Business process reengineering (BPR) began as a private sector technique to help organizations fundamentally rethink how they do their work in order to dramatically improve customer service, cut operational costs, and become world-class competitors. A key stimulus for reengineering has been the continuing development and deployment of sophisticated information systems and networks. Leading organizations are becoming bolder in using this technology to support innovative business processes, rather than refining current ways of doing work. Not surprisingly, BPR has captured the interest of federal agencies, which are faced with an urgent need to reduce costs and improve service to the American public. 1 This guide is designed to help auditors review business process reengineering projects in a federal setting, determine the soundness of these efforts, and identify actions needed to improve the prospects for their success. The nine major assessment issues in this guide deal with elements considered by experts to be stepping stones to successful business process reengineering. These issues cover a wide range of activities, such as identifying customer needs and performance problems, reassessing strategic goals, defining reengineering opportunities, managing reengineering projects, controlling risks and maximizing benefits, managing organizational changes, and successfully implementing new processes. Taken together, the issues in this guide provide a general framework for assessing a reengineering project, from initial strategic planning and goal-setting to post-implementation assessments.

The present study attempts to estimate cost differences associated with anti-retroviral therapy (ART) task shifting in a limited resource setting in Ethiopia, and to analyze the determinant factors for length and cost of a visit. A stratified random sample of health facilities was surveyed. An ordinary least square (OLS) regression model was employed. The average time spent by patients in ART services was estimated to be 8.5 minutes (Range: 1 to 60 minutes). The OLS model estimated that the median cost per visit for doctors was 15% higher than for the nurses, when controlling for type of facility and type of visit. We found that ART services were less costly when delivered by nurses and health officers, compared with doctors. Since task-shifting to less specialized health-care workers yields additional economic benefits, the expansion of ART task-shifting should be considered by healthcare policy makers and stakeholders in a limited resource settings.

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