In 5-Card Draw, one of the most popular versions of poker, you start with a specific question: “Can I win with the cards I have decided to play?” The final answer is yes or no. After looking at your initial cards (initial findings) you can be satisfied with what you have (preliminary data) or seek some new cards (new experiments). But in the end you must openly “show your cards” (results). Your cards give you the answer. You cannot hide a card, nor can you add an undealt card to make your hand look better. Playing poker and writing the Results section of a scientific paper have similarities, as I will point out in this article. In poker, how you present your cards affects how your competitors grasp the importance of the cards. One winning set of cards in poker is the straight, defined as 5 consecutively sequenced cards (e.g., 6, 7, 8, 9, 10). You may have this group of cards, but if you present them as 6, 10, 8, 7, 9, your straight is not immediately evident. The worth of cards when presented in a logical manner is clearer and easier to grasp. The same holds true for your Results section. Your important results may be better understood if presented in a certain order. There are several options for the presentation order of results (Table 1 ); one may work better than another for the type of study being reported. The most straightforward approach is to use a chronological order with subheadings that parallel the methods and their sequence presented earlier in the paper. This order allows readers to more easily go back and refer to the methods associated with a given result. Options for presentation order of results. Options for presentation order of results. A second approach is to group results by topic/study group or experiment/measured parameter. An example of this format is a comparison of the diagnostic and analytical performance of 3 assays for serum prostate-specific antigen. If grouped by assay as the topic, the results for diagnostic accuracy, analytical performance, interference testing, and cost analysis for assay 1 would be presented first, followed by a separate presentation of the same results for assay 2 and then assay 3. This order allows the reader to see the results for each assay as a packet of information, which is a logical way to remember information. By comparison, if the results are grouped by measured parameter, important similarities or differences in assay performance may be clearer and can be emphasized as important findings. Grouped by topic: Assay 1: diagnostic accuracy, performance, interferences, cost. Assay 2: diagnostic accuracy, performance, interferences, cost. Assay 3: diagnostic accuracy, performance, interferences, cost. Grouped by measured parameter: Diagnostic accuracy: assay 1, assay 2, assay 3. Performance: assay 1, assay 2, assay 3. Interferences: assay 1, assay 2, assay 3. Cost: assay 1, assay 2, assay 3. In clinical studies that involve multiple groups of individuals or patients receiving different treatments, it is common to order the results from general to specific. The characteristics of the overall study population, such as sex and age distribution, initial and final numbers in each group, and dropouts are first presented. This information is followed by the data and results for each specific group, i.e., starting with the control group or the group receiving the standard treatment, followed by the results for the disease group or the group receiving the experimental treatment. Lastly, if you undertook a study for which the order in which the results are presented is not critical to their being understood, presenting the results from most to least important immediately highlights the results you want to emphasize. Results should be presented in the past tense. The Results section usually ends up heavier on the passive voice, but some conscious use of the active voice can help the flow and readability of the text (e.g., “we observed that the 2 groups” versus “it was observed that the 2 groups”). One valuable lesson I learned about writing a well-crafted Results section came from Zeiger’s book, Essentials of Writing Biomedical Research Papers. The same concept—namely, that data and results are not the same—was discussed more recently in an article by Foote in the journal Chest (see Resources and Additional Reading). Authors can err by offering the reader results but no data, or data but no results. Data are facts and numbers. Data are usually presented in tables and figures as raw data (individual data points) or summarized data (mean, percent, median and range). Results are statements in the main text that summarize or explain what the data show. As an example, let’s use a hypothetical study comparing the effectiveness of radiation treatment, chemotherapy with an existing drug (Blasteride), and a new monoclonal antibody-based therapy (Neuroxomab) for the treatment of neuroblastoma. One of the endpoints in the study is survival rate after diagnosis and initiation of treatment (Figure 1 ). Four ways to present the information in Figure 1 for the reader might be as follows: Two-year survival rates for patients with neuroblastoma treated with Neuroxomab, Blasteride, and radiation. Figure 1 shows the survival rates following diagnosis and initiation of treatment in the 3 treatment groups. At 6 months the survival rates were 95% for the Neuroxomab group, 91% for the Blasteride group, and 39% for the radiation-treated group. At 12 months the rates were 83%, 69%, and 23%;, at 18 months 74%, 17%, and 15%; and at 24 months were 70%, 11%, and 9%. Figure 1 shows the survival rates following diagnosis and initiation of treatment in the 3 treatment groups. At 6 months the survival rates were significantly higher in the Neuroxomab and Blasteride treatment groups compared with the radiation-treatment group. At 12, 18, and 24 months the survival rates in the Neuroxomab group exceeded those of both the Blasteride and radiation-treatment groups. Six months after diagnosis and initiation of treatment, the survival rates for the Neuroxomab and Blasteride groups were 2.4 and 2.3 times higher, respectively, than the radiation treatment group (both P < 0.001), but survival rates were not found to differ between the Neuroxomab and Blasteride groups (P = 0.56) (Figure 1 ). By 12 months, however, patient survival in the Neuroxomab group was 1.2 times higher than in the Blasteride group (P = 0.031), and 4.3 and 6.4 times higher at 18 and 24 months (both P < 0.001). Six months after diagnosis and initiation of treatment, survival rates in the Neuroxomab and Blasteride groups (95% and 91%, respectively) were significantly higher than in the radiation treatment group (39%, P < 0.001 for both), but survival