Blockchain Papers

Yu Zhang, Suguru Mizunoya, You You, Mun C. Tsang

This is a study of financial disparities in primary and secondary education in OECD countries that have a relatively large population and a school finance system with decentralized features. These countries include the United States, Britain, Australia, Spain, Canada, and Japan. There are two major research questions: What are the trends in disparities in per-student education spending during the 1990s and early 2000s period? What government policies or factors may explain these trends? Common statistics such as the coefficient of variation, the restricted range, the federal range ratio, and Gini coefficient are used to measure disparity in per-student spending. Sub-national data for this study are obtained from published government sources. There are three major findings: (1) there was a general trend towards a reduction in inequity in per-student education spending in these countries; (2) this equalization trend was associated with a variety of financing policies implemented in these countries; and (3) a larger share of regional government funding relative to the share of local government funding, intergovernmental transfer, and the design of school funding formulas are crucial factors for enhancing equity in education funding. The policy towards centralization in education finance system also appears to be an important factor in financial equalization.

Fergal Reid, Martin Harrigan

Anonymity in Bitcoin, a peer-to-peer electronic currency system, is a complicated issue. Within the system, users are identified by public-keys only. An attacker wishing to de-anonymize its users will attempt to construct the one-to-many mapping between users and public-keys and associate information external to the system with the users. Bitcoin tries to prevent this attack by storing the mapping of a user to his or her public-keys on that user's node only and by allowing each user to generate as many public-keys as required. In this chapter we consider the topological structure of two networks derived from Bitcoin's public transaction history. We show that the two networks have a non-trivial topological structure, provide complementary views of the Bitcoin system and have implications for anonymity. We combine these structures with external information and techniques such as context discovery and flow analysis to investigate an alleged theft of Bitcoins, which, at the time of the theft, had a market value of approximately half a million U.S. dollars.

Joel Zylberberg, Michael R. DeWeese

The canonical model of primary visual cortex (V1) is that it forms a linear generative model of the image stimulus presented to the eyes. Thus, for a given image with pixel values Xj, the representation Xj*=∑ibiψij is formed by multiplying the activity of each neuron (bi) by the feature that neuron encodes (ψij), and summing over all neurons. We call this a cooperative representation, since it involves all of the neurons collectively forming a single representation. Over time, the network is thought to adapt so as to minimize, on average, the mean-squared error between the representation X* and the input X, ||X-X*||2. Performing gradient descent on this error function yields the usual learning rule Δψij= α bi(Xj- ∑ibiψij ), where α is some small positive constant called the learning rate. Typically, the features ψij are interpreted as the receptive fields (RF’s; features to which a neuron responds) of the neurons; indeed, there is strong evidence [1] that the feature encoded by a neuron is very similar to its RF. In that case, the value ψij can be thought of as the strength of the synaptic connection between input pixel value Xj, and neuron i. With that interpretation in mind, it is clear that the canonical learning rule Δψij= α bi(Xj- ∑ibiψij ), used by most previous work in this field [1,2], fails to be biologically realistic because the rule for updating one synaptic strength ψij requires knowledge of the strengths of many synaptic connections, all on different neurons (with indices i), and it is not clear that such information is available to each individual synapse in the brain. We consider instead a Hebbian learning rule that respects synaptic locality, Δψij= α bi(Xj- biψij ) [3]. In this case, the information required to change the strength of synapse ψij consists solely of the pre-synaptic activity Xj, the post-synaptic activity bi, and the current strength of the synaptic connection ψij. While this rule respects the locality of synaptic information, it does not appear to perform gradient descent on the desired error function ||Xj- ∑ibiψij||2. Instead, our local rule can be seen as gradient descent on the error function ∑i||Xj- biψij ||2, which is the sum over all neurons of the error between each neuron’s own internal representation of the input, biψij, and the input image. In other words, a network that follows Oja’s [3] local learning rule is a solipsistic one: each neuron makes its own individual representation of the input, and learning optimizes each of those representations individually. We have proven that, if neuronal activities {bi} are uncorrelated, and sufficiently sparse (the majority of the bi’s are zero for any given image), the local and non-local learning rules are approximately equal, when averaged over many image presentations: = α ≈ α . This suggests a previously undiscovered role for independence and sparseness in visual cortex: these properties allow the neuronal network to (approximately) form the optimal cooperative representation, despite the locality of its learning rules. The same proof applies other neuronal networks that form linear generative models. We will present the details of our proof, and an example network (similar to that of [4]) of leaky integrate-and-fire neurons that learns a sparse image code using the local learning rule Δψij= α bi(Xj- biψij ). In our network, inhibitory inter-neuronal connections and variable firing thresholds keep the neuronal activities uncorrelated and sparse throughout the learning process. When trained on natural scenes, this network learns the same diversity of receptive fields as do previous non-local algorithms [1,2].

Roberto Caranta

EU administrative law has some specific characters when compared with national administrative law. This is particularly so because of the weak democratic legitimacy of EU rules. EU administrative law however shares a number of developments with national legal orders, such as a general trend to strengthen the judicial review of individual measures, and this especially so when fundamental rights are at stake. When compared with some national legal orders, dialogue seems to be still in an early phase. This is a shame because the political circle linking the decision makers to the People through representative democracy is weak and benefits could had by supplementing it by more closely involving the civil society and the stakeholders. The little in terms of developments we have, however, is enough to confirm the role of law and courts in this different perspective as the tools «to police conditions of access to decision-making networks. A powerful incentive to dialogue for European institutions could however come – in sectors like competition policy – from a possible shift from a French administrative law presumption of legality pattern to a US adversarial adjudication model, the latter substantially imposing on EU institution a burden of proof where before was a duty to give reasons. Taken down from the high throne where traditional continental administrative law has placed it, it makes sense for the Commission to double its efforts to come at some sort of agreements with the undertaking concerned.

