid head acceleration/deceleration, focal blows, blasts, penetrating forces, and/or shearing forces, whereas hypoxic–anoxic injury (HAI) is caused through oxygen deprivation events, including strangulation. Most service-seeking domestic violence (DV) survivors have prior mechanistic exposures that can lead to both injuries. At the time of our study, some evidence existed about the exposure to both injuries over the course of a survivor’s lifetime from abuse sources, yet little was known about their co-occurrence to the same survivor within the same episode of physical intimate partner violence (IPV). To better understand the lived experience of service-seeking DV survivors and the context in which partner-inflicted brain injury (PIBI) is sustained, we sought to understand intentional brain injury (BI) exposures that may need to be addressed and accommodated in services. Our aims were to 1. characterize the lifetime co-occurrence of strangulation and intentional head trauma exposures from all abuse sources to the same survivor and within select physical episodes of IPV and 2. establish the lifetime prevalence of PIBI. (2) Methods: Survivors seeking DV services in the state of Ohio in the United States of America (U.S.) completed interview-administered surveys in 2019 (n = 47). Community-based participatory action approaches guided all aspects of the study development, implementation, and interpretation. (3) Results: The sample was primarily women. Over 40% reported having Medicaid, the government-provided health insurance for the poor. Half had less than a postsecondary education. Over 80% of participants presented to DV services with both intentional head trauma and strangulation exposures across their lifetime from intimate partners and other abuse sources (i.e., child abuse, family violence, peer violence, sexual assault, etc.), though not always experienced at the same time. Nearly 50% reported an experience of concurrent head trauma and strangulation in either the first or last physical IPV episode. Following a partner’s attack, just over 60% reported ever having blacked out or lost consciousness—44% experienced a loss of consciousness (LOC) more than once—indicating a conservative estimate of a probable brain injury by an intimate partner. Over 80% of service-seeking DV survivors reported either a LOC or two or more alterations in consciousness (AICs) following an IPV attack and were classified as ever having a partner-inflicted brain injury. (4) Conclusions: Most service-seeking IPV survivors experience repetitive and concurrent exposures to abusive strangulation and head trauma through the life course and by intimate partners within the same violent event resulting in brain injury. We propose the use of the term partner-inflicted brain injury (PIBI) to describe the physiological disruption of normal brain functions caused by intentional, often concurrent and repeated, traumatic and hypoxic neurologic insults by an intimate partner within the context of ongoing psychological trauma, coercive control, and often past abuse exposures that could also result in chronic brain injury. We discuss CARE (Connect, Acknowledge, Respond, Evaluate), a brain-injury-aware enhancement to service delivery. CARE improved trauma-informed practices at organizations serving DV survivors because staff felt knowledgeable to address and accommodate brain injuries. Survivor behavior was then interpreted by staff as a “can’t” not a “won’t”, and social and functional supports were offered. Full article