rates were not found to differ between the Neuroxomab and Blasteride groups (P = 0.56) (Figure 1 ). By 12 months, however, the patient survival rate in the Neuroxomab group was significantly higher than in the Blasteride group (83% vs 69%, P = 0.031), a difference that became even greater at 18 and 24 months (74% vs 17% and 70% vs 11%; both P < 0.001). The first paragraph above provides data but no results. What do the data show? What is the point? Are the treatment groups statistically different at 6 months? The second paragraph contains results but no data. Is it clear from the figure how much higher the survival rates for patients in the Neuroxomab and Blasteride groups were compared with patients in the radiation group and with each other? What is the level of significance of any differences? Paragraphs 3 and 4 above contain both data and results. They describe the important treatment differences and report when the differences occurred and whether they were statistically significant. Paragraph 3 states the magnitude (e.g., 2.4 times higher) of the most important differences between the treatments, and whether the differences were statistically significant. The reader must look at the figure to see the percent survival data, but this is perfectly fine as long as the reader can fairly easily estimate the percentages at 6, 12, 18, and 24 months. Paragraph 4 includes the actual survival rates (e.g., 95%, 91%, and 39% at 6 months) rather than the relative magnitudes of any differences. The inclusion of these survival-rate data in this paragraph is acceptable because the figure contains a lot of information and you are highlighting selected important differences. However, let’s now say that the survival data and P-values had been provided in a table (Table 2 ). Because Table 2 contains the same information included in paragraph 4, you need not repeat this information in both places: Neuroblastoma survival rates over time for Neuroxomab, Blasteride, and radiation-therapy patient groups. P < 0.001 vs radiation group. P = 0.56 vs Blasteride. P = 0.031 vs Blasteride. P < 0.001 vs Blasteride. Not significant vs radiation group. Neuroblastoma survival rates over time for Neuroxomab, Blasteride, and radiation-therapy patient groups. P < 0.001 vs radiation group. P = 0.56 vs Blasteride. P = 0.031 vs Blasteride. P < 0.001 vs Blasteride. Not significant vs radiation group. Six months after diagnosis and initiation of treatment, the Neuroxomab and Blasteride groups showed significantly higher survival rates compared with the radiation-treatment group (Table 2 ), but survival rates in the Neuroxomab and Blasteride groups were not found to differ. By 12 months, however, patient survival in the Neuroxomab group was significantly higher than in the Blasteride group, a difference that became even greater at 18 and 24 months. This rule about nonrepetition of data is not absolute, but is a rule that should be broken only in rare circumstances. If a table or figure supplies a large amount of data, it is acceptable to restate a key piece of data in the text, such as the 2 groups in the table with statistically significant differences, if this helps the reader zero-in on an important result without having to plow through a long list of data. In the American judicial system witnesses are sworn in by asking if they will tell the truth (the facts), the whole truth (tell everything), and nothing but the truth (no lies, conjecture, or interpretation). A complete Results section in a scientific paper also satisfies these requirements. Telling the facts is the easy part, because this is the goal of this section: to tell the reader what you found during the study. Requirements 2 and 3 above are areas in which authors can run into problems. Satisfying the second requirement involves an intentional effort to include all data. There are well-crafted guidelines and checklists available that can help you meet the minimal standards for reporting data and results for many types of studies (Table 3 ). As an author you should use the checklists and flow diagrams in these guidelines when appropriate for your study. Doing so not only helps make the strengths, weaknesses, and sources of bias clear to the reader, but also helps you remember to include key data that otherwise inadvertently might have been omitted. For example, how many patients were excluded from the study? How many were lost to follow-up? How many dropouts were there? How many patients finished the study? How many individuals had an inconclusive result or diagnosis? These are all data and results and belong in the Results section. Reporting guidelines for various types of studies. Reporting guidelines for various types of studies. Including all results also means not leaving out a negative result (hiding a card) or a result relevant to the report because it serves some other purpose for you as the author. Anyone who chooses to repeat your work or use your methods will likely encounter the same type of negative results that you did, and the fact that these were not acknowledged in your paper will not serve you well. Referring to “unpublished results” annoys most editors and peer reviewers unless you can present a good argument for not including them. Trying to stake a claim to a future study by presenting an attention-grabbing preliminary result, but then not showing any corresponding data, can make readers question your motive. The Results section is just that: results. To satisfy the third requirement above, this section should contain nothing but the results. No methods, no discussion. There is a temptation to remind the reader about the details of the experiment performed or the method used to generate the results, especially if it has been several pages since the Methods section ended. Method, study, and experimental details should not be restated in the Results section. Of course, you can refer to a specific experiment or method when describing the corresponding results; just do not repeat experimental details already described in the Methods section, as exemplified below. Although well intended as a link between a method and a result, the first 2 sentences of the next paragraph are unnecessary: We compared the death rates for the 262 healthy controls with those of the 203 congestive heart failure patients over a 2-year period. Survival curves were generated with the Masterson mortality index formula. The congestive heart failure group was found to have a significantly higher short-term mortality rate. However, this example is a good opportunity to illustrate how a transition phrase can serve as a link between a previously described experiment and a result without repeating what was in the Methods