Dermot Maher, Tido von Schoen-Angerer, Jennifer Cohn

The HIV epidemic is a leading global health challenge. While controversy has surrounded the best HIV prevention strategy, remarkable consensus has supported the campaign for universal access to antiretroviral therapy (ART) for people with HIV infection. As a necessary humane response to the epidemic, the moral imperative to provide ART to people with HIV infection has struck a chord of global solidarity. Much of the funding mobilised for the global response to HIV has supported successful expansion in ART access. Funding is now at a critical juncture as the global financial crisis bites and funders hesitate. Providing universal ART access is a steep hill only half climbed – faltering at this point risks rapid loss of recent gains, and the need to begin again an even steeper climb in future just to regain our current incomplete and perilous position. Against the background of overall efforts to roll back the HIV epidemic, we consider the implications of faltering finances for universal ART access and argue for additional funding, used efficiently. Progress towards universal ART access has individual and also potential community benefits. Although we focus mainly on sub-Saharan Africa as the region most badly affected by HIV and with the least resources to respond, other regions face similar issues. The seemingly inexorable rise in global HIV incidence during the first 30 years of the epidemic peaked towards the end of the 1990s. However, global HIV prevalence and deaths still remain at crisis levels, with 33.4 million people living with HIV and 2 million deaths in 2008 (1). The region most severely affected is sub-Saharan Africa, with 67% of HIV infections and 72% of HIV-related deaths worldwide in 2008 (1). Changing the course of an epidemic of a primarily sexually transmitted infection by changing sexual behaviour is difficult –‘king sex is an unruly monarch’. Demonstrating effectiveness and impact of behaviour change interventions has been difficult and there is little agreement on which specific interventions most effectively change behaviour. Male circumcision is one of few interventions shown in randomised trials to be effective in decreasing HIV transmission risk (2–4), but programmatic delivery is limited and long-term results are awaited. Thirty years’ advances in HIV virology and immunology have been a tremendous scientific success, but have not yet resulted in widely available HIV prevention technologies. The high variability of HIV envelope glycoproteins has frustrated attempts to develop an effective vaccine. After nearly 2 decades of research which failed to find an effective vaginal microbicide (5), the recent finding that tenofovir gel decreases risk of HIV acquisition by 39% is promising (6). Scientific advances have, however, resulted in widely applied HIV diagnosis and treatment technologies. Diagnostic HIV tests are widely available, rapid, easy-to-use, accurate and relatively cheap. Antiretroviral (ARV) drugs can effectively contain HIV even if a cure is not yet possible. Prolongation of life by ART – a tribute to science and technology – has transformed the previously bleak outlook for people with HIV infection. The impact of improved ART access on HIV-related mortality at the population level has been shown in countries with high income, e.g. UK (7) and low income, e.g. Malawi (8). The 10-fold expansion in access to ART in low- and middle-income countries over the 5 years up to 2007 is a tremendous achievement (9). However, the uphill task is not even half completed. The five million adults and children with HIV infection in low- and middle-income countries receiving ART by the end of 2009 represented only 36% of those in need (based on 2010 WHO guidelines) (9). This progress demonstrates proof of principle – that with political and financial commitment universal access to ART is possible – but an unfinished agenda remains. Faltering political and financial commitment threatens to stall progress towards universal ART access. Starting in 2008 the shock waves of the global financial crisis emanated quickly from the USA around the world. The myriad effects of the crisis include threats in developing countries to health services, including ART provision (much of which is funded by donors). The health infrastructure which has been painstakingly built up for ART provision can be easily dismantled in a funding downturn. Developed nations have responded to the ‘credit crunch’ and the collapse of banking systems by allocating vast national resources to bail out financial institutions and industries while their economies contract. Under domestic pressure to curb spending, donor governments are cutting back on development assistance, which may account for a significant proportion of health service expenditure in developing countries. Developing country governments under fiscal constraint may also squeeze health sector expenditure. The global economic downturn therefore compounds the problems of diseases of poverty (e.g. HIV, tuberculosis and malaria) by a double whammy – as socioeconomic conditions which favour the spread of these diseases deteriorate, funds for the health sector response are restricted (10). After substantial yearly increases since 2002 in support for ART access, the USA and other donors have stalled in their funding commitments, with disbursements decreased for 2009 (11). Already by 2009 UNAIDS reported an adverse effect of the economic crisis on ART programmes (12). The Global Fund replenishment pledges for 2011–2013 reached $11.7 billion, far short of the $20 billion needed to expand programmes and even short of the $13 billion needed to keep existing programmes running (13). Although the latest WHO guidelines recommend a CD4 cell count of 350 cells/μl as a starting threshold for ART (14), many centres in Africa continue to use a threshold of 200 CD4 cells/μl because of insufficient ARV supply (15). Medecins sans Frontieres have reported ART rationing to the sickest patients in developing countries, directly contradicting the evidence of benefits of earlier treatment and WHO guidelines (16). Consequences of failure to maintain even the existing ARV drug supply include: more HIV-related diseases and deaths that could have been prevented; without treatment people becoming more infectious, with increased risk of transmission; and increased drug resistance generated by treatment interruption, necessitating more expensive second-line therapies to prevent HIV progression. Financially squeezed ART programmes may further compromise the quality of ART provision in Africa, where mortality is high in the first year of ART because of health systems delays in ART initiation and the quality of care (17). The funds invested in achieving the current level of ART access are a platform for further progress. Additional investment in progress towards universal ART access benefits people with HIV infection, and also potentially the community through improved HIV prevention and improved health systems. Early ART initiation improves patient outcomes and also reduces HIV infectiousness (18) and transmission (19,20), with the potential for ‘treatment as prevention’ (21). Early ART with cessation of viral replication and subsequent immune restoration has benefits for the individual (less risk of HIV-related disease) and also potentially for public health (improved HIV prevention) and for society (increased productivity and decreased costs of HIV-related care) (22). The strategy of universal voluntary testing with immediate ART, which in a mathematical model could eliminate HIV transmission (23), needs evaluation in practice (24). Achieving universal ART access is easier if HIV incidence decreases. This is urgent as the rate of new HIV infections is greater than the rate that people with HIV start ART. Additional investments in implementing combined prevention interventions will decrease HIV incidence, thus facilitating ART provision. Progress towards universal and early ART access could become a virtuous cycle, as the more (and the earlier) that people start ART, the greater is the potential impact in decreasing transmission, with fewer incident cases and fewer people needing ART. Progress in ART provision requires investment in strengthened health systems as well as in the health system elements most directly involved in ART provision. The reasons why HIV has had a much greater impact in Africa than other regions include deficiencies in the region’s health systems. Such deficiencies lead to failure to recognise emerging health problems, diagnose cases, provide quality care, manage surveillance, promote a safe healthcare environment and gain public confidence. Lack of preparedness increases vulnerability to future emerging health problems, unless health systems are strengthened using adequate resources. Investing in ART provision while strengthening health systems is a win-win situation for people with HIV infection and the community. Additional funding generated for improved ART access must be used more efficiently (25). In developing countries, a built-in cost-efficiency is that ARV drug costs fall as coverage increases. Proposals for maximising cost-efficiencies include a cross-cutting agenda for global health to meet the challenges of the financial crisis (26). Disease-specific health initiatives and funding programmes should agree on a cross-cutting agenda to reform the global health architecture and maximise cost-efficiencies, instead of advocating and competing for their own stake in the limited and diminishing pool of donor funds. At country level, greater integration of HIV and other programme activities, e.g. tuberculosis, could improve efficiency and strengthen health systems (27). Scaling-up home-based ART (28) and clinically driven rather than routine laboratory monitoring of ART side-effects (29) can improve ART programme efficiency. ‘How to do more with less’ is a research priority for extending ART access in low-resource settings (30). Finding efficiencies in healthcare delivery is important but does not replace sufficient, predictable financing by donors and domestic funding from low- and middle-income countries. Measures to ensure the lowest possible ARV drug prices facilitate cost-efficiencies. Changes in wealthy nations’ trade policies are urgently needed to avoid creating new barriers for generic drugs. Generic competition has been critical to lowering drug costs and will be critical to also lower the prices of newer drugs needed for long-term survival (31). The free trade agreement with India pursued by the European Union, for example, will further increase monopoly protection, although India has already changed its patent law in compliance with World Trade Organization agreements (32). Donor countries’ support for policies to contain ARV drug costs should complement their commitment to fund ART provision. Achieving universal access to ART is an uphill task but feasible if funding is increased and used efficiently. The choice is stark – to build on progress or to embrace defeat and consign the global movement for universal access to the fate of Sisyphus (33). Note: The views expressed by Dermot Maher are not necessarily those of the Medical Research Council (UK). We thank Brian Williams for his encouragement –“The struggle itself towards the heights is enough to fill a man’s heart” (Camus). DM is a clinical epidemiologist and researcher with extensive experience of the global HIV epidemic as a clinician, public health expert and field researcher. TvS-A has extensive experience of the global HIV epidemic and is a leading advocate on behalf of Medecins sans Frontieres for universal access to HIV prevention and treatment. JC has extensive experience of HIV/AIDS policy and advises the Médecins sans Frontières Campaign for Access to Essential Medicines. DM had the idea for the article which he developed in discussion with TvS-A and JC. DM took the lead in drafting the article and all authors contributed to the development of successive iterations. The sources of information for the article were relevant papers from the peer-reviewed literature. DM is guarantor for the article. TvS-A is employed by, and JC is a policy adviser to, the Médecins sans Frontières Campaign for Access to Essential Medicines, which advocates for universal access to HIV prevention and treatment.

