Search Results (62)

The global aviation sector underwent an unprecedented shock due to the COVID-19 pandemic, severely disrupting the passenger flows, flight operations, and revenues of Polish airports. In response, the government launched protective measures under the Anti-Crisis Shield and the COVID-19 Counteraction Fund. This study examines the financial impact of such public support on 12 Polish airports between 2016 and 2022, applying a two-step cointegration ECM framework with Driscoll–Kraay inference. Profitability (ROA, ROE, OM), liquidity, debt, and operational activity indicators were analysed, with particular attention to methodological distortions arising from including subsidies in operating revenues. The results indicate a material decline in profitability from 2020 to 2022, albeit with pronounced heterogeneity across airports. Larger hubs (Warsaw–Chopin, Kraków, Gdansk, Katowice, Poznan, and Wroclaw) demonstrated relative resilience, while many smaller, regionally owned airports (e.g., Bydgoszcz, Lodz, Lublin, Olsztyn-Mazury, Zielona Gora) remained structurally unprofitable despite substantial subsidies. In several cases, profitability, liquidity, and operating activity recovered by 2021–2022, yet the improvement was not uniform: for fiscally dependent airports, transfers merely masked persistent inefficiencies. Passenger volumes, flight operations, and employment emerged as the primary performance drivers, while capital expenditure, turnover of current assets, and liquidity were particularly relevant for ROE. The novelty of this research lies in disentangling the stabilising effect of subsidies from underlying profitability, revealing how non-market revenues distort standard performance metrics and accelerate short-run adjustment dynamics once netted out. The findings demonstrate asymmetric impacts of state aid across ownership structures, i.e., central state control at Warsaw versus regional self-government involvement elsewhere, and highlight structural inefficiencies that weaken systemic resilience. These insights underline the importance of subsidy-adjusted financial indicators, more selective allocation of support, and reporting standards that separate operating from non-market revenues to enhance resilience and ensure sustainable airport operations. Full article

This study evaluates the operational efficiency of accredited private healthcare facilities in Italy, a sector increasingly complementing the public National Health Service. Unlike previous studies that aggregate public and private providers, this research focuses exclusively on private facilities, providing a consistent and detailed evaluation of their performance. Utilizing game-theoretic cross-efficiency Data Envelopment Analysis (DEA) combined with Classification and Regression Tree (CART) analysis, this study identifies endogenous and exogenous efficiency drivers. Results indicate that private facilities operate at high efficiency levels (mean cross-efficiency = 0.923), with smaller facilities outperforming larger ones, though resources remain underutilized. Inactive ward and bed non-occupancy rates emerge as key inefficiency factors. Regional analysis highlights minimal disparities between the north–center and south, but significant local variations persist, shaped by governance, funding allocation, and institutional frameworks. This study also identifies an “efficiency paradox”, as in deficit regions, private expenditure correlates with higher efficiency, whereas in surplus regions, greater spending does not necessarily improve performance. These findings provide actionable insights for healthcare managers and policymakers, emphasizing the need to maximize capacity utilization, optimize staffing, and structure public–private partnerships strategically. Methodologically, integrating game cross-efficiency DEA with CART strengthens accuracy, offering a robust tool for benchmarking and improving private healthcare performance. Full article

Background/Objectives: This study examines individual perceptions of national healthcare system efficiency before and after the COVID-19 pandemic across 18 countries grouped into three clusters (the Anglo-world, Europe, East Asia). This paper aims to identify the demographic, socioeconomic, health-related, and macroeconomic healthcare drivers of public assessments, and explain changes in attitudes between 2011–2013 and 2021–2023. Methods: Using individual-level data from the International Social Survey Programme (ISSP) for 2011–2013 and 2021–2023, logistic regression models of perceived healthcare inefficiency are estimated. In addition, the Oaxaca–Blinder decomposition model is adopted in order to decompose the assessment gap between the two periods. Models include a range of individual demographic and socioeconomic characteristics and national healthcare controls (healthcare expenditure, potential years of life lost). Results: Health-related factors, especially self-assessed health and trust in doctors, consistently emerge as predictors of more favourable evaluations across regions and periods. Higher national healthcare expenditure is associated with more positive public views and is the single largest contributor to the improved assessments in 2021–2023. Demographic and socioeconomic variables show smaller regionally and temporally heterogeneous effects. Decomposition indicates that both changes in observed characteristics (notably, expenditure and trust) and unobserved behavioural, cultural, or institutional shifts account for the gap in public healthcare assessments between the two time periods. Conclusions: Public assessments of healthcare systems are primarily shaped by individual health status, trust in providers, and national spending rather than differential demographic and socioeconomic traits. Therefore, policymakers should couple targeted investments in the healthcare sector in order to address adequately public healthcare needs, and strengthen doctor–patient relationships in order to sustain public support. Future research should focus on disentangling the cultural and behavioural pathways influencing healthcare attitudes. Full article