section: When the 2-year survival curves for healthy controls and congestive heart failure patients were compared, the congestive heart failure group was found to have a significantly higher short-term mortality rate. The only time that experimental details are appropriate for the Results section is when the initial experiments (rightly described in the Methods section) yield data that lead to additional experiments, not part of the original protocol, but which became necessary later on. The description of these experiments may make more sense if included in the Results section with the corresponding results. When reporting results, authors feel an urge to comment on the results, e.g., how the results compared with prior work, were consistent with what was predicted in another paper, or explained the reason that a marker is increased in a disease. The interpretation or analysis of the results, however, belongs in the Discussion section. In the Results section you can describe what the data show, in the Discussion section you describe what the data mean. The purposely incorrect heading here is meant to emphasize the fact that the terms significant, significance, and significantly are used erroneously in many submitted papers. In biomedical publications these terms are intended to identify relationships that have been statistically tested and determined unlikely to have occurred by chance. These terms should also be followed by a mathematical value or limit (e.g., P = 0.067 or P < 0.001). Unless you have such proof of statistical significance, you should use other terms such as substantial, considerable, or noteworthy. Similarly, authors like to draw unwarranted attention to nonsignificant findings by stating that the data “trended toward” or “tended to show.” If the findings are not clear, don’t try to imply something about them that cannot be supported. Lastly, make sure that the Results section is consistent with all of the other sections in the final version of your paper. Is there a result that does not have a corresponding method or experiment in the Methods section? Conversely, is there a method or experiment for which you have reported no results? Is there a result not covered in the Discussion section, or discussion of a result not contained in the Results section? Are the most important results the same as those highlighted in the Abstract? Do the results relate to the study question, hypothesis, or problem first presented in the Introduction? 1. Point out which information is data and which is a result in the following paragraph: Baseline median IL-6 concentrations were 12, 26, 96, and 144 μg/L for categories 1 to 4, respectively, and were not found related to age or sex. Median β-selectin concentrations increased 30% across the 4 categories. Increased disease severity and mortality were associated with higher IL-6 concentrations, but not β-selectin. Intraindividual variation for group 1 was 14% for IL-6 and 36% for β-selectin. 2. Choose whether the presentation of results in the following sentence is chronological, grouped by topic/study group, grouped by experiment/measured parameter, general to specific, or most to least important: The mean (SD) admission interleukin concentrations were 13.6 (1.4) μg/L, 10.3 (1.1) μg/L, and 3.6 (05) μg/L in the coronary bypass graft, percutaneous intervention, and congestive heart failure patient groups, respectively. 3. Pretend that a journal editor has decided that you must remove Table 4 from your paper and place the information it contains into the main text. How might you write a paragraph that presents the data and results in this table? Serum antiproxin concentrations in patients with congestive heart failure. P = 0.019 vs healthy patients. P < 0.001 vs healthy patients. P = 0.017 vs asymptomatic heart failure. Serum antiproxin concentrations in patients with congestive heart failure. P = 0.019 vs healthy patients. P < 0.001 vs healthy patients. P = 0.017 vs asymptomatic heart failure. A Results section that clearly presents your results, makes effective use of both data and results, includes all the important results, and does not wander off into discussion of the results, will result in a better paper and a greater chance of its acceptance for publication. In the end, isn’t that the result you are looking for? Foote M. The proof of the pudding: how to report results and write a good discussion. Chest 2009; 135:866–8. Huth EJ. Writing and publishing in medicine. Baltimore: Williams and Wilkins; 1999. Katz MJ. From research to manuscript. New York: Springer; 2009. Lang TA. How to write, publish, and present in the health sciences. Philadelphia: ACP Press; 2010. Zeiger M. Essentials of writing biomedical research papers. New York: McGraw Hill; 2000. Baseline median IL-6 concentrations were 12, 26, 96, and 144 μg/L for categories 1 to 4, respectively [DATA], and were not found related to age or sex [RESULT]. Median β-selectin concentrations increased 30% across the 4 categories [RESULT]. Increased disease severity and mortality were associated with higher IL-6 concentrations, but not β-selectin [RESULT]. Intraindividual variation for group 1 was 14% for IL-6 and 36% for β-selectin [DATA]. The presentation is grouped by experiment/measured parameter, which is the mean admission interleukin concentration. Even though the data are presented from the highest (13.6 μg/L) to the lowest (3.6 μg/L) value, the higher value is not necessarily the most important finding. Median (interquartile range) serum antiproxin concentrations were 99 (36–144), 216 (147–296), and 556 (328–791) ng/L in healthy individuals, asymptomatic heart failure patients, and symptomatic heart failure patients, respectively. The median concentrations in asymptomatic and symptomatic heart failure patients were 2.2-fold higher (P = 0.019) and 5.6-fold higher (P < 0.001), respectively, than in healthy individuals, and symptomatic patients had significantly higher serum antiproxin concentrations compared with asymptomatic patients (P = 0.017). Author Contributions:All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article. Authors’ Disclosures of Potential Conflicts of Interest:Upon manuscript submission, all authors completed the Disclosures of Potential Conflict of Interest form. Potential conflicts of interest: Employment or Leadership: T.M. Annesley, AACC. Consultant or Advisory Role: None declared. Stock Ownership: None declared. Honoraria: None declared. Research Funding: None declared. Expert Testimony: None declared. Role of Sponsor: The funding organizations played no role in the design of study, choice of enrolled patients, review and interpretation of data, or preparation or approval of manuscript.