Apurva Dargar

The security of electronic devices is of crucial importance to companies as well as to users.Moreover, companies that develop Intellectual Property also want to protect them from counterfeiting and overbuilding.Company profits, brand reputations and personal information of the users are at stake if there is a breach in the security of these electronic devices.In the classical approach, a system is secured by storing the cryptographic keys permanently in the non-volatile memories that are present in the security devices.However, this permanent storage of the key makes them easy targets for physical attacks; hence compromising the security of the system.A more secure, cost-effective and elegant solution to this permanent key storage is the use of Physical Unclonable Functions (PUFs).PUF is a method of producing a signature from a physical object, such as an Integrated Circuit, by relying on the non-reproducible physical attributes of a device.These signatures are unique because fabricated circuits exhibit slightly different electrical behavior from one another even if their design, mask and manufacturing process are identical.Various kinds of PUFs exist; examples are Optical PUF, Butterfly PUF and SRAM PUF.However, the start-up value based SRAM PUFs appear to be the most promising ones for usage in ICs.Although the SRAM PUFs are becoming very popular, only a little has been published in the field of modeling and analysis of their start-up behavior.Reproducing the same start-up behavior, every time the chip is powered-on, is very crucial in order to produce the same cryptographic key.This thesis proposes an analytical model for the start-up value based SRAM PUFs; it helps in understanding the impact of both non-technological parameters (such as supply voltage and temperature) as well as technological parameters (such as the geometry of the transistors and threshold voltage) on the behavior of the start-up values of an SRAM.Various experiments have been performed to analyze and quantify their impact.The results obtained indicate a major impact of the non-technology parameters.The reproducibility of start-up values becomes more likely with slower ramp-ups and lower temperatures.For example, the percentage of reproducible bits increase from 93.5% at 1s ramp-up to 96% at 10ms ramp-up.Amongst the technology parameters, it is observed that a small mismatch of 1.6% in the threshold voltage is enough to flip the start-up value of the cell for 65nm technology.These results have been validated by comparing them with actual silicon data measured at Intrinsic ID.The validation of the results proves the correctness of the analytical model proposed and gives a proof of robustness of the start-up values. Modeling SRAM Start-up Characteristics ForPhysical Unclonable Functions

Ioannis Chatzigiannakis, Apostolos Pyrgelis, Paul G. Spirakis, Yannis C. Stamatiou

Elliptic Curve Cryptography (ECC) is an attractive alternative to\nconventional public key cryptography, such as RSA. ECC is an ideal candidate\nfor implementation on constrained devices where the major computational\nresources i.e. speed, memory are limited and low-power wireless communication\nprotocols are employed. That is because it attains the same security levels\nwith traditional cryptosystems using smaller parameter sizes. Moreover, in\nseveral application areas such as person identification and eVoting, it is\nfrequently required of entities to prove knowledge of some fact without\nrevealing this knowledge. Such proofs of knowledge are called Zero Knowledge\nInteractive Proofs (ZKIP) and involve interactions between two communicating\nparties, the Prover and the Verifier. In a ZKIP, the Prover demonstrates the\npossesion of some information (e.g. authentication information) to the Verifier\nwithout disclosing it. In this paper, we focus on the application of ZKIP\nprotocols on resource constrained devices. We study well-established ZKIP\nprotocols based on the discrete logarithm problem and we transform them under\nthe ECC setting. Then, we implement the proposed protocols on Wiselib, a\ngeneric and open source algorithmic library. Finally, we present a thorough\nevaluation of the protocols on two popular hardware platforms equipped with low\nend microcontrollers (Jennic JN5139, TI MSP430) and 802.15.4 RF transceivers,\nin terms of code size, execution time, message size and energy requirements. To\nthe best of our knowledge, this is the first attempt of implementing and\nevaluating ZKIP protocols with emphasis on low-end devices. This work's results\ncan be used from developers who wish to achieve certain levels of security and\nprivacy in their applications.\n

Ioannis Chatzigiannakis, Apostolos Pyrgelis, Paul G. Spirakis, Yannis C. Stamatiou

Elliptic Curve Cryptography (ECC) is an attractive alternative to conventional public key cryptography, such as RSA. ECC is an ideal candidate for implementation on constrained devices where the major computational resources i.e. speed, memory are limited and low-power wireless communication protocols are employed. That is because it attains the same security levels with traditional cryptosystems using smaller parameter sizes. Moreover, in several application areas such as person identification and eVoting, it is frequently required of entities to prove knowledge of some fact without revealing this knowledge. Such proofs of knowledge are called Zero Knowledge Interactive Proofs (ZKIP) and involve interactions between two communicating parties, the Prover and the Verifier. In a ZKIP, the Prover demonstrates the possesion of some information (e.g. authentication information) to the Verifier without disclosing it. In this paper, we focus on the application of ZKIP protocols on resource constrained devices. We study well-established ZKIP protocols based on the discrete logarithm problem and we transform them under the ECC setting. Then, we implement the proposed protocols on Wiselib, a generic and open source algorithmic library. Finally, we present a thorough evaluation of the protocols on two popular hardware platforms equipped with low end microcontrollers (Jennic JN5139, TI MSP430) and 802.15.4 RF transceivers, in terms of code size, execution time, message size and energy requirements. To the best of our knowledge, this is the first attempt of implementing and evaluating ZKIP protocols with emphasis on low-end devices. This work's results can be used from developers who wish to achieve certain levels of security and privacy in their applications.

