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Super Unleaded Malbec? A Case Study In Flawed International Standard Setting At The Codex Alimentarius, Justin Schwegel Dec 2018

Super Unleaded Malbec? A Case Study In Flawed International Standard Setting At The Codex Alimentarius, Justin Schwegel

Journal of Food Law & Policy

The World Trade Organization’s (WTO) Agreement on the Application of Sanitary and Phytosanitary Measures (SPS Agreement) provides rules on the adoption and enforcement of SPS measures. It also presumes that food safety regulations adopted by WTO Members that conform to relevant international standards are consistent with the SPS Agreement. The relevant international standard setting body for food safety is the Codex Alimentarius Commission, which conducts most of its food safety risk management work through subsidiary bodies such as the Codex Committee on Contaminants in Food (CCCF). CCCF establishes maximum limits for food contaminants and codes of practice for reducing food …


Identifying Risk Factors Associated With Cardiovascular Disease Risk In Lesbians, Sofia S. Velazquez Dec 2018

Identifying Risk Factors Associated With Cardiovascular Disease Risk In Lesbians, Sofia S. Velazquez

Dissertations and Theses (Open Access)

Cardiovascular disease (CVD) is the leading cause of female deaths in the United States (1). While women, in general, are at risk for CVD, current research indicates that sexual minority women (i.e. lesbians and bisexual women [SMW]) may be at greater risk for CVD than heterosexual women. This heightened risk potentially stems from an increased prevalence of traditional CVD risk factors in SMW, creating health disparities between SMW and their heterosexual counterparts (2). Further research into this high-risk population is needed, in order to minimize these disparities.

The purpose of this study was to establish differences in the prevalence of …


Hemoglobin A1c Improvements And Better Diabetes-Specific Quality Of Life Among Participants Completing Diabetes Self-Management Programs: A Nested Cohort Study, Abhinav Khanna Dec 2018

Hemoglobin A1c Improvements And Better Diabetes-Specific Quality Of Life Among Participants Completing Diabetes Self-Management Programs: A Nested Cohort Study, Abhinav Khanna

Dissertations and Theses (Open Access)

Background: Numerous primary care innovations emphasize patient-centered processes of care. Within the context of these innovations, greater understanding is needed of the relationship between improvements in clinical endpoints and patient-centered outcomes. To address this gap, we evaluated the association between glycosylated hemoglobin (HbA1c) and diabetes-specific quality of life among patients completing diabetes self-management programs.

Methods: We conducted a retrospective cohort study nested within a randomized comparative effectiveness trial of diabetes self-management interventions in 75 diabetic patients. Multiple linear regression models were developed to examine the relationship between change in HbA1c from baseline to one-year follow-up and Diabetes-39 (a diabetes-specific quality …


Association Between Psychosocial And Organizational Factors And Objectively Measured Sedentary Behavior In Desk-Dependent Office Workers, Andrew Lafrenz, Taryn Lust, Minot Cleveland, Alar Mirka, Andrew Downs, Bryan Goodin, Jacquie Van Hoomissen Dec 2018

Association Between Psychosocial And Organizational Factors And Objectively Measured Sedentary Behavior In Desk-Dependent Office Workers, Andrew Lafrenz, Taryn Lust, Minot Cleveland, Alar Mirka, Andrew Downs, Bryan Goodin, Jacquie Van Hoomissen

CUP Faculty Research

Cross-sectional analysis of data from the Recharge@Work study was used to assess individual, interpersonal and organizational correlates of objectively- measured sedentary time, in desk-dependent office workers at 2 U.S. hospitals. Analysis included 65 participants (62 females and ~49.2 years old). Sedentary time was assessed by accelerometry across five consecutive days and expressed as prolonged sedentary bouts (60 min ≤ 150 cpm). Correlates measured a baseline included: age, BMI, active break enjoyment, active break outcome expectancy, active break self-efficacy, active break social support, direct supervisor support of active breaks and senior manager support of active breaks. As expected, we found that …


Descriptive Census Survey Of Community Gardens Supported By The Big Garden, Abigail R. Hughes Dec 2018

Descriptive Census Survey Of Community Gardens Supported By The Big Garden, Abigail R. Hughes