One of the emerging forms of cooperation in managing government projects is partnering (samspill) to address repetitive problems in large projects. Inefficiency, conflict, and cost volatility remain work issues in the public sector. Although risk sharing and incentive schemes are other aspects of partnering that are the subject of a significant amount of research, there is limited investigation into the softer aspects of partnering. The nature of partnering and how it is practiced depends on various components, such as trust, leadership, and culture; however, they are not well defined or appreciated. This paper investigates how these soft aspects are implemented and perceived in four mega Norwegian public construction projects that use a partnering model. In the present study, a qualitative research approach was adopted, and nine face-to-face interviews were conducted with project leaders from four case organizations in public sector healthcare, government, and education sectors. However, despite having similar contractual provisions, the projects exhibited varying degrees of collaboration success, indicating that formal agreements alone do not determine effective partnering. The outcomes from this study established that value-based leadership is central to the success of collaboration and should, therefore, be a priority when designing partnering in the public sector. Additionally, the results add to the existing debates regarding the application of soft values in the formal structures of the business and support the notion of leadership-based approaches in construction management, especially in the public domain. Full article

Iraq has faced escalating water scarcity over the past two decades, driven by climate change, upstream water withdrawals, and prolonged economic instability. These factors have caused deterioration in irrigation systems, inefficient water distribution, and growing social unrest. As per capita water availability falls below critical levels, Iraq is entering a period of acute water stress. This escalating water scarcity directly impacts water and food security, public health, and economic stability. This study aims to develop a general framework combining decision support systems (DSSs) with Integrated Comprehensive Water Management Strategies (ICWMSs) to support water planning, allocation, and response to ongoing water scarcity and reductions in Iraq. Implementing such a system is essential for Iraq to alleviate its continuing severe situation and adequately tackle its worsening water scarcity that has intensified over the years. This integrated approach is fundamental for enhancing planning efficiency, improving operational performance and monitoring, optimizing water allocation, and guiding informed policy decisions under scarcity and uncertainty. The current study highlights various international case studies that show that DSSs integrate real-time data, artificial intelligence, and advanced modeling to provide actionable policies for water management. Implementing such a framework is crucial for Iraq to mitigate this critical situation and effectively address the escalating water scarcity. Furthermore, Iraq’s water management system requires modifications considering present and expected future challenges. This study analyzes the inflows of the Tigris and Euphrates rivers from 1933 to 2022, revealing significant reductions in water flow: a 31% decrease in the Tigris and a 49.5% decline in the Euphrates by 2021. This study highlights the future 7–20% water deficit between 2020 and 2035. Furthermore, this study introduces a flexible, tool-based framework supported by a DSS with the DPSIR model (Driving Forces, Pressures, State, Impacts, and Responses) designed to address and reduce the gap between water availability and increasing demand. This approach proposes a multi-hazard risk matrix to identify and prioritize strategic risks facing Iraq’s water sector. This matrix links each hazard with appropriate DSS-based response measures and supports scenario planning under the ICWMS framework. The proposed framework integrates hydro-meteorological data analysis with hydrological simulation models and long-term investment strategies. It also emphasizes the development of institutional frameworks, the promotion of water diplomacy, and the establishment of transboundary water allocation and operational policy agreements. Efforts to enhance national security and regional stability among riparian countries complement these actions to tackle water scarcity effectively. Simultaneously, this framework offers a practical guideline for water managers to adopt the best management policies without bias or discrimination between stakeholders. By addressing the combined impacts of anthropogenic and climate change, the proposed framework aims to ensure rational water allocation, enhance resilience, and secure Iraq’s water strategies, ensuring sustainability for future generations. Full article