Gyorgy Adina Crsitina, Attila György

The importance of the local public finance is growing in accordance with the increasing proportion of the decentralization process. The mechanism of resource allocation, and especially the allocation criteria used, constitutes subjects of debate. Our objective pursued is to assess whether the avoidance of the first step for balancing the allocation of funds can provide enhanced fairness in balancing the local budgets across the country. Local budgets in Romania receive significant resources from the state budget in the form of amounts and quotas distributed from certain taxes, which are revenues for the state budget. Some of these amounts are designed to balance the local budgets. The distribution of funds from the state budget to the local budgets requires two steps. Firstly, the amounts are divided by county, secondly, these amounts are directed within the county especially towards localities which have a lower financial standing. Given the significant disparities between counties, we believe that this mechanism does not ensure fairness in the allocation because the funds distributed according to the first step may not use fair criteria to meet the requirements for balanced local budgets. Therefore, we intend to simulate a balanced allocation of national funds for eliminating the first step that produces the most significant inequities. Direct application of the second step of allocation, with its two phases, will provide more funds serving those local administrative units for the income tax per capita is lower than the national average. Comparing the values allocated for the year 2011 with those obtained in the simulation we will examine changes that occur after the application of this method which seems to be more equitable and appropriate. This work was supported by CNCSIS-UEFISCSU, project number PNII-IDEI 1780/2008

Dodescu Anca

Romania's integration in the European Union implies, apart the complex process of policy transfer, the learning of new modes to make policies characteristic to a multi-level governance and partnership culture. Of the different levels of governance of the European model, the regional level ("regional governance") most faithfully reflects, in our opinion, the complexity of reconfiguring the role of state in economy, at the beginning of this new millennium, in the European Union space and presents the highest practical importance for Romania, as a new Member State of the European Union, for, at the regional level, the structures are more flexible and the good practices are more rapidly assimilable. The selection of the best regional growth and development economic policies, the choosing of the objectives out of a series of competing options, the calibration in time and space of powers, roles, capabilities, and responsibilities and the encouragement of the win-win solutions call upon the choice and combination of some appropriate and efficient instruments. Representative for the new context, the regional growth and development policy must integrate, in Romania too, more knowledge, more creativity, new combinations of capabilities and new fields of expertise. This paper presents preliminary research results afferent to the post-doctoral research project: "Growth and regional development economic policies. Challenges for Romania in the context of economic-financial crisis and European model integration", carried out in the project "Economic scientific research, reliance of human welfare and development in European context", the Romanian Academy, "Costin C. Kiriţescu" National Institute for Economic Research, project financed for the 2010-2013 period from the European Social Fund (EFS) and implemented by the Romanian Academy, Costin C. Kiritescu National Institute for Economic Research, in the period of time 1 December 2010 - 30 November 2012, coordinator: Professor Dr. Valeriu Ioan Franc. The question we intend to answer, in the present phase of our research, based on the comparative analysis of the decentralisation systems of several Member States of European Union, respectively on the analysis of the regional disparities existing at the European Union level and of the effects of the economic integration, is- to what extent the capabilities of the regional policy should rather be concentrated in the hands of regional authorities or of the European Union than to be left individually to the Member States which should conceive their own regional policy? What we intend in this paper, based on the analysis of some experiences to decentralize the capabilities of economic policy at the European Union level, is to identify the regional implications of the interconnection of decentralization, centralization, respectively supra-nationalization tendencies and, implicitly, the analysis of the way to reconfigure the role of state in economy at the regional level, in the context of integration in the European model. The examination of the way to reconfigure the role of state in economy at regional level requires the review of the allocative, distributive, and regulating roles of the state from a regional perspective, the analysis, on one side, of the decentralization of economic policy capabilities from the national level to the regional level (for example, national level: pure public goods supply, for instance, national defence and the centralization of fiscal policy capabilities in order to achieve macroeconomic stability and revenue redistribution; regional level: mixed public goods supply, for instance, waste collection and community policy), on the other hand, the centralization/decentralization of regional capabilities at the European Union level.