El primer objetivo de esta tesis es la identificación y análisis de aspectos clave para la gobernanza de los servicios de agua rural en países que adolecen de bajos niveles de cobertura, altos índices de pobreza, se encuentran en procesos de descentralización, reciben un importante apoyo de donantes internacionales. Esta situación es común para muchos países de África Sub-sahariana. Por ello, se eligió Tanzania como objeto de estudio. El segundo objetivo de esta tesis ha sido el ensayo de nuevas herramientas y mecanismos institucionales para la mejora de la eficiencia, equidad y sostenibilidad en la provisión de agua en las zonas rurales, con especial énfasis en el nivel de gobierno descentralizado. Para ello, se desarrollaron experiencias piloto así como procesos de investigación-acción. En el capítulo 1 se estudia el papel desempeñado por los diferentes actores internacionales en la financiación del sector del agua en los países en desarrollo durante la década 1995-2004. En el capítulo 2 se analizan los indicadores existentes para el seguimiento del sector del agua a nivel internacional, específicamente los utilizados para valorar el cumplimiento de los Objetivos del Milenio, así como el Índice de Pobreza Hídrica (Water Poverty Index). Se detallan algunos limitantes en cuanto al alcance y metodología de cálculo de estos indicadores, y se proponen las características básicas que los indicadores deben tener para apoyar la toma de decisiones a nivel gubernamental. En el capítulo 3 se presenta una metodología para el desarrollo de indicadores más completos de acceso al agua, basándose en el Mapeo de Puntos de Agua (Water Point Mapping-WPM). La metodología propuesta, denominada Mapeo Mejorado de Puntos de Agua, incluye la medición de parámetros básicos de calidad del agua y estacionalidad de los servicios. La factibilidad y pertinencia de la adopción de esta metodología a nivel nacional se desarrolló satisfactoriamente a modo de experiencia piloto en dos distritos de Tanzania, con una población rural aproximada de 840.000 personas (capítulo 4). En el capítulo 5 se analiza la sostenibilidad de los servicios de agua rural en relación al tipo de tecnología utilizada para el abastecimiento. El análisis se basa en los datos de 6814 puntos de agua, sobre una población equivalente al 15% de la población rural de Tanzania. El capítulo 6 se analiza el proceso de toma de decisiones, desde el nivel central al nivel comunitario, para la asignación de recursos en el sector del agua rural. Los resultados en los 4 distritos estudiados muestran que menos de la mitad de los proyectos asignados se destinan a zonas con baja cobertura de servicios. Las incoherencias entre el diseño y la implementación de los planes nacionales, y la influencia de los poderes políticos locales son los mayores obstáculos para una equitativa distribución de los recursos. El capítulo 7 detalla el caso de investigación-acción ejecutado a nivel de gobierno local entre 2006 y 2009 con el gobierno del distrito de Same, Tanzania. La mejora de la equidad y la sostenibilidad se fomentaron mediante el desarrollo de herramientas de planificación basadas en el WPM y de mecanismos institucionales para el apoyo a largo plazo a los sistemas de agua rurales. En el capítulo 8 se detallan las conclusiones generales y líneas de investigación futuras. La resolución de los desafíos principales encontrados implican la adopción de paradigmas diferentes: i) la aceptación del agua rural como un servicio responsabilidad del gobierno y no de las comunidades; ii) las actuaciones deben decidirse en función de las necesidades de las comunidades, y no de su capacidad de demanda, iii) el establecimiento de sistemas de información internos que partan desde el nivel local y estén adaptados a las capacidades de actualización disponibles, iv) el desarrollo de mecanismos para la orientación y el seguimiento cercano de los procesos de toma de decisión a nivel local The first objective of this thesis is the identification and analysis of key issues in the governance of rural water services in countries that suffer from a lack of rural water access, high levels of poverty, are under decentralization processes and receive significant donor support. This is a common situation for many Sub-Saharan countries. To address the relevant aspects, Tanzania was taken as a case study and was analyzed in depth. The second objective was to test tools and propose institutional arrangements at that can improve efficiency, equity and sustainability in the provision of water for the rural areas, with special focus at the local government level. This was made through pilot experiences and an action research case study. In Chapter 1 we analyse the role played by the international actors in the financing of the water sector of developing countries, in the period 1995-2004. In Chapter 2 we study existing indicators for international monitoring, specifically the ones used by the Joint Monitoring Programme for the monitoring of the MDGs, as well as the Water Poverty Index (WPI). Some drawbacks are found the indicators’ scope and methodology, which prevents them from being used as policy drivers at national level. The chapter concludes by proposing the main characteristics that those indicators must entail to be useful for governmental decision making. In Chapter 3, a methodology to define water access indicators, based on GIS-based Water Point Mapping (WPM) is proposed. The methodology, named Enhanced Water Point Mapping (EWPM), includes the measurement of basic parameters of quality of water and seasonality of the service. The feasibility and relevance of adopting this methodology at national level was tested with success in two districts in Tanzania, covering a rural population of approximately 840,000 people, as described in Chapter 4. In chapter 5, we analyze the sustainability of systems over time, and the relation between sustainability and technology; this chapter is based on the study of 6814 water points, covering 15% of the rural population in the country. Chapter 6 analyses the aspects affecting financial resource allocation for rural water in Tanzania at all levels, from central government to village level. Results in four districts studied showed that less than half of allocated projects go to underserved areas. Incoherencies between the design and the implementation of the plans and political influences at local level are highlighted as major obstacles to the effective, equitable allocation of resources. In chapter 7, we describe an action research process that was carried out at local government level, together with Same District Council, between 2006 and 2009. The improvement of equity and sustainability was supported through the development of EWPM based planning tools and new institutional arrangements for the long-term support of community managed water supplies. In Chapter 8 the overall conclusions and future research lines are presented. We propose some new paradigms in the sector: i) rural water supply must be considered as a service, with government and not communities as main duty bearers; ii) the adoption of a needs-based approach to projects planning at community level, instead of the current demand driven, iii) the establishment of bottom-up internal information systems adapted to available updating capacities and iv) the development of mechanisms for the guidance and close monitoring of local government decision-making.