Background/Objectives: Hearing aids are essential for managing hearing loss, yet their accessibility, consistent use, and maintenance remain challenging in public healthcare systems, particularly in low- and middle-income countries (LMICs) such as South Africa. Despite the availability of these services, many patients struggle with device utilization, resulting in suboptimal rehabilitation outcomes. This study explores patient experiences with hearing aids in South Africa’s public healthcare sector. This study aimed to (1) assess patients’ experiences with hearing aid access, including waiting times and service delivery; (2) identify challenges related to hearing aid maintenance and repairs in the public sector; (3) explore factors influencing consistent hearing aid use, including social, psychological, and practical barriers; and (4) propose strategies to enhance hearing aid provision and aftercare services in South Africa. Methods: This descriptive qualitative study was conducted at two public healthcare facilities in Johannesburg. Purposive sampling was used to recruit 15 adult hearing aid users who had received government-funded hearing aids within the past 12 months. Semi-structured interviews were conducted, transcribed verbatim, and analyzed using thematic analysis. Results: Participants reported long waiting periods (up to a year) for hearing aids, with poor communication regarding timelines. Challenges included difficulties adjusting to amplification, discomfort, and battery shortages, leading to inconsistent use or device abandonment. Social stigma and lack of family support further discouraged consistent use. Repair services were slow, with waiting times exceeding three months. Participants recommended decentralized battery distribution, structured follow-up appointments, improved aftercare, awareness campaigns, and mobile audiology services to improve accessibility and usability. Conclusions: While public hearing aid provision is essential for hearing rehabilitation, systemic inefficiencies, maintenance issues, and social barriers limit its impact. Strengthening aftercare services, decentralizing hearing aid distribution, and increasing public awareness could significantly improve hearing aid accessibility and adherence. Furthermore, policy interventions that incorporate tele-audiology, community-based maintenance programs, and integrated healthcare approaches are crucial in ensuring sustainable hearing healthcare outcomes. Full article

Brief family support interventions may be an effective and acceptable option when demands on services and pressures on families can often mean intensive, long-term family support interventions are an inefficient and unappealing course of action. The purpose of this scoping review was to better understand the nature of non-medical brief interventions targeted at parents and families experiencing adversity or challenging circumstances that may lead them to seek support from family services. We used a systematic search and selection process to identify publications (papers or webpages) about brief interventions for parents and families within three academic databases and 70 websites. Publications were in scope if the interventions were targeted to parents and families, were non-medical in nature, and were brief (no longer than 10 h duration, or up to four sessions). We identified 78 papers and webpages eligible for inclusion in this scoping review, covering 46 brief interventions. Data were extracted by two researchers and charted in a spreadsheet. Most interventions were delivered in the mental health sector, followed by the education, and then community or family services sector, and most often in a clinical setting. Intervention duration varied, ranging from 45 min to a two-day workshop, and were usually aimed at improving the mental health of children and young people. Interventions were delivered to groups of parents, followed by whole families or individual parents. This review highlights the pressing need for high-quality evaluations of brief interventions for family support, and given the diversity of delivery modes, durations and conceptualisation of ‘brief intervention’ in the field and literature, further synthesis of the evidence through systematic reviews is required. This paper advances understanding and clarity on how brief interventions may be beneficial for families experiencing adversity, yet further evaluation and systematic review for acceptability and efficacy is required. Full article

The circular economy has emerged as a pivotal strategy for cities to reconcile economic growth with environmental sustainability. However, its implementation in resource-dependent Gulf Cooperation Council contexts remains underexplored. This study is among the first to empirically assess circular economy readiness in a Gulf Cooperation Council industrial hub through a mixed-method approach, bridging the gap between expert perceptions and localized policy implementation. Focusing on the Dammam Metropolitan Area, Saudi Arabia, a critical industrial anchor for Saudi Vision 2030, this study combines a cross-sectional survey of 230 policymakers, industry leaders, and academics with descriptive/inferential statistics (SPSS) and qualitative thematic coding (NVivo). The findings identify renewable energy (mean = 4.10) and municipal waste management (mean = 3.78) as top sectoral priorities, aligning with national sustainability goals. Yet systemic challenges, including fragmented governance, limited public awareness (mean = 3.65), and funding gaps (mean = 3.52), underscore disparities between Vision 2030’s ambitions and localized capacities. Statistical analyses reveal strong associations between institutional fragmentation and financial inefficiencies (χ² = 23.45, * p = 0.010), while mid-career workforce dominance (54.8%) and underrepresentation of policymakers (6.5%) highlight governance gaps. The current study advocates hybrid strategies: stricter waste regulations (40.0% stakeholder priority), circular economy training programs, and public–private partnerships to scale waste-to-energy infrastructure and industrial symbiosis. Despite pragmatic optimism (48.7% foresee 21–40% recycling by 2030), limitations such as reliance on expert perspectives and exclusion of citizen voices necessitate future interdisciplinary and longitudinal research. By aligning regulatory rigor with inclusive governance, the Dammam Metropolitan Area can model a Gulf-centric circular economy transition, advancing regional sustainability while contributing actionable insights for resource-dependent economies globally. Full article