Frank Shann

(See the article by Aaby et al, on pages 245–52.) There is now clear evidence that the simplistic conventional model of immunization is invalid [1]. We can no longer assume that a vaccine acts independently of other vaccines, or that it influences only infections caused by the target disease. Strong evidence from randomized trials suggests that bacillus Calmette-Guérin vaccine (BCG) reduces mortality from infections other than tuberculosis and that measles vaccine reduces mortality from infections other than measles [1–4]. However, there is worrying evidence that whole-cell diphtheria-tetanus-pertussis vaccine (DTP) may increase mortality from infections other than diphtheria, tetanus, or pertussis in high-mortality areas [1, 3–8]. These nonspecific effects of BCG, measles vaccine, and DTP are generally stronger in girls, appear to be maximal in the first 6 months after immunization, and are largely determined by the most recent vaccine administered [1]. Randomized trials show that measles vaccine has strong nonspecific effects. Providing it is not given after vitamin A or followed by DTP, measles vaccine reduces mortality from diseases other than measles by 45% (95% confidence interval [CI], 14%–65%) when given at 4.5 months of age [9], and by 47% (95% CI, 23%–63%) when given to girls at 9 to 10 months of age [1]. In this issue of the Journal, Aaby et al present further evidence, from Guinea-Bissau, that BCG has potent nonspecific effects on mortality [4]. Low-birth-weight neonates were randomized to receive BCG at birth or via the routine immunization program at an older age (median, 7.7 weeks). The biological effects of BCG are shown by the outcome during the first 4 weeks after randomization, before children in either group had been given DTP and when few children in the control group had received BCG. In this period, BCG reduced mortality by 45% (95% CI, 11%–66%); there were fewer deaths from sepsis and acute respiratory infection, and no deaths from tuberculosis (which is a rare cause of death at this age). This spectacular reduction in mortality is consistent with the results of 6 controlled trials performed in 45,662 children in the United States and the United Kingdom in the 1940s and 1950s, in which BCG reduced mortality from causes other than tuberculosis by 25% (95% CI, 6%–41%) [1, 2]. Although BCG reduced mortality in the first 4 weeks of life in the trial in Guinea-Bissau, investigators observed no difference in mortality after that age [4]. This is not surprising, because by 2 months of age 58% of the controls had received BCG and over 60% of children in both groups had received DTP. Consequently, BCG did not significantly reduce mortality in the first 12 months of life, the observed reduction being 17% (95% CI, −8% to 37%). This was the primary endpoint of the trial, which was underpowered because infant mortality was 101 deaths per 1000 live births, rather than 250 deaths per 1000 live births as predicted when the trial was designed. A lower-than-expected mortality often occurs when trial participants in a high-mortality area are offered free treatment, as in this study. This illustrates how difficult it is to do randomized trials in high-mortality areas, where we most need to obtain information about how to lower mortality. A worrying finding in this trial was that children who had received DTP by 2 months of age had an increased mortality between 2 and 6 months of age: Mortality was increased 4.3-fold (95% CI, 1.5–12.2-fold) in the BCG-at-birth group and 1.7-fold (95% CI, .7–4.0-fold) in the control group [4]. DTP was observed to have similar effects in a randomized trial of revaccination with BCG at 19 months of age in Guinea-Bissau [3]. In that trial, 60% of the participants had not received their last dose of DTP (DTP4) at the time of enrollment, and many of these children were given DTP4 after entering the study. Children who received BCG had a lower mortality than controls if they had received DTP4 before enrollment (hazard ratio, .36; 95% CI, .13–.99) but a higher mortality if they had not received DTP4 before enrollment (hazard ratio, 1.78; 95% CI, 1.04–3.04); the difference was highly significant (P = .006). Mortality was 0.36 deaths per 100 person-years if DTP4 had been given before BCG revaccination, 1.02 deaths per 100 person-years in controls who were not revaccinated with BCG (mortality was not affected by DTP4 status at enrollment), and 1.83 deaths per 100 person-years if DTP4 had not been given before BCG revaccination [3, 10]. These 2 studies suggest that BCG lowers mortality if it is given alone or after DTP, but that mortality may be increased if DTP is given after BCG as recommended in the schedule for the Expanded Program on Immunization (EPI) [3, 4]. The administration of DTP after BCG was not randomized in these studies, so the observed increase in mortality with DTP may have been caused by bias. However, this seems unlikely. In the trial of BCG in low-birth-weight babies [4], the infants who had received DTP by 2 months of age (and had increased mortality) were larger babies who would be expected to have a lower mortality in the absence of a nonspecific effect of DTP. In the trial of BCG revaccination at 19 months of age [3], mortality in the control group (no additional BCG) was not influenced by DTP4 status at the time of randomization, suggesting that this was not an independent risk factor. Even in unimmunized communities, diphtheria, tetanus, and pertussis cause far fewer deaths than pneumonia, sepsis, and diarrhea [11]; despite reducing mortality from diphtheria, tetanus, and pertussis, DTP will, therefore, increase total mortality if it causes even a small increase in mortality from pneumonia, sepsis, and diarrhea in high-mortality areas [12]. When DTP was first introduced into Guinea-Bissau, despite the absence of herd immunity, mortality was 5.1 deaths per 100 person-years among children who did not receive DTP but 11.3 deaths per 100 person-years among children who did receive DTP (risk ratio, 2.03; 95% CI, 1.17–3.52) [7]. I know of no other study of the introduction of DTP in a high-mortality area with sufficient power to test the effect on total mortality. No randomized trial has demonstrated that it is safe to give DTP to young infants in high-mortality areas, and there is now worrying evidence that DTP may increase mortality under these circumstances—especially when it is given after BCG as recommended in the EPI schedule [1, 3–8]. In 2002, 2003, and 2004, the WHO Global Advisory Committee on Vaccine Safety (GACVS) concluded that the evidence did not support an increased risk of mortality after DTP immunization [13]. However, the onus of proof is surely the reverse of this—we need clear evidence that a vaccine is safe when it is given routinely to all infants in high-mortality areas. In addition, the Committee based its conclusion on observational studies, all of which had one or more serious methodological problems [1, 5, 14–16]. First, any observational study (with nonrandom allocation of vaccines) may induce a spurious association between vaccination and survival [16]. Second, vaccination was often withheld in sick children, which causes selection bias in favor of DTP [5]. Third, many of the studies classified dead children as unvaccinated if there was no evidence they had been immunized; as some of these children will have been vaccinated, this causes survival bias in favor of DTP [1, 5, 14–16]. Fourth, most of the studies did not test the effect of the most recent vaccine received by each child over time: the first dose of DTP has different effects when given before, with, or after BCG [4, 5]; the last dose of DTP has different effects given before, with, or after measles vaccine [5, 6]; and the effects differ by sex [1]. Fifth, many children were given BCG at the same time as DTP, rather than at birth (6 weeks before DTP) as specified in the EPI schedule [5]. In 2008, GACVS finally endorsed the view that evidence for the safety of DTP is “unlikely to be obtained from observational studies” [17]. Given the very large number of lives at stake, it is disappointing that it took the Committee so long to decide that observational studies are unlikely to provide adequate evidence that it is safe to give DTP to infants who have been vaccinated with BCG at birth, and even more disappointing that international agencies have not funded randomized trials to test the effect of DTP on all-cause mortality in children in high-mortality areas [5, 18]. We could obtain this information while still immunizing against diphtheria, tetanus, and pertussis if we randomized children to receive the primary series of DTP at different ages, or to receive a booster dose of DTP at different ages [18, 19]. The current EPI schedule is BCG-polio at birth; DTP-polio at 6, 10, and 14 weeks; and measles vaccine at 9 months–but tuberculosis, polio, diphtheria, tetanus, pertussis, and measles are not the main causes of death in children, even in unimmunized communities [11]. The main reason that the EPI program has been beneficial may not be because it protects against these infections, but because the nonspecific effects of BCG and measles vaccines reduce the very large number of deaths from pneumonia, sepsis, and diarrhea. It is exciting that we may be able to save several million more lives each year just by making better use of the current EPI vaccines in an improved schedule—we urgently need randomized trials of the effects of the EPI vaccines on total mortality to help us design the optimal schedule [5, 18].

Shlomi Dolev, Panagiota N. Panagopoulou, Mikaël Rabie, Elad M. Schiller · 5 authors

Players in a game are assumed to be totally rational and absolutely smart. However, in reality all players may act in non-rational ways and may fail to understand and find their best actions. In particular, participants in social interactions, such as lotteries and auctions, cannot be expected to always find by themselves the "best-reply" to any situation. Indeed, agents may consult with others about the possible outcome of their actions. It is then up to the counselee to assure the rationality of the consultant's advice. We present a distributed computer system infrastructure, named rationality authority, that allows safe consultation among (possibly biased) parties. The parties' advices are adapted only after verifying their feasibility and optimality by standard formal proof checkers. The rationality authority design considers computational constraints, as well as privacy and security issues, such as verification methods that do not reveal private preferences. Some of the techniques resembles zero-knowledge proofs. A non-cooperative game is presented by the game inventor along with its (possibly intractable) equilibrium. The game inventor advises playing by this equilibrium and offers a checkable proof for the equilibrium feasibility and optimality. Standard verification procedures, provided by trusted (according to their reputation) verification procedures, are used to verify the proof. Thus, the proposed rationality authority infrastructure facilitates the applications of game theory in several important real-life scenarios by the use of computing systems.

