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Background: As opportunities grow for resource-constrained countries to use eHealth (digital health) to strengthen health systems, a dilemma arises. Wise eHealth investments require adequate appraisal to address opportunity costs. Economic appraisal techniques conventionally utilised for this purpose require sufficient economic expertise and adequate data that are frequently in short supply in low- and middle-income countries. This paper aims to identify, and, if required, develop, a suitable framework for performing eHealth investment appraisals in settings of limited economic expertise and data. Methods: Four progressive steps were followed: (1) identify required framework attributes from published checklists; (2) select, review, and chart relevant frameworks using a scoping review; (3) analyse the frameworks using deductive and inductive iterations; and, if necessary, (4) develop a new framework using findings from the first three steps. Results: Twenty-four candidate investment appraisal attributes were identified and seven relevant frameworks were selected for review. Analysis of these frameworks led to the refinement of the candidate attributes to 23 final attributes, and each framework was compared against them. No individual framework adequately addressed sufficient attributes. A new framework was developed that addressed all 23 final attributes. Conclusions: A new evidence-based investment appraisal framework has been developed that provides a practical, business case focus for use in resource-constrained African settings.

(1) Background: Decisions to use eHealth are complex and involve addressing a large opportunity cost. Sound choices are essential. Weighing up investment options is challenging in resource-constrained settings where there are frequently insufficient economics data and expertise to conduct adequate appraisals. To address this, a new eHealth Investment Appraisal Framework (eHIAF) for Africa has been designed and developed. The aim of this paper was to validate the new framework to consider whether it is fit for purpose and to refine it as needed. (2) Methods: An online survey of purposively selected eHealth experts was used to conduct a desktop validation of the proposed eHIAF for Africa. The survey covered the framework development process, structure, content, completeness, and utility. Expert opinions were charted, and a reflective and iterative process used to assess the tool and extract recommendations for refinement. (3) Results: Eleven eHealth experts who completed the survey had experience in African countries and elsewhere. The majority agreed with the eHIAF for Africa development approach and output. They provided valuable suggestions for minor refinements and felt that with these amendments, the eHIAF for Africa would be ‘fit for purpose’. (4) Conclusions: The eHIAF for Africa is considered appropriate for use by policy- and decision-makers working in resource-constrained settings who face the task of selecting optimal eHealth investments. It has the potential for applicability beyond Africa and the framework should now be tested in African countries.

PurposeDue to the disruptive nature of digital transformation, firms can hardly ignore the further digitalisation of processes and business models. Implementing such initiatives triggers enormous investments in infrastructure and software, making the evaluation of digital investments crucial for a firm’s competitive situation.Design/methodology/approachGiven the dynamics and uncertainties inherent in digital transformation, a qualitative, inductive research approach based on semi-structured interviews with high-level finance executives has been employed.FindingsOur findings indicate widespread dissatisfaction with traditional investment appraisal methods for evaluating digital investments. Data also suggest that non-financial considerations are frequently taken into account, albeit implicitly, as participants struggled to clearly conceptualize these criteria.Originality/valueThe literature indicates important research gaps regarding the applicability and usage of traditional, predominantly financial, investment appraisal methods in digital contexts. This research enhances our understanding of digital investment evaluation, by (i) developing an exploratory conceptual framework of potential qualitative evaluation criteria and (ii) providing an in-depth and detailed understanding of the barriers to implementing investment appraisal methods.

PurposeRobotic process automation (RPA) has recently emerged as a technology focusing on the automation of repetitive, frequent, voluminous and rule-based tasks. Despite a few practical examples that document successful RPA deployments in organizations, evidence of its economic benefits has been mostly anecdotal. The purpose of this paper is to present a step-by-step method to RPA investment appraisal and a business case demonstrating how the steps can be applied to practice.Design/methodology/approachThe methodology relies on design science research (DSR). The step-by-step method is a design artefact that builds on the mapping of processes and modelling of the associated costs. Due to the longitudinal nature of capital investments, modelling uses discounted cashflow and present value methods. Empirical grounding characteristic to DSR is achieved by field testing the artefact.FindingsThe step-by-step method is comprised of a preparatory step, three modelling steps and a concluding step. The modelling consists of compounding the interest rate, discounting the investment costs and establishing measures for comparison. These steps were applied to seven business processes to be automated by the case company, Estate Blend. The decision to deploy RPA was found to be trivial, not only based on the initial case data, but also based on multiple sensitivity analyses that showed how resistant RPA investments are to changing circumstances.Practical implicationsBy following the provided step-by-step method, executives and managers can quantify the costs and benefits of RPA. The developed method enables any organization to directly compare investment alternatives against each other and against the probable status quo where many tasks in organizations are still carried out manually with little to no automation.Originality/valueThe paper addresses a growing new domain in the field of business process management by capitalizing on DSR and modelling-based approaches to RPA investment appraisal.