Innovation in public sector management is essential for improving service delivery and strengthening citizen trust. However, in highly populated municipalities with budgetary constraints, such as Ecatepec de Morelos, administrative opacity and inefficiencies in the provision of essential services pose significant structural challenges. This study examines the relationship between citizens’ perceptions of public resource management and the quality of municipal services, with a particular focus on transparency and accountability. Through perception surveys, statistical analysis, and documentary review, the research identifies operational barriers affecting the provision of basic services such as potable water, sanitation, and public lighting. The findings reveal high levels of citizen dissatisfaction and distrust in local institutions, highlighting the urgent need to implement innovative strategies to optimize resource allocation and enhance municipal governance. This study contributes to the ongoing discussion on public sector modernization by emphasizing the need for participatory decision-making mechanisms, strengthened transparency, and the adoption of best practices in municipal management. Full article

Background: Radiotherapy is a critical component of effective cancer treatment, yet access remains limited in many low- and middle-income countries, including South Africa. This study explores structural quality indicators influencing radiotherapy access in Gauteng province, a region with a dual public–private healthcare system. Methods: A concurrent triangulation mixed-methods approach using a descriptive cross-sectional study was employed; for the quantitative phase, data from public and private radiotherapy facilities was analysed, and for the qualitative phase, insights were obtained from interviews with the heads of departments and members of three multidisciplinary professions in radiation oncology, namely radiation oncologists, radiation therapists, and medical physicists. Results: Findings reveal stark disparities in radiotherapy access. Gauteng province has only two major public radiotherapy facilities serving a large population, while multiple private facilities exist. The data indicate substantial differences in resource distribution, equipment accessibility, and personnel levels between public and private institutions. Bureaucratic inefficiencies, personnel shortages, and operational limitations in the public sector have surfaced as significant barriers to prompt equitable access to radiotherapy. This research shows the urgent need for focused strategies to address these systemic issues in order to improve access to radiation treatment in Gauteng province. The study’s findings will inform the development of a comprehensive framework to enhance radiotherapy access and contribute to more equitable cancer care delivery in South Africa. Full article

The integration of health and social care has been a key focus in Scotland, driven by demographic changes, rising healthcare costs, and the need for more efficient service delivery. The Public Bodies (Joint Working) (Scotland) Act 2014 sought to formalise this integration by restructuring governance and service provision to improve coordination between health and social care sectors. Despite these efforts, challenges remain in fully achieving the intended outcomes of the integration. This study analysed Scotland’s integrated health and social care through the theoretical frameworks of public choice, institutionalism, and functionalism. The objective was to examine policy drivers, structural mechanisms, and governance implications, providing insights into the broader impact of integrated care reforms. A qualitative research approach was employed, synthesising data from peer-reviewed literature, government publications, and policy documents. The findings on integration were systematically examined through the lens of each public policy model, allowing for a nuanced analysis of how Scotland’s approach to integration aligns with and diverges from these frameworks. A literature search was performed on PUBMED, Google Scholar, and Scottish government portals. While integration improved coordination and service delivery in some areas, limitations in funding allocation, workforce distribution, and governance autonomy limited its overall success. Scotland’s integrated care model demonstrates potential benefits in reducing service fragmentation and improving patient-centred care; however, persistent challenges such as funding constraints, workforce shortages, and governance conflicts indicate that integration alone is not sufficient to resolve systemic healthcare inefficiencies. This study provides a perspective on Scotland’s health and social care integration, offering valuable lessons for other European countries facing similar demographic and healthcare challenges. Full article