Capstone Experience: Master of Public Health

The goal of this capstone and service learning project is to provide The Big Garden, an Omaha, NE based nonprofit organization, with survey data on the growth of their sites and programming over the past five years along with information on current garden needs and capacity. A census survey of a subsample of gardens supported by The Big Garden will provide leadership with information needed as they plan next steps for the organization and specific programming planning. Surveys were distributed to all gardens within their network to collect data on garden characteristics (e.g., size, length of time in operation), production …


Examining The Impact Of Hiv Medical And Social Case Management Program On Viral Load For Clients Living With Hiv/Aids In Nebraska, Abdulla Munir Dec 2018

Examining The Impact Of Hiv Medical And Social Case Management Program On Viral Load For Clients Living With Hiv/Aids In Nebraska, Abdulla Munir

Capstone Experience: Master of Public Health

Abstract

Case management (CM) is one of the standard practices that has been implemented since 1990 to help people living with HIV/AIDS (PLWHA) in the United States. The program is designed for low-income populations and it aims to address the barriers related to access to health care and improve the HIV outcomes. Previous studies identified a positive association with the provision of CM and improvement in viral outcomes. Increasing the viral suppression rates among HIV diagnosed individuals proved to reduce the risk of transmitting the infection, and disease incidence. Although CM program is provided to Nebraskans diagnosed with HIV, but …


The Public Health Lens: An Introduction To Population-Based Care In Athletic Training, Jenna L. Allocco Dec 2018

The Public Health Lens: An Introduction To Population-Based Care In Athletic Training, Jenna L. Allocco

Capstone Experience: Master of Public Health

Historically, the athletic training profession has been focused on the individual; however, potential exists to drive large-scale prevention efforts in the athletic community with a population-based, public health approach. Relationship between the two professions has been acknowledged in in previous literature to do with educational competencies and opportunities for research, as well as in policy development involving sudden cardiac death, sport-related concussion and osteoarthritis prevention. Incorporating public health concepts such as the ecological model, health literacy, health behavior and evidence-based program planning and evaluation may improve athletic training health outcomes and prove beneficial to each respective discipline.


Nutritional Factors Associated With Thyroid Cancer And Nodules Using The Integrated Cancer Repository For Cancer Research (Icare2), Dong Liu Dec 2018

Nutritional Factors Associated With Thyroid Cancer And Nodules Using The Integrated Cancer Repository For Cancer Research (Icare2), Dong Liu

Capstone Experience: Master of Public Health

Introduction: The incidence of thyroid cancer in the United States has rising on average 3.1% each year over the last 10 years. Much of this increase is attributed to increased detection using ultrasound. Dietary habits can be an important modifiable risk factors for different types of cancer, but the association between dietary factors and thyroid cancer has not been well studied. The goals of this capstone were to: 1) review the literature for the association between dietary factors and thyroid cancer, 2) describe demographic and behavioral characteristics of patients with thyroid nodules and cancer in a hospital-based registry, and 3) …


Health And Wellness Factors Affecting The Wholistic Lifestyle Of National And International Christian Missionaries, Angela C. Williams Dec 2018

Health And Wellness Factors Affecting The Wholistic Lifestyle Of National And International Christian Missionaries, Angela C. Williams

Doctoral Dissertations and Projects

This thesis will focus on the health and wellness of missionaries and will develop a wholistic framework for healthier living. This framework will be used as a guide to help sustain missionaries living in various cultural contexts by connecting and integrating the mind, body, and spirit in harmony for wholistic lifestyle. God intended for His people to live a healthy lifestyle and to take care of their temples. Missionaries are the backbone of cross-cultural evangelism, but they often find themselves living unhealthy lifestyles. These unhealthy lifestyles can have a negative impact on missionaries’ overall health, wellness, and fruitfulness in serving …


An Examination Of The Relationship Between Food Security And Body Weight In Children, Elyse Barletta-Sherwin, Ramona Stone Dec 2018

An Examination Of The Relationship Between Food Security And Body Weight In Children, Elyse Barletta-Sherwin, Ramona Stone

Public Health Sciences Faculty Publications

This observational study examined the association between food security and healthy weight in children ages 6 to 12, using the 2013-2014 NHANES cross-sectional survey. The relationship between children’s food security and their weight was tested using logistic regression, while controlling for race, gender, physical activity, and poverty level. A significant association was found; children in households with low or very low food security were about 2.4 times more likely to be overweight than those with full or marginally secure food. Hispanic and multi-racial children were more than twice as likely to be overweight than white children. Children from low-income families, …


