Putting Adequate Financial and Human Resources in Healthcare for Effective Universal Health Coverage in Kenya: Lessons and Experiences from China

In recent years, most low and middle-income countries, have adopted different approaches to universal health coverage (UHC), to ensure equity and financial risk protection in accessing essential healthcare services. UHC-related policies and delivery strategies are largely based on existing healthcare systems, a result of gradual development (based on local factors and priorities). Most countries have emphasized on health financing, and human resources for health (HRH) reform policies, based on good practices of several healthcare plans to deliver UHC for their population.

Health financing and labor market frameworks were used, to understand health financing, HRH dynamics, and to analyze key health policies implemented over the past decade in Kenya’s effort to achieve UHC. Through the understanding, policy options are proposed to Kenya; analyzing, and generating lessons from health financing, and HRH reforms experiences in China. Data was collected using mixed methods approach, utilizing both quantitative (documents and literature review), and qualitative (in-depth interviews) data collection techniques.

The problems in Kenya are substantial: high levels of out-of-pocket health expenditure, slow progress in expanding health insurance among informal sector workers, inefficiencies in pulling of health are revenues, inadequate deployed HRH, maldistribution of HRH, and inadequate quality measures in training health worker. The government has identified the critical role of strengthening primary health care and the National Hospital Insurance Fund (NHIF) in Kenya’s move towards UHC. Strengthening primary health care requires; re-defining the role of hospitals, and health insurance schemes, and training, deploying and retaining primary care professionals according to the health needs of the population; concepts not emphasized in Kenya’s healthcare reforms or programs design. Kenya’s top leadership commitment is urgently needed for tougher reforms implementation, and important lessons from China’s extensive health reforms in the past decade are beneficial. Key lessons from China include health insurance expansion through rigorous research, monitoring, and evaluation, substantially increasing government health expenditure, innovative primary healthcare strengthening, designing, and implementing health policy reforms that are responsive to the population, and regional approaches to strengthening HRH.

Moduli Space of (0,2) Conformal Field Theories

In this thesis we study aspects of (0,2) superconformal field theories (SCFTs), which are suitable for compactification of the heterotic string. In the first part, we study a class of (2,2) SCFTs obtained by fibering a Landau-Ginzburg (LG) orbifold CFT over a compact K\"ahler base manifold. While such models are naturally obtained as phases in a gauged linear sigma model (GLSM), our construction is independent of such an embedding. We discuss the general properties of such theories and present a technique to study the massless spectrum of the associated heterotic compactification. We test the validity of our method by applying it to hybrid phases of GLSMs and comparing spectra among the phases. In the second part, we turn to the study of the role of accidental symmetries in two-dimensional (0,2) SCFTs obtained by RG flow from (0,2) LG theories. These accidental symmetries are ubiquitous, and, unlike in the case of (2,2) theories, their identification is key to correctly identifying the IR fixed point and its properties. We develop a number of tools that help to identify such accidental symmetries in the context of (0,2) LG models and provide a conjecture for a toric structure of the SCFT moduli space in a large class of models. In the final part, we study the stability of heterotic compactifications described by (0,2) GLSMs with respect to worldsheet instanton corrections to the space-time superpotential following the work of Beasley and Witten. We show that generic models elude the vanishing theorem proved there, and may not determine supersymmetric heterotic vacua. We then construct a subclass of GLSMs for which a vanishing theorem holds.

FtsZ Protofilament Curvature is the Opposite of Tubulin Rings

Bacterial tubulin homolog FtsZ assembles straight protofilaments (pfs) that form the scaffold of the cytokinetic Z ring. These pfs can adopt a curved conformation forming a miniring or spiral tube 24 nm in diameter. Tubulin pfs also have a curved conformation, forming 42 nm tubulin rings. We have previously provided evidence that FtsZ generates a constriction force by switching from straight pfs to the curved conformation, generating a bending force on the membrane. In the simplest model the membrane tether, which exits from the C terminus of the globular FtsZ, would have to be on the outside of the curved pf. However, it is well established that tubulin rings have the C terminus on the inside of the ring. Could FtsZ and tubulin rings have the opposite curvature? In the present study we explored the direction of curvature of FtsZ rings by fusing large protein tags to the N or C terminus of the FtsZ globular domain. FtsZ with a protein tag on the N terminus did not assemble tubes. This was expected if the N terminus is on the inside, because the protein tags are too big to fit in the interior of the tube. FtsZ with C-terminal tags assembled normal tubes, consistent with the C terminus on the outside. The FN extension was not visible in negative stain, but thin section EM gave definitive evidence that the C-terminal tag was on the outside of the tubes. This has interesting implications for the evolution of tubulin. It seems likely that tubulin began with the curvature of FtsZ, which would have resulted in pfs curving toward the interior of a disassembling MT. Evolution not only eliminated this undesirable curvature, but managed to reverse direction to produce the outward curving rings, which is useful for pulling chromosomes.