Lizardo Huamán-Angulo, Lindaura Liendo-Lucano, Manuel Núñez

Los recursos humanos son el eje del accionar del sector salud; sin embargo, no necesariamente son el aspecto mejor atendido, por ello el Ministerio de Salud del Perú (MINSA) conjuntamente con los gobiernos regionales generó el Plan Sectorial Concertado y Descentralizado para el Desarrollo de Capacidades en Salud 2010-2014 (PLANSALUD) con el propósito de fortalecer las capacidades de los Recursos Humanos en Salud (RHUS) y contribuir para que la atención de salud se desarrolle con eficiencia, calidad, pertinencia, equidad e interculturalidad en el marco de la descentralización, el Aseguramiento Universal de la Salud (AUS) y las políticas de la salud. Con ese objeto se han propuesto tres componentes (asistencia técnica, capacitación y articulación educación - salud) que agrupan a un conjunto importante de intervenciones, las cuales son planteadas y definidas de acuerdo al contexto nacional, regional y local, contribuyendo de ese modo a la mejora de las capacidades de gobierno, de gestión por competencias y la prestación de servicios de salud. El presente artículo muestra una primera aproximación de PLANSALUD, incluyendo aspectos relacionados a su planificación, gestión, financiamiento, estructura y funcionamiento, así como las medidas de monitoreo y evaluación.<br>Human resources are the backbone of health sector actions; however, they are not necessarily the area with the greatest attention, therefore, the Ministry of Health of Peru (MINSA) together with regional governments, led the Decentralized and Agreed Sector Plan for the Capacity Development in Health 2010-2014 (PLANSALUD) with the aim of strengthening the capacities of Human Resources for Health (HRH) and contribute to health care efficient development, quality, relevance, equity and multiculturalism, in the context of descentralization, the Universal Health Insurance (AUS) and health policies. To achieve this goal, they have proposed three components (technical assistance, joint training and education - health articulation) that bring together an important set of interventions, which are planned and defined according to the national, regional and local levels, thus contributing to improve the government capacity, capability management and delivery of health services. This paper presents a first approach of PLANSALUD, including aspects related to planning, management, financing, structure and functioning, as well as monitoring and evaluation measures.

Fabio Fiorillo, Agnese Sacchi

We hereby propose a model to analyze the provision of environmental protection activities (United Nation 2005) with positive interregional externalities in order to verify - at least in theory - whether this kind of policy is better accomplished through centralized policymaking, which implies a coordinated solution among local representatives, or a decentralized system, whereby local authorities independently finance and implement their environmental protection policy. The research question concerns the identification of criteria on how to allocate powers and functions to environmental management at different tiers of government. Moreover, modelling interregional externalities as a mechanism contributing to lowering the cost of financing environmental policy in each region (production externality), we can assume that different environmental policies are allowed across regions. Given this general framework, considerations favouring either institutional setting in terms of individuals’ welfare seem to involve interaction among these key elements: the extent of the inter-jurisdictional spillovers, the size of local jurisdictions and the regional preferences for environmental protection policy.

José Jesús Martín Martín, María del Puerto López del Amo González

The Spanish National Health System (SNHS) has sustainability problems resulting from weaknesses in institutional design and governance compounded by the economic crisis it faces. The global economic crisis has had a particularly virulent impact in Spain, characterized by high levels of unemployment and public and private debt. Fiscal adjustment policies implemented may significantly compromise the SNHS. Along with general funding problems, the strong territorial decentralization of health jurisdictions in the Autonomous Communities has not been backed up by efficient State-level health coordination. The SNHS suffers from problems in its rules of governance, its autonomous financing system, human resource policies and diversity of direct and indirect management models in different Autonomous Communities. A reform strategy in Spanish healthcare governancemust be articulated within the context of a broader review of public policies to stabilize the lines of defense of the welfare state. Within the scope of the health sector, the financing system must be improved and institutional changes to increase efficiency must be implemented.

Claudia Dziobek, Miguel Alves, Majdeline El Rayess, Carlos Gutierrez Mangas · 5 authors

A useful but little known feature of the IMF’s Government Finance Statistics Yearbook (GFSY) is the information on the structure of governments. Institutional tables, included in the GFSY, provide detail on the central, state, and local levels of governments, social security, and extrabudgetary units. We refer to the main levels of government as GL1, GL2, and GL3 in ascending order of institutional coverage. We present maps of the various levels of government for 74 countries to illustrate the usefulness of this database and make it more accessible to users. The maps provide information about how centralized or decentralized government finances and employment are and their size relative to the overall economy. Government map data facilitate the monitoring of fiscal policy and fiscal rules.

Daniel Arias Vazquez

The article aimed to analyze the impacts of earmarking revenues and conditional transfers on the supply of health financing in Brazil. After analyzing the role of these Federal regulation mechanisms on decentralized healthcare administration, the article verified the effects on total expenditure in health and disaggregated by level of government, evaluated whether transfers by the Unified National Health System (SUS) were consistent with the evolution in the decentralized supply, and measured the inequalities in per capital health spending by municipalities. The conclusions showed the complementary relationship between earmarking revenues and conditional transfers according to supply, which: (1) increased the share of State and Municipal governments in health financing; (2) provided incentives for the decentralization of primary care according to Federal guidelines; and (3) reduced the inequalities between municipalities in per capita health expenditures.

International Monetary Fund

Conventional wisdom postulates that there are benefits from decentralizing government finances but there is little empirical evidence about actual country practices. This paper presents data on fiscal decentralization for about 80 countries over a period of about 20 years (1990-2008) from the IMF’s Government Finance Statistics Yearbook (GFSY), the only global database with fiscal data for several levels of government. The data show that in many countries, revenue collection remains relatively more centralized than expenditures and that employment tends to be concentrated in lower levels of government. Except for transition economies, the levels of decentralization are relatively stable over the time period. The findings are shown by degree of economic development, constitutional power arrangements, and geographic area, broadly confirming key factors identified in the literature as determining the extent of fiscal decentralization.