Observed Cooking Behaviors Of Families With And Without Childhood Cancer Survivors And The Development Of A Healthy Cooking Assessment Tool, Margaret Pleta Raber Dec 2018

Observed Cooking Behaviors Of Families With And Without Childhood Cancer Survivors And The Development Of A Healthy Cooking Assessment Tool, Margaret Pleta Raber

Dissertations and Theses (Open Access)

Diet is a modifiable risk factor for several cancers and other chronic diseases. Cooking skills are a target for dietary intervention, with much of the general population reporting infrequent and inadequate home preparation of meals. Childhood cancer survivors (CCS) are a population at high risk of several chronic conditions including secondary cancers that may be influenced by home cooking behaviors. We conducted observations of food preparation practices in 29 parents of healthy school-aged children and 11 parents of CCS. Observations included an audio and video recording of one evening meal per family. Parents were asked to wear a small body …


Validation Of A Type 2 Diabetes Risk Stratification Tool In A Low Income Hispanic Population, Dara Grieger Dec 2018

Validation Of A Type 2 Diabetes Risk Stratification Tool In A Low Income Hispanic Population, Dara Grieger

Dissertations and Theses (Open Access)

A pilot study was undertaken to evaluate the appropriateness of a previously published diabetes risk stratification tool in a diabetic population. The tool was applied to a sample of 500 prediabetic and diabetic adults receiving primary care services at a Federally Qualified Health Center (FQHC) in Cameron County, Texas. The study population was largely Hispanic and underserved. The National Health and Nutrition Examination Survey (NHANES) 2015-2016 data set was used as a comparison group. The risk assessment tool was applied to separately to the prediabetic and diabetic subset of both study groups. The tool stratified the patients into three risk …


How Participatory Are We? A Systematic Review Comparing Women’S Participation In Participatory Action Research, Community Based Participatory Research And Participatory Learning In Action, Magdalene Hakala-Hartman Dec 2018

How Participatory Are We? A Systematic Review Comparing Women’S Participation In Participatory Action Research, Community Based Participatory Research And Participatory Learning In Action, Magdalene Hakala-Hartman

Dissertations and Theses (Open Access)

Objective. This systematic review compares the extent of participation of women in maternal and child health and healthy living-type research projects based on three participatory research frameworks, Participatory Action Research (PAR), Community Based Participatory Research (CBPR), and Participatory Learning in Action (PLA), by examining roles, tasks, engagement, and the duration and complexity of their participation- as guided by the Community Engagement in Research Index (CERI). The review analyzed differences in underlying structure of the studies connected to their theoretical underpinnings. Methods. Ovid Medline, PubMed, EBSCO, CINAHL, Embase, Scopus, and Academic Search Complete were searched for studies published 2009 – 2018. …


Quantifying The Impact Of Laboratory And Care Systems On Relinkage To Hiv Care In A Southern, Urban Environment, Kellie L. Watkins Dec 2018

Quantifying The Impact Of Laboratory And Care Systems On Relinkage To Hiv Care In A Southern, Urban Environment, Kellie L. Watkins

Dissertations and Theses (Open Access)

Background: HIV viral suppression reduces the likelihood of transmission to just 5%,1 demonstrating the critical link between care and prevention, yet only 51% of people living with HIV (PLWH) were retained in care and 46% achieved viral suppression in the Houston area (2012), with the out-of-care (OOC) population increasing between 2008-2011.2,3

Methods: Record-search investigations across HIV surveillance and care data systems determined if potentially OOC persons referred to the Houston Health Department (HHD) from 2013-2015 (N=1287) qualified for public health follow up. A portion were randomized to a non-intervention group (n=200) to assess the program effectiveness. Participants without a disposition …


Sociodemographic Determinants Of Mental Health Outcomes Among Unhealthy Weight Youth In The United States, Chenchita Malolan Dec 2018

Sociodemographic Determinants Of Mental Health Outcomes Among Unhealthy Weight Youth In The United States, Chenchita Malolan

Dissertations and Theses (Open Access)

Background

The prevalence of unhealthy weight (defined as a body mass index ≥ 85th %ile for age and sex) among children and adolescents in the United States remains unacceptably high. In parallel, the prevalence of mental health issues in youth is rising as well. Current research shows a strong association between overweight/obesity and poor mental health outcomes. Specifically, youth of unhealthy weight have higher rates of anxiety and depression. The objective of this study is to evaluate the specific the current (2016-17) population-level prevalence of unhealthy weight, mental health issues and the sociodemographic (e.g. sex, age, race, ethnicity, household income) …


The Hungry Cancer Patient: A Case Of Money Ill Spent., Allison Zibelli Dec 2018

The Hungry Cancer Patient: A Case Of Money Ill Spent., Allison Zibelli

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

No abstract provided.