Emissions associated with hydropower are often forgotten. Lifecycle assessments of greenhouse gas emissions emanating from hydropower must count embedded carbon, emissions from reservoir lakes and the loss of carbon sinks, as well as backup diesel generation emissions when dependence on hydropower fails to deliver energy. Using Zambia as a case study, we estimate using a bottom-up approach that the emissions associated with backup diesel generation from Zambia's power utility ZESCO and three largest sectors of consumers were up to 27 000 tonnes of CO2 in the worst months of drought in 2019. This is significantly higher than what a previous top-down approach would have estimated. We worked out ZESCO's diesel generation attributable to drought using trend analysis. We worked out the mining sector's emissions using copper production data, on-grid electricity consumption and calculated electricity intensity to infer off-grid electricity consumption in years of drought. From our household survey we learned average duration of generator use, average capacities of generators and acquired household income and generator use data which we ran in a Tobit regression. These together with labour force survey data helped us infer the level of diesel generation by households of different income brackets. For manufacturing firms we surveyed 123 firms. We collected rich diesel generation use data covering years of drought, input this into an OLS regression to identify predictors of diesel generation use (installed capacity of generator in kVA, in litres and whether generation was in a drought year) which we then used to extrapolate implied diesel generation for the firms for which we had less rich data. As global average temperatures and the frequency of El Niño droughts rise in hydropower dependent countries which account for a fifth of the world's population, backup generation emissions have implications for the formulation of low carbon energy policy.

Understand the role and potential of fixed income as an asset class Systematic Fixed Income: An Investor's Guide offers readers a powerful, practical, and robust framework for investors and asset managers to preserve the diversifying properties of a fixed income allocation, and add to that unique sources of excess returns via systematic security selection. In other words, this framework allows for efficient capture of fixed income beta and fixed income alpha. Celebrated finance professional Dr. Scott Richardson presents concrete strategies for identifying the relevant sources of risk and return in public fixed income markets and explains the tactical and strategic roles played by fixed income in typical portfolios. In the book, readers will explore: The implementation challenges associated with a systematic fixed income portfolio, including liquidity and risk The systematic return sources for rate and credit sensitive fixed income assets in both developed and emerging marketsAn essential read for asset managers and institutional investors with a professional interest in fixed income markets, Systematic Fixed Income: An Investor's Guide deserves a place in the libraries of advanced degree students of finance, business, and investment, as well as other investment professionals seeking to refine their understanding of the full potential of this foundational asset class.

This paper assesses the economic benefits of 57 World Bank Group-sponsored hydropower dam plant investments. Hydropower dams are among the main sources for producing electricity and the largest renewable source for power generation throughout the world. Hydropower dams are often a lower-cost option for power generation in Clean Energy Transition for addressing global climate change. Despite its conspicuous aspects, constructing hydropower dams has been controversial. Considering the World Bank’s long history as the largest hydropower development financier, this study investigates its performance in supporting hydropower dams. The outcomes of this study apply to the wider hydropower development community. Of the projects in this study, 70% experienced a cost overrun, and more than 80% of projects experienced time overruns, incurring potential additional costs as a result. Despite the high cost and time overruns, this hydropower portfolio of dams produced a present value of net economic benefits by 2016 of over half a trillion USD. Based on our findings, the evaluated hydropower portfolio helped avoid over a billion tonnes of CO2 for an estimated global environmental benefit valued at nearly USD 350 billion. The projects’ additional environmental benefits raise the real rate of return from 15.4% to 17.3%. The implication for hydropower developers is that the projects’ assessment should consider cost and time overrun and factor them into the project-planning contingency scenarios. There is a considerable benefit for developing countries to exploit their hydropower resources if they can be developed according to industry practices and international standards. The case for developing hydropower may be stronger when considering its climate benefits. The net economic benefits of hydropower can be even higher if there is a greater effort to manage cost and time overruns.