George Drymiotes, KONDURU SIVARAMAKRISHNAN

Recent work in the corporate governance literature stresses the need to provide boards of directors (BoDs) with explicit incentives to safeguard shareholder welfare (Bebchuk, Fried, and Walker 2002; Bebchuk and Fried 2004). Jensen (1993) observes that “encouraging outside board members to hold substantial equity interests would provide better incentives.” In a similar spirit, the National Association of Corporate Directors (National Association of Corporate Directors 1995) proposed that “boards should pay directors solely in the form of stock and cash — with equity representing a substantial portion of the total up to 100 percent.” Indeed, equity-based BoD compensation has been on the rise in recent years (Bhagat and Black 2002; Conference Board 2006; Pearl Meyer & Partners 2007).1 The underlying premise is that equity awards help align BoD incentives with shareholder interests and enhance long-term firm value (Byrne 1996; Gabrielle 2001). However, to the extent that directors hold both vested and unvested (restricted) equity-based instruments, their actions are likely influenced by a combination of short-term and long-term incentives. The literature has focused mainly on the beneficial long-term incentive effects of equity awards. However, the effects of accompanying short-term incentives are not clear. Are they non–value adding, or do they in fact affect BoD behavior in a way that benefits shareholders? We address these questions in this paper. In particular, our purpose is to jointly examine the short-term and long-term incentive effects of equity-based BoD compensation on the BoD’s corporate governance (contracting and monitoring) and advisory (consulting) roles.2 The boards’ corporate governance role has been examined extensively.3 However, directors are typically individuals with considerable management experience and expertise and serve as a natural resource for top management in making crucial strategic and operational decisions.4,5 In fact, surveys have indicated that most directors view advising as their primary role (Mace 1972; Demb and Neubauer 1992; Adams 2009). Nevertheless, the BoD’s advisory role has received relatively little attention in the literature. Adams and Ferreira (2007), for example, examine the BoD’s monitoring and advisory role and show that a less independent BoD is sometimes optimal because it is less likely to monitor management, which, in turn, induces management to share information with the BoD, and receive better advice leading to greater investment efficiency.6 If this advisory role is indeed value-enhancing for shareholders, it cannot be ignored when examining the short-term and long-term incentive effects of BoD compensation. We use a simple agency model in which the BoD performs three roles: contracting, monitoring and consulting. The BoD contracts with the manager to supply some productive input that results in firm output. A performance evaluation system that produces an informative signal about firm output, and consequently about managerial effort, is used to contract with the manager. By monitoring, the BoD improves the precision of this information signal. By serving as a consultant, the BoD makes the manager more productive, that in turn means higher expected firm output. The BoD and the manager’s inputs are unobservable and personally costly.7 We assume that board members are themselves rational and self-serving, and must be motivated to provide consulting and monitoring inputs. Consequently, there are two agency problems in our model. The first is between the BoD and the manager, and the second is between the BoD and the shareholders. Both the agency problems arise because the BoD and manager’s respective inputs are unobservable and personally costly. In this respect, our paper adds to the growing literature that models shareholder-manager conflict as arising from a two-tier agency relationship. In our context, a single-tier model that examines shareholder-manager agency conflict stemming from the separation of ownership and control does not permit a role for the BoD. Therefore, by examining a multi-tier agency relationship our paper helps us better understand organizations (Bolton and Scharfstein 1998). In related work, Kumar and Sivaramakrishnan (2008) examine the BoD’s corporate governance role using a double agency model. They focus on the impact of the lack of BoD independence from management on corporate governance, and characterize optimal equity awards to the BoD to create the right BoD incentives. Harris and Raviv (2008) present a model where control of the board can be given to either insiders (the non-independent board) or outsiders (the independent board) — both insiders and outsiders have private payoff-related information. They show that it is sometimes beneficial to give board control to insiders in order to better exploit their information. We begin our analysis by examining a benchmark setting in which the BoD’s inputs are commonly observable. In this benchmark case, it suffices to compensate the BoD for the personal cost of providing consulting and monitoring inputs. When the BoD’s inputs are not observable, explicit BoD incentives become necessary. We show that long-term incentives (i.e., incentives tied to firm output) make the BoD explicitly care about the firm’s output and thereby motivate the BoD to play an active consulting role. Thus, compensating the BoD with restricted stock awards (equity) motivates the BoD to supply consulting input. However, we identify conditions under which long-term incentives alone do not suffice in motivating the BoD’s monitoring input. The is that the BoD’s monitoring input improves the of the performance evaluation system used to managerial and has on firm output. The BoD, does not have incentive to supply monitoring input. the need for short-term incentives. 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We begin our analysis by examining a where the BoD’s monitoring and consulting inputs are commonly and the manager productive input (the manager’s productive input is not setting a benchmark which we the benefits from providing short-term and long-term incentives to the BoD when the BoD’s inputs are not observable. In this benchmark explicit incentives are to motivate the BoD to provide these it suffices to compensate the BoD for the of these inputs. Thus, the that the BoD monitoring input the from monitoring — expected compensation cost — the BoD’s cost of the the BoD consulting input they a If consulting has a on the manager’s performance the consulting input from the BoD the from and expected managerial compensation the BoD’s cost of consulting. If on the consulting has a the consulting input from the BoD the from the in expected managerial compensation and the BoD’s cost of consulting. We this in the In the benchmark the the BoD consulting monitoring inputs in the benefits from these inputs the BoD’s cost of monitoring and consulting. We a setting in which these inputs are unobservable to the manager and to outside shareholders. setting us to examine the role of short-term and long-term BoD In BoD compensation vested stock and equity the value of these is by short-term is to examine the role of short-term BoD incentives in motivating their consulting and monitoring we first characterize the BoD’s optimal compensation contract on and on and We examine the optimal contract can the form of a to the BoD on short-term performance and restricted equity stock tied to long-term and the BoD’s and of we to and assume the monitoring and consulting by the BoD. 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The BoD has to be explicitly for the cost of monitoring, in to the cost of to supply monitoring and consulting inputs in contract the that are more likely when the BoD monitoring input. monitoring is that the firm must provide incentive for the BoD to supply monitoring input in and which are the two that become more likely when the BoD monitoring input — by monitoring improves the precision of about by the that is when the firm’s long-term performance is that the BoD optimal of the cost of monitoring to the cost of consulting is a of both short-term and long-term Thus, the BoD’s compensation to both short-term and long-term and is to that the BoD consulting and monitoring inputs in We this in the does not a BoD contract on long-term performance that the BoD monitoring input. 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In particular, equity awards and long-term performance incentives as are not because the BoD with equity makes a of the firm’s output — firm output compensation — of Nevertheless, we a more in our analysis and our attention to contracts of the form where a share of the firm given to the BoD, and a a us to to the role of equity awards in the BoD compensation is similar to that in the benchmark for the incentive that the BoD’s monitoring and consulting inputs. equity as in share the BoD to care about the firm’s expected long-term that given a equity the BoD would in the However, as we in restricted equity awards are not in motivating monitoring input. the BoD that the manager has productive effort, it does not by to the of the performance about the manager’s productive has incentive to monitoring that given the the BoD’s consulting input the of about the manager’s productive restricted equity awards provide incentive to the BoD to that the manager productive the as the BoD a portion of that incentive to the BoD to not monitoring If the BoD that the manager has productive effort, it not supply monitoring input to the that and thereby the manager’s expected compensation as is to that the BoD’s incentive to not supply monitoring input does not solely on to the manager’s expected compensation. 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The manager the firm’s short-term performance in results in higher expected compensation We examine the BoD’s compensation incentives to monitor the manager in the of performance We first the role of long-term BoD incentives. We that compensating the BoD with an equity share does not give the BoD incentive to supply monitoring input in The is similar to the The is that the BoD’s monitoring input is for the BoD and it improves the of about the manager’s productive the fact that monitoring the of performance by the manager the BoD that the manager productive in the BoD does not by monitoring input. an equity share the BoD not supply monitoring input. the use of the short-term BoD incentives. that on monitoring the of and thereby the of the the of on by the that the BoD that the manager productive in is more likely to means that the the BoD short-term they can that the BoD monitoring input in short-term BoD incentives incentive with to monitoring role in the of performance The of providing corporate boards with long-term incentives equity awards has been by recent corporate governance literature. as a most directors hold both vested and unvested (restricted) equity and their actions are likely influenced by a combination of short-term and long-term incentives. it would that long-term incentives should suffice in that boards to shareholder the effects of short-term incentives are not clear. In this we examine the effects of short-term and long-term incentives on the corporate governance (contracting and monitoring) and management advisory (consulting) of the BoD using a two-tier agency primary is that long-term incentives not suffice and that short-term BoD incentives can play a role in shareholder as restricted equity provide the BoD with the incentive to supply consulting by not motivate the BoD to monitor when monitoring is personally to the BoD. 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Ali Kakhbod, Joseph C. Koo, Demosthenis Teneketzis

