Helping to improve malaria health care in southern Africa

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Work conducted by a Bristol Business School Professor on organisational systems in malaria zones has had a significant impact on international efforts to eradicate the disease.  Backed by the Bill and Melinda Gates Foundation-funded Malaria Elimination Initiative, Professor Peter Case’s work has introduced a new approach to tackling malaria in Zimbabwe and Swaziland.

Every year some half a million people die from the disease, which still exists in nearly 100 countries. Humans bitten by infected mosquitoes carrying the parasite can experience high fevers, chills, and other severe symptoms.

Although many NGOs distribute treated mosquito nets, or supply anti-malaria tablets to high-risk communities, human and organisational factors are often overlooked, says the academic.

“A vaccine or technology used as a solution is often seen as a silver bullet and is vital. But I believe this makes up only five percent of what can be done – the remaining 95% comes down to dealing with the flaws, difficulties, idiosyncrasies and foibles of human organisational systems,” he says.

Professor Case’s work, in partnership with the University of California, San Francisco (UCSF), provides methods to identify, analyse, and resolve context-specific challenges. Through a series of workshops taking place in the country where malaria poses a threat, members of staff (from the most junior front-line staff to the most senior medics and administrators) are able to meet in the same space and communicate the challenges they face when tackling malaria.

Together, they can then generate collective solutions and trace necessary changes that need to be made within the delivery system to improve prevention and treatment.

“While all the workshop participants play a crucial role in the process, hands-on expertise lies at the front line, because these are the people who see others with the disease day in day out, or who go in to spray homesteads,” says Professor Case.

Past examples of challenges these workers have experienced include instances when villagers who are issued with mosquito nets are later seen using them for fishing. In another African village, witnesses have noted that people who develop malaria symptoms sometimes seek non-medical care from traditional healers rather than go to a clinic.

Professor Case and colleague Dr Mberikunashe in Zimbabwe

This exercise of generating a list of shared challenges leads to a practical work plan with a dedicated group of people who take responsibility for implementing solutions. It has helped instil self-confidence and assertiveness within individuals who work on the front line, helping staff to realise that they can rely on themselves and colleagues to problem solve.

Professor Case’s work has had significant impact in southern Africa. Implementing this methodology across Swaziland has led to improvement in the reporting of malaria cases by health facilities and increased collaboration between the malaria program, schools, and community organisations. It has also led to improved communication between leaders within the National Malaria Control Programme (NMCP).

In Zimbabwe’s Matabeleland South, Case’s system of structured organizational development has led to improvement in the availability and use of malaria registers by health facilities, a decrease in stock-outs of key malaria treatment drugs, and an increase in malaria case investigation rate within three days.

To ensure the project remains sustainable, Bristol Business School has begun training six medical staff at all levels of seniority in Zimbabwe via a PG Cert in Leadership and Professional Practice, which they are undertaking through distance learning.

These initial trainees will be assisting with similar process improvement initiatives in other malaria-prone countries in southern Africa, beginning in 2018 with Namibia.

UK’s complex tax code and complacency leads to more tax avoidance – UWE Professor

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Nicholas Ryder, who is a Professor in Financial Crime at the University of the West of England (UWE Bristol) says the UK authorities’ ‘lacklustre’ approach to enforcing its financial crime provisions, and a highly complex tax code, has played a significant role in enabling individuals to avoid or evade tax.  Tax evasion expert Sam Bourton (who is an Associate Lecturer in Law at UWE Bristol), agrees that such complexity means a lot of money is siphoned from the City of London.

Once again documents revealing the tax activities of some of the rich and powerful have come to light in the media, after a whistleblower leaked 6.8m documents relating to Appleby, a firm that helps companies set up shop in low-tax jurisdictions. These ‘Paradise Papers’ (so-called because many tax havens are located on paradise-like islands) have led to a media storm, decrying the likes of F1 driver Lewis Hamilton and Apple because of their links to tax avoidance schemes through the firm. Tax avoidance involves by-passing payment of tax legally using loopholes to your advantage, while tax evasion means illegally evading paying tax.

“These schemes might not be a criminal offence per se,” says Ryder, “but ethically speaking, is it right for a multibillion pound company to be avoiding tax, when that money could go to funding a new hospital or a school?”

Ryder explains that a lot of jurisdictions, including the UK, have a flexible taxation system, as this can lead to more investment. It also possesses a highly complex tax code, which is one of the longest in the world. “You could argue that tax avoidance has been indirectly encouraged by government because it has such a complex legal framework that allows people to use loopholes,” says Ryder. “This also means that it’s often difficult to identify whether a business transaction constitutes tax avoidance or tax evasion,” he adds.

Bourton agrees, saying that there is often a connection between many of UK’s overseas territories (like the Cayman Islands or the British Virgin Islands) and London, and this benefits the City. “Often tax advisers set up structures offshore that interact with accounts in London,” says Bourton. She points out that, looking at the data from the Paradise Papers, the UK features towards the top of the list when you look at individuals and companies implicated in tax avoidance.

Both Bourton and Ryder agree that more transparency in tax transactions is needed. “I am concerned about the secrecy that still exists around these tax cases,” says Ryder, commenting on the Paradise Papers. “How do we know that organised criminal gangs are not using these offshore financial centres to hide their proceeds of crime? If they are doing this, they are in effect money laundering, and that’s where they could be prosecuted,” he adds. In this respect, he believes that the UK adopts what he calls a “lacklustre” approach to enforcing its financial crime provisions.

The Organisation for Economic Co-operation and Development (OECD) has drawn up and is still developing a set of guidelines to ensure transparency and exchange of information where tax is involved.  But although most jurisdictions have signed up to the OECD standards, implementing them is likely to take several years to complete.