PurposeDespite major progress made in improving the health and well-being of millions of people, more efforts are needed for investment in 21st century health care. However, public hospital waiting lists continue to grow. At the same time, there has been increased investment in e-health and digital interventions to enhance population health and reduce hospital admissions. The purpose of this study is to highlight the accounting challenges associated with measuring, investing and accounting for value in this setting. The authors argue that this requires more nuanced performance metrics that effect a shift from a technical practice to one that embraces social and moral values.Design/methodology/approachThis research is based on field interviews held with clinicians, accountants and administrators in public hospitals throughout Australia and Europe. The field research and multidisciplinary narratives offer insights and issues relating to value and valuing and managing digital health investment decisions for the post-COVID-19 “value-based health-care” future of accounting in the hospital setting.FindingsThe authors find that the complex activity-based hospital funding models operate as a black box, with limited clinician understanding and hybridised accounting expertise for informed social, moral and ethical decision-making. While there is malleability of the health economics-derived activity-based hospital funding models, value contestation and conflict are evident in the operationalisation of these models in practice. Activity-based funding (ABF) mechanisms reward patient throughput volumes in hospitals but at the same time stymie investment in digital health. Although classified as strategic investments, there is a limit to strategic planning.Research limitations/implicationsAccounting in public hospitals has become increasingly visible and contested during the pandemic-driven health-care crisis. Further research is required to examine the hybridising accounting expertise as it is increasingly implicated in the incremental changes to ABF in the emergence of value-based health care and associated digital health investment strategies. Despite operationalising these health economic models in practice, accountants are currently being blamed for dysfunctional health-care decisions. Further education for practicing accountants is required to effect operational change. This includes education on the significant moral and ethical dilemmas that result from accounting for patient mix choices in public hospital service provision.Originality/valueThis research involved a multidisciplinary team from accounting, digital health, information systems, value-based health care and clinical expertise. Unique insights on the move to digital health care are provided. This study contributes to policy development and the limited value-based health-care literature in accounting.

To overcome the inadequacy of traditional financial metrics in appraising green infrastructure, this study develops and validates an integrated framework combining financial and sustainability indicators to more accurately predict project performance. Employing a mixed-methods design, this study synthesized metrics from expert interviews (N = 24) and literature, then collected data from 42 completed projects in Gulf Cooperation Council countries. The framework’s predictive validity was tested using a novel application of a Gradient Boosting Machine (XGBoost) model, with SHAP (SHapley Additive exPlanations) analysis ensuring model interpretability. The integrated framework yielded higher out-of-sample discriminatory performance (AUC-ROC = 0.88) than a baseline using only traditional metrics (AUC-ROC = 0.71). In SHAP analyses, RBCR and LCC contributed most to the model’s predictions, whereas NPV and IRR contributed least. These results indicate stronger predictive associations for sustainability-oriented metrics in this study’s model. Because the design is cross-sectional and predictive, all findings are associational rather than causal; residual confounding is possible. The validated, interpretable model is therefore positioned as a decision support tool that complements, rather than replaces, expert appraisal.

PurposeThe Stress-Prevention@Work implementation strategy has been demonstrated to be successful in reducing stress in employees. Now, we assess the economic return-on-investment to see if it would make for a favourable business case for employers.MethodsData were collected from 303 health-care workers assigned to either a waitlisted control condition (142 employees in 15 teams) or to Stress-Prevention@Work (161 employees in 15 teams). Main outcome was productivity losses measured using the Trimbos and iMTA Cost questionnaire in Psychiatry. Measurements were taken at baseline, 6, and 12 months post-baseline.ResultsThe per-employee costs of the strategy were €50. Net monetary benefits were the benefits (i.e., improved productivity) minus the costs (i.e., intervention costs) and were the main outcome of this investment appraisal. Per-employee net benefits amounted to €2981 on average, which was an almost 60-fold payout of the initial investment of €50. There was a 96.7% likelihood for the modest investment of €50 to be offset by cost savings within 1 year. Moreover, a net benefit of at least €1000 still has a likelihood of 88.2%.ConclusionsIn general, there was a high likelihood that Stress-Prevention@Work offers an appealing business case from the perspective of employers, but the employer should factor in the additional per-employee costs of the stress-reducing interventions. Still, if these additional costs were as high as €2981, then costs and benefits would break even.This study was registered in the Netherlands National Trial Register, trial code: NTR5527.