Abstract In recent decades, many changes have occurred in the approach to financing and operating water services in developing countries. The demand‐responsive approach is now adopted in many countries in a context of donor‐supported decentralization processes, which gives more responsibility to end users. However, the government's responsibility at different levels is enforced by the international recognition of the human right to water. This paper examines specific actions that build the role of local government authorities in this scenario. A collaboration between an international NGO and a rural district in Tanzania from 2006 to 2009 is used as an action research case study that is representative of local capacity‐building needs in decentralized contexts and rural areas. Three main challenges were detected: i) lack of reliable information; ii) poor allocation of resources in terms of equity; and iii) lack of long‐term community management support from the district. Two mechanisms were established: i) water point mapping as a tool for information and planning; and ii) a District Water and Sanitation Unit Support (DWUS) for community management. The results show how the framework provided by the goal of human right to water helps to define useful strategies for equity‐oriented planning and post‐project support at the local level.
Decentralization involves the dispersion of power, functions and finances from a central authority to regional and local authorities. Decentralization reforms have become widespread in low- and middle-income countries, mainly due to movements towards democratiza-tion, the spread of multi-party electoral systems and transitions towards market economies. In particular, decentraliza-tion of financing systems, particularly for health, is now a common aspect of reform in these countries. The main advantage is the dynamism it can bring into the resource allocation mechanism; it also can facilitate re-allocation of funds through a visible, vibrant and bottom-up approach.
Let k be a field, let R be a ring of polynomials in a finite number of variables over k, let D be the ring of k-linear differential operators of R and let f be a non-zero element of R. It is well-known that R_f, with its natural D-module structure, has finite length in the category of D-modules. We give a characteristic-free proof of this fact. To the best of our knowledge this is the first characteristic-free proof.
Recently we have observed a growing demand for secure technologies for e-commerce that do not put customers at risk of identity theft. We have also experienced the advent of Web 2.0 which has led to new business models and which has changed the way users interact with the Web. This thesis proposes a set of strategies and enhancements towards providing improved security and privacy in such new settings. We introduce a novel concept: Fair Rights Management (FRM). It can be classified as a usage control solution. FRM enables a flexible way of managing digital content. There was a need to provide additional security extensions to keep such a flexible model applicable. Thus, in our approach we take advantage of trust obtained from social networks. This is also the reason why we created an efficient zero-knowledge proof protocol that is lightweight enough to be deployed within existing web-applications. The proposed protocol is also successfully integrated with Semantic Web architecture and associated components. It enables practical Web and mobile applications which employ trust-based transactions as part of their workflow. This core contribution overcomes various disadvantages of prior art and enables a range of new applications and potentially new business models. We show that compared to existing Usage Control Models (UCON) (i) FRM is a step towards fair use in the digital world and we also argue that our approach is enforced by law; (ii) the participants of the proposed solution do not put their privacy at risk. Our research shows that existing infrastructure is sufficient to support ZKP-based solutions; and thus, it is feasible to offer the users enhanced privacy within existing deployed solutions.
year as Switzerland's Federal Office of Public Health (FOPH) announces the annual round of health insurance premium increases, this nation of 7.5 million people lets out a collective groan. Last year, the pain was greater than usual. Concerned about the depletion of cash reserves insurers' coffers, the FOPH allowed rises of up to 14.6% for basic insurance premiums depending on the canton. That hurt. Since 1999 the Swiss have seen health insurance costs rise by 50%, according to the FOPH. From 2008-2009, the price hike was significant enough to cut 0.1% from rising household disposable income. Nadia Bouchardy does not need an announcement to know that a sizeable portion of her family's income is being spent on health. Married to an ambulance driver with two young daughters, the family has an annual income of 90 000 Swiss francs (US$ 83 000) before taxes and insurances. year around 10 500 Swiss francs (US$ 9700) or 12.5% of their income goes on health insurance and extra expenses such as dental care. Last year, Bouchardy, who is aged 41, had an operation and had to pay 10% of the costs of the operation, medicine and her stay hospital. (In out-of-pocket expenses are capped to ensure families do not suffer what is termed catastrophic expenses). We are not very happy with the health insurance system Switzerland, she says. Every year we pay more and we get less. The lists with items that are not covered anymore by the health insurance gets longer. Some items like glasses or basic medicine are not fully covered, so we have to pay these costs out of our non-health budget. So far we are lucky we have not been forced to borrow money order to pay the health bill. The Bouchardy family represents how middle-income Switzerland is being squeezed financially. They earn too much to benefit from the health subsidy received by households that spend more than about 8% of their income on premiums (the level of subsidy depends on the canton). Some 40% of households receive the subsidy--either through a lower premium or tax rebate--which is the government's mechanism for preventing the cost of insurance from unfairly disadvantaging low-income families. Professor Alberto Holly, of the University of Lausanne, is an expert Switzerland's health financing system. He points to a system that is envied for its universal coverage, its equity, standard of care and lack of waiting lists. of the strengths of the Swiss system is equity with respect to health risk and patient ratio. No one is penalized for age, gender or medical history. However, it is not totally equitable and is regressive respect to income, he says. Under the Swiss constitution, the Federal Government is responsible for managing the health insurance but has limited responsibility terms of health policy. Instead, this energetically democratic country has a decentralized system which the 26 cantons are autonomous and choose how to organize their own health care. results a wide disparity terms of insurance premiums, which are usually paid by householders, not employers. [ILLUSTRATION OMITTED] Since 1996, it has been illegal not to have basic health insurance Switzerland. There are 82 not-for-profit insurers that offer policies costing around 350 Swiss francs (US$ 325) a month per adult. No one can be turned away under this scheme, known as LAMal. Further, some 44 companies offer complementary forms of insurance, which allow benefits such as dental treatment and access to luxurious hospitals, and these companies are free to choose clients according to their risk profile. One characteristic of Switzerland's health-financing system is its expense. This is not an efficient system, says Holly, in that it has not been possible to control costs. The result is that Switzerland has the third most expensive medical system the world. …