The current research work emphasizes the urgent need for a paradigm shift in Mediterranean tourism, advocating for the adoption of a comprehensive framework centered on sustainability in Tunisia. The establishment of an Inter-Ministerial Task Force is proposed to facilitate collaboration across governmental sectors, thereby enhancing governance and addressing the complexities of waste management within the tourism industry. Results reveal significant waste management inefficiencies and underscore the potential of integrated approaches that can lead to substantial environmental improvements. By fostering inter-ministerial collaboration, a strategic roadmap is provided that promotes effective resource recovery and sustainable waste management practices. Furthermore, the integration of the informal sector, exemplified by local recyclers, into formal waste management systems is anticipated to enhance social equity and bolster environmental stewardship. A comprehensive SWOT analysis identifies Tunisia’s intrinsic strengths, including its rich cultural heritage and significant eco-tourism potential, while simultaneously exposing shortcomings such as fragmented governance structures and insufficient infrastructure. It is posited that the creation of a centralized coordination body, coupled with the enhancement of public–private partnerships, could catalyze innovation in sustainable tourism practices, leading to increased investment opportunities and the successful implementation of circular economy principles. Drawing inspiration from Spain’s successful circular economy model, actionable recommendations for policymakers are offered, including the introduction of eco-certification programs aimed at incentivizing environmentally responsible practices within the tourism sector. Ultimately, the proposed framework aspires to position Tunisia as a regional leader in sustainable tourism, delivering long-term benefits to local communities through enhanced environmental protection and economic resilience. Full article

The European Commission’s 2015 aging report forecasts a substantial increase in public spending on Long-Term Care (LTC) for OECD countries by 2060, posing significant fiscal challenges. This study aims to assess the efficiency and productivity of the LTC sector from 2010 to 2019 and explore whether efficiency gains can alleviate these fiscal pressures. Using a non-parametric Data Envelopment Analysis (DEA) model, combined with Tobit regression, we estimate the efficiency of OECD countries and examine the role of decentralization in shaping performance outcomes. The findings reveal that, on average, countries operate at 94% efficiency, with modest productivity growth. However, technical inefficiencies persist, especially in unitary countries, while federal countries, though initially less efficient, show greater improvements over time. Despite these gains, the current efficiency levels are insufficient to counterbalance the projected increase in LTC demand. Policymakers should prioritize reforms that enhance efficiency through decentralization, promoting accountability and competition as mechanisms to sustain the LTC system in the face of demographic shifts. Full article

Digital transformation offers transformative potential for public service delivery, yet many local administrative organizations (LAOs) in Thailand struggle with integrating digital tools effectively into their workflows. This study investigates the integration of social listening tools (SLTs) to enhance the efficiency and responsiveness of public service delivery in Thailand’s LAOs. The primary goal is to redesign traditional, manual workflows through the development of a digital-by-design framework, addressing inefficiencies in public engagement and service provision. Employing a mixed-method approach, this research combines interviews and focus groups with municipal staff from four municipalities in Northeast Thailand to identify challenges and co-create solutions. The redesigned workflow integrates digital practices into existing organizational structures and achieves a significant 282% improvement in efficiency, measured in transactions per manpower-hour. Additionally, the new process enhances operational speed, responsiveness, and public engagement. To ensure sustainability, this study recommends a phased implementation strategy and consistent staff training. This research contributes to the public administration literature by providing a practical, scalable framework for digital transformation in local governance. It underscores the potential of SLTs to modernize public sector workflows, enabling more dynamic, responsive, and citizen-centric interactions between LAOs and the communities they serve. Full article

This study evaluates the efficiency of public hospitals in Greece during the COVID-19 epidemic in 2020, using Data Envelopment Analysis (DEA) and the Analytical Hierarchy Process (AHP). Faced with unprecedented pressure from increased demand for medical services, these hospitals had to adapt quickly while playing a crucial role in supporting local economies, similar to the effect of tourism on rural economies. This study reveals that, despite average efficiency scores of 83% for result-oriented models (BCC) and 65% for constant return models (CCR), inefficiencies of scale emerged under the pressures of the pandemic. The AHP, by incorporating qualitative criteria and decision-makers’ preferences, offers a valuable perspective but shows little correlation with DEA’s quantitative results. This research emphasizes the importance of utilizing integrated methods to formulate a more comprehensive assessment, adapted to the complex challenges of the healthcare sector during crisis periods. Full article