Stress Management In The Kitchen, Haley Rosano Dec 2018

Stress Management In The Kitchen, Haley Rosano

Capstone Projects and Master's Theses

Catholic Charities - Diocese of Monterey has implemented Stress Management in the Kitchen though the Family Support Services department of the Seaside office. Stress Management in the Kitchen was implemented to address the knowledge gap between nutrition and healthy living.The purpose of the workshop series was to give clients a fun and digestible way to increase their knowledge on how their health and nutritional habits can or should be applied to how they deal with stress. These workshops were implemented through presentation and a series of activities.The measurement of these workshops will be obtained through an exit survey from participants. …


A Longitudinal Assessment Of Change In Blood Pressure Among Participants In The Heart Smarts Program, Kathryn Haskins, Susana Suzrez, Rickie Brawer, Phd, Mph, Sandra Sherman, Edd, Michelle Abel, Msph, James Plumb, Md, Mph Dec 2018

A Longitudinal Assessment Of Change In Blood Pressure Among Participants In The Heart Smarts Program, Kathryn Haskins, Susana Suzrez, Rickie Brawer, Phd, Mph, Sandra Sherman, Edd, Michelle Abel, Msph, James Plumb, Md, Mph

Phase 1

Many low-income areas of the United States are considered food deserts because people living in those communities have limited access to fresh fruits and vegetables (FFV); lack of FFV is tied to numerous health issues, including cardiovascular disease and obesity. The Heart Smarts Program (HSP) provides increased access to FFV in food deserts, as well as providing participants with nutrition education courses and health screenings, including blood pressure. The purpose of this study is to examine HSP participants who have been with the program for differing lengths of time in order to determine if length of participation has an impact …


Analyzing Policies Through A Dohad Lens: What Can We Learn?, Julia M. Goodman, Janne Boone-Heinonen, Dawn M. Richardson, Sarah B. Andrea, Lynne C. Messer Dec 2018

Analyzing Policies Through A Dohad Lens: What Can We Learn?, Julia M. Goodman, Janne Boone-Heinonen, Dawn M. Richardson, Sarah B. Andrea, Lynne C. Messer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Social, health, and environmental policies are critical tools for providing the conditions needed for healthy populations. However, current policy analyses fall short of capturing their full potential impacts across the life course and from generation to generation. We argue that the field of Developmental Origins of Health and Disease (DOHaD), a conceptual and research framework positing that early life experiences significantly affect health trajectories across the lifespan and into future generations, provides an important lens through which to analyze social policies. To illustrate this point, we synthesized evidence related to policies from three domains—family leave, nutrition, and housing—to examine the …


Association Of Adverse Birth Outcomes With Maternal Exposure To Nitrate In Private Well Drinking Water: An Action Plan For Prevention, Jessyka R. Johnson Dec 2018

Association Of Adverse Birth Outcomes With Maternal Exposure To Nitrate In Private Well Drinking Water: An Action Plan For Prevention, Jessyka R. Johnson

Capstone Experience: Master of Public Health

Abstract

Goal: The goal of the capstone project is to collect information required to develop an action plan focusing on minimizing exposure to nitrate in pregnant women, which, if implemented, can either prevent or reduce adverse health outcomes associated with nitrate exposure in utero.

