Globally, Pakistan ranks fifth in terms of missing tuberculosis (TB) patients' burden. Missed TB cases are either undiagnosed or diagnosed but not notified to the national TB database. Public-private mix interventions are contributing significantly to the case detection, diagnosis, and treatment of TB in Pakistan. However, it is estimated that many cases of infected TB patients go undetected. It is likely that these "undiagnosed" active TB cases seek treatment from community pharmacies, among other venues. This study aimed at assessing the feasibility of community pharmacy-based TB case detection. Case detection protocol implementation in three Pakistani districts in a nonrandom selection of pharmacies was followed by a review of routinely maintained prospective records of patients referred from these private community pharmacies to general practitioner (GP) clinics. The study engaged 500 community pharmacies for referring presumptive TB patients to GP clinics. In total, 85% of the engaged pharmacies remained active in providing referrals during the study period. The community pharmacy-referral network achieved an annual referral rate of 3,025 presumptive TB patients and identified 547 active TB cases for the period January-December 2017. Every fifth referral among presumptives presenting and counseled at pharmacies was diagnosed with TB at GP clinics. This contribution was 9% of all new TB cases identified in these districts through all other private venues linked with the Greenstar Social Marketing setup. Identified barriers and facilitators to implementation and cost effectiveness of pharmacy models for TB case detection should be considered if the model were to be scaled up.
This paper attempts to explore the effect of excess control, ownership structure and corporate governance on firm performance in Pakistan. The study takes a sample of 184 non-financial sectors' group firms listed on the Karachi Stock Exchange (KSE) covering a period from 2004 to 2012. The multiple regression models are applied using panel data framework to test the significance of relationship. The results are consistent with the findings of the prior studies conducted in both advanced and emerging economies. The results show that firm ownership is a strong influential factor in affecting firm performance in Pakistan. Both inside ownership and ownership concentration are negatively related to firm performance consistent with divergence of interest effect and entrenchment effect. However, inside ownership squared is strongly positively related to firm performance indicating that inside ownership beyond a certain threshold level started to influence firm performance positively consistent with incentives effect. Ownership disparity affects strongly negatively the financial performance of group firms consistent with the divergence of interest effect. Institutional ownership contributes positively towards firm performance. Noticeably, board independence and outside block holdings play a significantly positive role in affecting financial performance of the group firms in Pakistan. The results show strong evidence that ultimate controllers in group firms use complex ownership and pyramidal structures to extend their ultimate control over many firms with least cash flow rights. The higher the divergence between ownership and control, the greater the potential of the ultimate controllers exerted their entrenched behavior in group firms. These results highlight the internal corporate governance problems faced by the group firms and suggest the need for strengthening the corporate governance mechanism in Pakistan.
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