We present a decentralized message exchange process (tatonnement process) for determining the level at which a certain public good will be provided to a set of individuals who finance the cost of attaining that level. The message exchange process we propose requires minimal coordination overhead and converges to the optimal solution of the corresponding centralized problem.

Ahser Edward

s - This study investigated the causal relationship between quantity of fish sold and marketing costs in Adamawa State. Specifically, the profitability was determined and distribution channels identified. Structured questionnaires were used to collect data from 80 fish marketers using purposive and simple random sampling technique from Jimeta, Yola, Gurin and Labondo markets. Analytical tools used were descriptive statistics, market margin and multiple regression analysis. The result showed a margin of 39.8% which could be attributed to the marketing functions. The study identified a decentralized distribution channel in the area. Regression analysis revealed an R2 of 63.8%, F-value of 8.93 and a very low standard error of 0.38889. The result further revealed that initial capital, cost of fish, processing cost and handling charges were positive and significant at different levels indicating that they were the major determinants of selling prices of processed fish in the area. The study concluded that processed fish marketing in the study area was profitable. It recommended that marketers should form a strong co-operative society. There is also a need for government intervention by reducing tax and providing licence to increase the number of micro-credit finance institutions.

Célia Regina Pierantoni, Ana Cláudia Pinheiro Garcia

BACKGROUND: The Brazilian health reform process, following the establishment of the Unified Health System (SUS), has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. Brazil is a federal country and the Ministry of Health (MoH), through the Secretary of Labour Management and Health Education, is responsible for establishing national policy guidelines for health labour management, and also for implementing strategies for the decentralization of management of labour and education in the federal states. This paper assesses whether the process of decentralizing human resources for health (HRH) management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level. METHODS: The research methods used comprise a survey of HRH managers of states and major municipalities (including capitals) and focus groups with these HRH managers - all by geographic region. The results were obtained by combining survey and focus group data, and also through triangulation with the results of previous research. RESULTS: The results of this evaluation showed the evolution policy, previously restricted to the field of 'personnel administration', now expanded to a conceptual model for health labour management and education-- identifying progress, setbacks, critical issues and challenges for the consolidation of the decentralized model for HRH management. The results showed that 76.3% of the health departments have an HRH unit. It was observed that 63.2% have an HRH information system. However, in most health departments, the HRH unit uses only the payroll and administrative records as data sources. Concerning education in health, 67.6% of the HRH managers mentioned existing cooperation with educational and teaching institutions for training and/or specialization of health workers. Among them, specialization courses account for 61.4% and short courses for 56.1%. CONCLUSIONS: Due to decentralization, the HRH area has been restructured and policies beyond traditional administrative activities have been developed. However, twenty years on from the establishment of the SUS, there remains a low level of institutionalization in the HRH area, despite recent efforts of the MoH.

C. C. Anyaegbu

Background Over the past two decades the quest for safe blood supply has led to tremendous growth in the content and scope of the science and practice of Transfusion Medicine (TM). The desire by the various stakeholders in the blood establishment for zero‐risk blood transfusion has not only stretched the level of quality expected of the Transfusion Medicine Service to apical height, but has also resulted in the demand by these stakeholders for concrete proofs that expected degrees of quality have been met or preferably exceeded. Quality indicators (QIs) are a Quality Management System (QMS) tool that are instituted in an organization with intent on not just providing this much needed proof of the level of quality performance tenable in the organization, but they are also intent on utilizing the information gained to seek improving the quality of performance in the organization. In the last decade, huge efforts have been exerted by government and non‐government hospital‐based blood banks, national and international organizations to collate, select, establish and analyze quality QIs for several dimensions of healthcare quality. Notable contributions have been made by such eminent bodies as the Agency for Healthcare Research and Quality (AHRQ), the Organization for Economic Cooperation and Development (OECD) and the College of American Pathologists (CAP). Unfortunately these efforts have only sparsely addressed quality indicators for TM. A year ago, the International Society of Blood Transfusion (ISBT) instituted its Working Party on Quality Management (WPQM). Quality indicators for TM are of priority to the WPQM which presumably is intent on redressing this imbalance and providing robust and valid quality indicators to monitor quality performances in key processes and outcomes in TM practice, globally. Objective This paper therefore highlights some basic essentials for successful monitoring of quality of transfusion medicine service through appropriate selection and implementation of quality indicator projects. It is hoped the information shared through this medium might be of value to Transfusion Medicine practitioners as well as to the ISBT WPQM as they thinker with quality indicators for Transfusion Medicine. Material and Method Considerable review of published literature in the form of journal articles, books and online publications on quality management and quality indicators in Healthcare/Transfusion Medicine was performed with the view to extract essentials elements that could be considered building blocks for the selection, implementation, analysis and utilization of quality indicators in Transfusion Medicine. Result Elements deemed as essential building blocks that were appraised included, but were not limited to: understanding Transfusion Medicine terrain; concept of quality and quality indicators selection criteria; choice of improvement model, data analysis and manner of communication of findings as well as the role of effective education and leadership. Conclusion Quality indicators are indispensible tools which various stakeholders in the Blood Transfusion establishment now demand to adjudge and improve on quality performance. Practitioners as well as policy makers in Transfusion Medicine need to ensure that the quality indicators they institute are appropriately selected and analyzed to be effective and efficient monitors of quality. Knowledge of basic building blocks discussed here is therefore a fundamental prerequisite.

Laurent Gosse

No abstract is available for this record.