Jeff Greene, Dennis Purcell, Brian Edelman, Doug Giordano · 9 authors
In a roundtable published in this journal a year ago, there was a clear consensus that the R&D function in big pharma was inefficient and in need of major restructuring, possibly through increased investments by venture capital and private equity firms. In this discussion, an accomplished group of industry practitioners begins by looking at the prospects for both venture capital and private equity to play meaningful roles in financing early‐ and mid‐stage drug development. In so doing, they explore questions like the following: Are there ways for big pharma and biotech to reduce “science risk” and make R&D funding more profitable and attractive to venture capital and private equity—and perhaps even hedge funds? What roles do you see for specialty PE firms like Symphony Capital and Paul Capital, which are now bundling mid‐stage development assets and securitizing royalties? Then the panelists turn to the broader life sciences industry and consider the outlook for leveraged private equity transactions involving marketed products, late‐stage development, and services. Here they consider issues like the following: Will PE be attracted to less‐R&D‐intensive activities like medtech and generics? Have the recent consolidation through mergers and reorganization of big pharma into decentralized business units created opportunities for carve‐outs of certain businesses? For big pharma and life sciences companies in general, the answers to such questions point to greater specialization and focus achieved partly through strategic alliances with venture capital, private equity, and even hedge funds, and involving marketed products and services as well as early‐stage drug development.
International migration is an integral part of the lives of many people in the South, and many households add remittances to their income in order to finance the daily costs of living that cannot be met by their traditional source of income. In the literature, a debate has emerged on the impacts of these remittances on development, focusing in particular on the micro level, namely the impact on households. Many studies also contend that national governments should try to redirect the impacts of remittances. However, the role of actors in local governance structures seems to be overlooked in this discussion. We argue that in the discussion on managing development through remittances, local governments and other stakeholders at the local level — such as NGOs — might also play a role, especially in those countries that have implemented decentralization. However, thus far, interventions aimed at leveraging remittance flows and facilitating migration processes are only in an initial phase. Our study of 12 municipalities in Bolivia shows that a lack of knowledge and capacities among local governments and NGOs is a decisive factor.
Many cancer centers reach out to their elected officials by meeting with them on Capitol Hill and inviting them to tour their institutions. But few go as far as the Ohio State University Comprehensive Cancer Center (OSUCCC). At this National Cancer Institute-designated center based in Columbus, Ohio, elected officials and their staffs take on the roles of patients, researchers, or healthcare providers to gain a more personalized understanding of the importance of translational research and its impact on patient care. “At the end of their visit, we have roundtable discussions, and the feedback is always, ‘we never knew how complex cancer care and research is’,” says Jennifer Carlson, director of government relations for OSUCCC. As further proof of the program's success, legislators discussing cancer-related legislation at government hearings have referred to their participation in Project Cancer Education and the knowledge they gained from it, Carlson notes. “This hands-on program literally takes policymakers from the bench to the bedside and helps them understand some of the challenges we face,” she says, adding that it also helps illustrate some of the lost opportunities that can occur with lack of government investment or support of medical research and care. Because Project Cancer Education has been so successful in Ohio, OSUCCC Director Michael Caligiuri, MD, who was recently elected president of the Association of American Cancer Institutes (AACI), proposed making it available to member centers across the country. The program is “the cornerstone of our advocacy efforts this year,” he notes. “We have had amazing success in seeing important anticancer legislation move forward in Ohio because of the impact Project Cancer Education has had on our elected officials,” Dr. Caligiuri says. “We are asking the community of American cancer centers through the AACI to implement this best practice at their centers because it will help to justify the greater investment in cancer research and make our elected officials and staff aware of why our cause is such an urgent one.” Participants in Project Cancer Education learn about the challenges of cancer care through role-playing scenarios. Carlson is chairing the committee within the AACI that is developing a toolkit based on her center's existing collateral materials for all member centers to refine and adopt to fit their specific needs. They plan to have the materials available this spring. Additionally, they are working with the National Cancer Institute to roll out a similar program for congressional committee staffers who are based in Washington, DC. The toolkits will include different “tracks,” such as a patient scenario or a researcher scenario. The program can range from 2 hours, geared mainly toward the elected officials, to a half-day or full day, which is designed for their staff members. Participants also receive graduation certificates and pose for a photograph, which is later E-mailed to them to reinforce the program's messages. The program that supported your research has been eliminated because of federal budget cuts. Your second- and third-year budgets have been zeroed out. The institutional review board determined that you did not plan to have enough research nurses for your proposed phase 1 study. Wait 6 months and try again. Due to cuts in federal funding line for your grant, your budget has been reduced by 30% for the next 3 years. Visits to cancer care and research facilities allow participants to see the intricacies of discovery and treatment firsthand. Participants encounter positive results too, such as, “The drug you developed is ready to come to market and is expected to bring in large profits to the university during its patent lifetime. The new science building on campus will be named in your honor.” In the patient scenario, some of the challenges participants learn about are lack of insurance coverage for clinical-trial patient-care costs, the importance of proper insurance authorization for specific treatments, and the intensive recovery that occurs with an allogeneic marrow transplant for acute myeloid leukemia. In some cases, policymakers get a chance to talk with patients participating in clinical trials who are living proof of research's value, Carlson notes. She is confident that cancer centers across the country will find the program beneficial. “By partnering with our elected officials, we can take cancer care to the next level,” she says. The Ohio legislative cancer education program, Project Cancer Education, is set to roll out nationwide. The program gives elected officials a chance to walk in the shoes of researchers and patients. Legislators and their staffs experience firsthand the challenges faced by cancer centers. Cancer centers will receive toolkits from AACI to help tailor their own programs.