Objective: The capstone project objective is to gain a better understanding of what programs to prevent exposure to nitrate from private well drinking water in pregnant women are already in place throughout the United States; to identify any areas of improvement in these programs; and to utilize this information to create a unique action plan in …


Trends In Childhood Elevated Blood Lead Levels In Nebraska, 2013 – 2017, Ellana Haakenstad Dec 2018

Trends In Childhood Elevated Blood Lead Levels In Nebraska, 2013 – 2017, Ellana Haakenstad

Capstone Experience: Master of Public Health

This project explored the exposure to lead among children in Nebraska. Using the Nebraska Department of Health and Human Services’ Blood Lead Level database, trends were investigated in screening; demographics; incidence; and prevalence of elevated blood lead levels, statewide and by census tract. The study further explored the geography of lead exposure and elevated blood lead level cases with maps. Based on these results, policy recommendations were made to the Nebraska Department of Health and Human Services’ Childhood Lead Poisoning Prevention Program, particularly about areas of Nebraska with high risk of lead incidence and exposure risk where testing should be …


Cleaver: Classification Of Everyday Activities Via Ensemble Recognizers, Samantha Hsu Dec 2018

Cleaver: Classification Of Everyday Activities Via Ensemble Recognizers, Samantha Hsu

Master's Theses

Physical activity can have immediate and long-term benefits on health and reduce the risk for chronic diseases. Valid measures of physical activity are needed in order to improve our understanding of the exact relationship between physical activity and health. Activity monitors have become a standard for measuring physical activity; accelerometers in particular are widely used in research and consumer products because they are objective, inexpensive, and practical. Previous studies have experimented with different monitor placements and classification methods. However, the majority of these methods were developed using data collected in controlled, laboratory-based settings, which is not reliably representative of real …


Compassion Fatigue Among Mental Healthcare Providers And The Impact On Overall Wellbeing, Ruchi Patel Dec 2018

Compassion Fatigue Among Mental Healthcare Providers And The Impact On Overall Wellbeing, Ruchi Patel

Doctoral Dissertations

Compassion, a virtue of the helping profession, can be jeopardized by a provider’s continuous exposure to the trauma experiences of others. The impact of burnout, secondary stress and compassion fatigue on a mental healthcare provider’s work and personal life has been increasingly studied due to negative ramifications on our community healers. The present study used a cross-sectional design to survey mental healthcare providers across specialty and discipline in efforts to gain a better understanding of the relationship between a provider’s degree of compassion fatigue and specific demographic variables, physical health and their spirituality. One hundred and thirty-seven participants across the …


Multiple-Micronutrient Supplementation: Evidence From Large-Scale Prenatal Programmes On Coverage, Compliance And Impact, Cristiana Berti, Michelle F. Gaffey, Zulfiqar Ahmed Bhutta, Irene Cetin Dec 2018

Multiple-Micronutrient Supplementation: Evidence From Large-Scale Prenatal Programmes On Coverage, Compliance And Impact, Cristiana Berti, Michelle F. Gaffey, Zulfiqar Ahmed Bhutta, Irene Cetin

Department of Paediatrics and Child Health

Micronutrient deficiencies during pregnancy pose important challenges for public-health, given the potential adverse outcomes not only during pregnancy but across the life-course. Provision of iron-folic acid (IFA) supplements is the strategy most commonly practiced and recommended globally. How to successfully implement IFA and multiple micronutrient supplementation interventions among pregnant women and to achieve sustainable/permanent solutions to prenatal micronutrient deficiencies remain unresolved issues in many countries. This paper aims to analyse available experiences of prenatal IFA and multiple micronutrient interventions to distil learning for their effective planning and large-scale implementation. Relevant articles and programme-documentation were comprehensively identified from electronic databases, websites …


Lead And Crime: An Ecological Study Between Lead Contaminated Topsoil And Violent Crime., Brian Guinn Dec 2018

Lead And Crime: An Ecological Study Between Lead Contaminated Topsoil And Violent Crime., Brian Guinn

Electronic Theses and Dissertations

Lead is a known neurotoxicant. Human exposure to lead comes primarily through environmental exposures, including remnant lead paint, lead contaminated topsoil and lead contaminated water. Prenatal and early life lead exposure has been associated with numerous neurocognitive and neuropsychiatric disorders. This dissertation presents findings from an ecological study which evaluated the geospatial association between topsoil lead content and the incidence of FBI designated violent crime in Jefferson County, Kentucky. A total of 412 topsoil samples were collected along roadways (n=300) and from Louisville Metro Parks (n=112). Jefferson County crime data was obtained from the Louisville Metro Police Department – Crime …


Association Between Cigarette Smoking And Ovarian Reserve Among Women Seeking Fertility Treatment With Effect Modification By Race And Nat2 Genotype., Islamiat A. Oladipupo Dec 2018

Association Between Cigarette Smoking And Ovarian Reserve Among Women Seeking Fertility Treatment With Effect Modification By Race And Nat2 Genotype., Islamiat A. Oladipupo

