We propose that blockchain technology complemented by secure computation methods can foster implementation of a learning healthcare system (LHCS) by minimizing upfront patient-facing compromises with unsurpassed data security and privacy, and by optimizing the system’s fulfillment of its obligations to respect patients through transparency, engagement, and accountability. We demonstrate how a blockchain-enabled LHCS could foster patient willingness to contribute to learning by providing desired security and control over health data. In addition, secure computation methods could enable meta-analysis without exposing individual-level data, thus allowing the system to protect patients’ privacy while simultaneously learning from their data. The transparency and immutability of blockchain ledgers would also support the public’s trust in the system by allowing patients to audit and oversee which of their data are used, how they are used, and by whom. Furthermore, blockchain communities are community-governed peer-to-peer networks in which sharing builds mutually beneficial value, offering a model for engaging patients as LHCS stakeholders. Smart contracts could be used to ensure accountability of the system by embedding feedback mechanisms by which patients directly and automatically realize benefits of sharing their data.
Blockchain menawarkan berbagai dobrakan di bidang teknologi, mulai dari bidang keuangan hingga kesehatan. Beberapa usulan juga menerapkan blockchain pada teknologi IoT untuk meningkatkan unjuk kerja dan scalability. Namun, tipikal penerapan teknologi IoT dalam skala masif masih memiliki beberapa kendala, terlebih dalam hal manajemen akses dan identitas peranti yang terkoneksi. Makalah ini mengusulkan kombinasi dari permissioned blockchain dan teknologi Keyless Signature Infrastructure (KSI) sebagai metode untuk mengatur hak akses dan identitas peranti IoT. KSI dikenal mampu untuk memberikan layanan tanda tangan digital tanpa tergantung pada kunci privat maupun publik dengan menggunakan teknik pohon hash. Dengan karakteristik dari blockchain yang terdistribusi, teknologi KSI dapat dipadukan secara lebih efisien. Hasil yang diperoleh memberikan manajemen akses dan identitas dengan scalability yang tinggi.
Key messages In different provinces or districts, the same laws can be applied in very different ways. Participation of customary land users and local communities remains ad hoc and requires that implementing regulations are strengthened, as the existing safeguarding laws are not sufficiently specific. Further developments of safeguarding laws and regulations (specifically the distribution of benefits from carbon financing) need to be well defined and better aligned with decentralization processes. Subnational actors are unclear on their role in a national REDD+ strategy and how they will be involved in decision making. REDD+ is challenged by a misalignment between land use decision-making powers and REDD+ management powers allocated to different bodies and levels.
Open access
Indonesian Legal and Regulatory Studies
Conservation, Biodiversity, and Resource Management
The right to participation is the "the right of rights"--the basic right of people to have a say in how decisions that affect their lives are made. All legally binding international human rights treaties explicitly recognize the essential role of participation in realizing fundamental human rights. While the substance of the human right to health has been extensively developed, the right to participation as one of its components has remained largely unexplored. Should rights-based health advocacy focus on participation because there is a relationship between an individual's or a community's active involvement in health care decision-making and the highest attainable standard of health? In the context of the human right to health, does participation mean primarily political participation, or should we take the right to participation to mean more specifically the right of persons, individually and as a group, to shape health care policy for society and for themselves as patients? Decentralization of health care decision-making promises greater participation through citizen involvement in setting priorities, monitoring service provision, and finding new and creative ways to finance public health programs. Between 1999 and 2008, Indonesia decentralized health care funding and delivery to regional governments, resulting in substantial exclusion of its poor and uneducated citizens from the health care system while simultaneously expanding the opportunities for political participation for educated elites. This article explores the tension between the right to participation as an underlying determinant of health and as a political right by reviewing the experience of Indonesia ten years after its decision to decentralize health care provision. It is ultimately argued that rights-based advocates must be vigilant in retaining a unified perspective on human rights, resisting the persistent tendency to separate and prioritize the civil and political aspects of participation over its social component.