In the years following 2008, developing countries as a whole may invest as much as US$100 billion annually in information infrastructure (Khalil &amp; Kenny, 2008). In addition, the rapid expansion of mobile phones—even in the poorer regions of the world1,2—and the emergence of the “social” (i.e., participatory and collaborative) Web3 are rapidly reshaping not only the ways people access and share information, but also how they relate, collaborate, and organize (Benkler, 2006; Shirky, 2008). These new tech-nologies, most notably information and communication technologies (ICTs), offer new and transformative applications and services, means to communicate and produce content, and decentralized innovation models (Heeks, 2008). In this context of expanding ICT networks and applica-tions, Khalil and Kenny (2008) appropriately ask, “How can we catalyze the impact of ICTs on development?” The hypothesis of this paper is that open social arrangements, enabled by ICTs, can help to catalyze the development impacts of ICTs. In other
In this paper, we consider the effects of the 2003 local government reform (Law 131) on the budgetary systems of local governments in Russia, paying special attention to the allocation of functions and tax resources between different levels of government. An evaluation based on the standard theory of fiscal federalism and an international comparison indicated that Russia's institutional characteristics exhibit two parallel and contradictory tendencies. On the one hand, they tend to normalize according to the theory of public finance, but, on the other hand, the administrative and budgetary systems become centralized, which contradicts the global trend of decentralization.
Two broad and interlinking themes have dominated much of the recent literature on local governance1 and participation: the dynamics, spatialities and temporalities of the ‘neoliberalization’ of local governance; and the relationship between local governance and democracy, especially the ‘meanings, potentials and pitfalls of “participation” ’ (Melo and Baiocchi, 2006: 596). Taking the latter first, Beaumont and Nicholls (2008) in identifying new research issues emerging from a symposium have highlighted a range of questions: frictions between representative and participative local democracy; distinctions and overlaps between participation, democratization and social movements in cities; and the tools for deepening democratic engagement with impoverished and marginalized communities in cities of the global North and South. Purcell (2007) argues that there is a need for more and more sustained work on the political as well as the economic dynamics of city regions, and that this means engaging with questions of democracy as well as of citizenship. Melo and Baiocchi suggest there are two key questions: whether deliberative, ‘horizontal’ governance structures favour middle-class and elite interests; and what are the conditions under which participatory arrangements can be both democratic and governance-enhancing. A related issue is the potentially problematic power relationship between elite forms of local governance — for example the influence of unelected local notables in institutions such as local partnerships — and participatory practices (Geddes, 2006). The abundant literature on decentralization initiatives in many Southern states frequently questions the extent to which such initiatives have been able to embed effective and democratically accountable institutions at the subnational level (Stren, 2004; Batterbury and Fernando, 2006). These issues of the politics of local governance — the interplay of participation and partnership, social movements and the representative democracy of political parties and leaders — are central to this symposium. Many, if not all, of the contributors to the above debates position issues of democracy and participation in the context of processes of neoliberalization, and the ‘market democracy’ or ‘market citizenship’ associated with neoliberalism (Kohl and Farthing, 2006). The concept of neoliberalism is complex, diverse and contested, and works on a number of levels. These range from institutionalized cognitive principles —‘a deep, taken-for-granted belief in neoclassical economics’, through consequent normative principles favouring free market solutions to economic problems, to a set of policies implemented during the 1980s and 1990s to promote a lean welfare state, low taxation and flexible labour markets (Dumenil and Levy, 2001: 5). In an important recent contribution, Harvey (2005: 19) argues that neoliberalism should not be understood as a bundle of characteristics, but as a political project, a process of neoliberalization ‘to re-establish the conditions for capital accumulation and to restore the power of economic elites’, and specifically to disembed capital from the constraints of the ‘embedded liberalism’ of social democracy and the Keynesian welfare state (ibid.: 11). When theoretical neoliberal principles clash with the need to restore or sustain capitalist class power, or when such principles lead to tensions and contradictions, ‘then the principles are either abandoned or become so twisted as to be unrecognisable’ (ibid.: 19). He cites the rhetorical commitment of neoconservatives to democracy as an example. Harvey reflects on the important role of urban crisis — such as the New York fiscal crisis of the 1970s — in paving the way for neoliberalism, and also points to neoliberal forms of elite, closed governance such as partnership, which circumscribe both ‘old’ representative and ‘new’ participatory democratic processes (Fuller and Geddes, 2008). In this vein, other key contributions have resonated widely in the recent literature. Jessop (2002: 466) noted how key global neoliberal strategies envisage a growing ‘role for cities in managing the interface between the local economy and global flows, between the potentially conflicting demands of local sustainability and local wellbeing and those of international competitiveness, and between the challenges of social exclusion and global polarization and the continuing demands for liberalization, deregulation, [and] privatization’. Along similar lines, Brenner and Theodore (2002: 369–72) referred to the ‘neoliberalization of urban space’ (or ‘neoliberal localization’) as one of destructive creation in which the old local state apparatus is replaced by new forms of local governance — including ‘networked’ forms of governance based upon public–private partnerships; ‘new public management’ strategies; privatization and competitive contracting of municipal services. In a widely cited formulation, Peck and Tickell (2007) distinguished two phases of neoliberalism in the UK context: roll-back (when a primary