Electronic Theses and Dissertations

Cigarette smoking in women has been associated with adverse reproductive outcomes such as reduced ovarian reserve, poorer in vitro fertilization (IVF) outcomes and increased adverse pregnancy outcomes. This study examined the association of smoking with ovarian reserve in a cross-sectional study of women seeking fertility treatment, and potential effect modification by race and NAT2 acetylator phenotype. Data from 265 women from the Louisville Tobacco Smoke, Genetic Susceptibility, and Infertility (LOUSSI) Study were analyzed. A total of 265 women were recruited through a single infertility clinic between September 2016 and June 2018. Information on current smoking status was assessed using a …


Risky Business: Millennials’ Protection Motivation Factors For Norovirus Outbreaks On College Campuses, Dylan Conrad Martinez Dec 2018

Risky Business: Millennials’ Protection Motivation Factors For Norovirus Outbreaks On College Campuses, Dylan Conrad Martinez

Graduate Theses and Dissertations

The risk and severity of hNoV transmission is obscurely recognized to foodservice millennial customers. Most commonly associated with cruise ships, consumers are not aware of its full potential to strike at other locations, especially college campuses. For the foodservice industry and the university community, it is imperative that a proactive method for increasing millennials’ motivation to practice mitigation methods emerges to reduce future hNoV outbreaks on college campuses. Research has shown that students can play a major role in the spread of hNoV on college campuses. Therefore, the purpose of these studies is to examine motivations for health protective behaviors …


Work-Related Skin Diseases Among Workers In The Sewing Section At Pt. X Shoe Company In West Java, Hendra Hendra, Eva Nirwana, Marzuki Isahak Nov 2018

Work-Related Skin Diseases Among Workers In The Sewing Section At Pt. X Shoe Company In West Java, Hendra Hendra, Eva Nirwana, Marzuki Isahak

Kesmas

Occupational skin diseases are the most common work-related diseases in many countries. Shoe industry workers are potential to be affected by work-related skin diseases (WRSDs). This study aimed to analyze the risk factors associated with WRSDs among workers in the sewing section at a shoe company in West Java. A total of 477 workers were examined and interviewed using the modified Nordic Occupational Skin Questionnaire-2002/LONG from May 2016 to July 2016. Chi-square test and logistic regression were used to analyze the risk factors related to WRSDs. The results showed that 57.7% of the workers suffered from WRSDs. Most of the …


Health Promotion Toward Knowledge And Intention For Early Detection Of Cervical Cancer In Commercial Sex Workers, Desi Rusmiati, Tiurlan Yunetty Silitonga, Warendi Warendi Nov 2018

Health Promotion Toward Knowledge And Intention For Early Detection Of Cervical Cancer In Commercial Sex Workers, Desi Rusmiati, Tiurlan Yunetty Silitonga, Warendi Warendi

Kesmas

Cervical cancer is one of the cancer types that become a haunting danger for many women in the world. In Indonesia, the prevalence rate reached 0.8% or an estimated 98,692 patients. Its prevalence increased to 10% in the commercial sex worker group. This study aimed to explain the effect of health promotion on knowledge and intention for early detection of cervical cancer using the inspection of visual acetate method in the commercial sex workers. This study was quantitative with a quasi-experimental type, one group of pretest and posttest design. The population sample included the commercial sex workers at Genteng Subvillage, …


Impact Of Budget Increase On Primary Health Care Performance In The Era Of National Health Insurance: Case Study In Buleleng District, Kadek Suranugraha, Ni Made Sri Nopiyani, Pande Putu Januraga Nov 2018

Impact Of Budget Increase On Primary Health Care Performance In The Era Of National Health Insurance: Case Study In Buleleng District, Kadek Suranugraha, Ni Made Sri Nopiyani, Pande Putu Januraga

Kesmas

Since 2014, there has been an increase in funds for primary health care (PHC) coming from the National Health Insurance program capitation funds and the Health Operational Assistance Fund. This study aimed to explore the effect of this budget increase on the health care services at PHC. The case study used a qualitative approach and interviews from 19 PHC health workers with the highest and lowest budget. Data were analyzed using thematic analysis and supported by quantitative data. The positive impact of the increasing PHC budget was felt by PHC staff due to the addition of operational equipment and incentives …