objective was to roll back the pre-existing political economy of the social democratic welfare state, via deregulation and public expenditure cuts) and roll-out (the extension and deepening of neoliberal forms such as networked governance, fiscal responsibility and reregulation). Cerny (2008), emphasizing the importance of place in the global evolution of neoliberalism, identifies a ‘social neoliberalism’ in which welfare is not rolled back but restructured and marketized in highly complex ways. Thus: the neoliberal ascendancy of the past three decades has been associated with a series of paradoxical and contradictory ‘double movements’ . . . neoliberalism involves the simultaneous and iterative roll-back of institutional and social forms (especially those associated with Keynesianism) together with the roll-out of restructured institutional and state forms (Peck and Tickell, 2007). While this literature initially focused primarily on the changes encountered by urban institutions across countries and regions in Europe and North America, there is now increasing recognition that the neoliberalization of local governance is a global phenomenon (Leitner et al., 2007). An insistent skein in the increasingly globalized literature has been the call to recognize the diversity of ‘actually existing neoliberalisms’. Larner (2005: 17), for example, is concerned to move beyond neoliberalism as a monolithic hegemonic entity in order to understand its uneven, contested and contingent nature, and recognizes that institutional landscapes are characterized by diverse, ‘contradictory spatialities, socialities and subjectivities’, operating through divergent political, institutional and regulatory strategies that are characterized by contradiction and contestation. It is also important to recognize that policy change can involve a degree of the ‘pragmatic and opportunistic’ (Peck and Tickell, 2007: 30). There are, though, important differences between perspectives which essentially identify variants of neoliberalism, and others which talk in terms of hybrids between neoliberalism and other political projects. In this perspective, many rationalities and approaches are prioritized by the state, which come to form a ‘hybridity of approaches and rationalities’ (Purcell and Nevins, 2005; Raco, 2005: 325), in which there is no assumption of the dominance of neoliberalism (Barnett, 2005). Exploring both the temporal and spatial dynamics of neoliberalization, Geddes (2005) suggests that the transition to a neoliberalized local governance remains highly differentiated. Beyond a neoliberal heartland (US, UK, Australia, New Zealand) there are marked differences between a ‘new Europe’ eager to embrace neoliberalism, a social Europe still as yet with a markedly different vision, and a transitional Europe, itself divided into several trajectories. Beyond Europe, there can be not just mimicry of European/US models, but also very different local governance initiatives, some of which challenge neoliberal prescriptions. Summarizing a symposium on the geographies of neoliberalism in America, (2005: that spatial and . . . processes of state and the of neoliberal landscapes and a but also that is a as well as destructive . . . which for or social emphasizing that such of are at the by neoliberal In and neoliberalization has been associated with the deepening and of market the role of the state and its relationship with its in order to and and 2005; and Farthing, 2006). In no a local been on the social its role has been in with the neoliberal by recent 2008). The spatial and temporal dynamics of neoliberalization can a contested and (Leitner et al., in which of neoliberalism can itself a not as a to neoliberalism, but also of the of neoliberalism by and practices and with (ibid.: 5). that to in terms of neoliberalism are (2005: for example, argues that of neoliberalism to of which are not to neoliberalism and from the not how this While that not is to neoliberalism, in that neoliberalism has the to with such which in the context of phases of symposium with debates local governance, and especially participatory in global from the UK and this to and this and (Geddes, this While and the cities on which of the not of more a of global to issues in a set of very different — including the and different past the global and countries and with both and very different governance and this of by to the literature. In this with the issue of what to the of ‘actually forms of local governance under suggest that such an to two of both of the upon which the process of neoliberalization and other to that of neoliberalization, which are also on local latter in to local governance are processes of with a in contradictory relationship to neoliberalism, as Harvey is one of with in which are in both and in formulation, . . . . . . the of across and when and are In the of this primarily on which to of in local also reflects the that the contributors to the symposium different the extent to which neoliberalization of and the of a of The in the symposium primarily on neoliberalism — that is to in one on the extent to which processes in local governance in very different local not understand a to and the in which both tensions and neoliberalism, and forms of in complex of local governance both and now under — the social and political and and the process — which are in different in the of the The of the state, including the extent — or — of democratic political institutions is a primary local noted Jessop and Brenner and Theodore to the process of the local neoliberal Harvey the neoliberal state is a contested political form a number of and tensions to the between and democracy; in the of the existing social order which neoliberal and extension of between and In to the of and forms of The countries and cities in this symposium such tensions and the local of both and Southern and and and in which the extension of democratic forms markedly different The of the states which the cities are are important in of local governance in at three which are the of the state, the of the local state and its In the UK the countries in the the social democratic state a form of ‘embedded liberalism’ 2005: which the neoliberal has to the extent of this the of the UK state, to the of neoliberalism to on the of social democracy and its in have for neoliberal local state forms and In in the other states — and — the transition neoliberalism has place or state there are also important differences between The states in and very of political in the state to its the was and still is characterized by a level of political and and 2006: The characterized by social that in local political and in the of the of and the of local et al., In in the can be that when with neoliberal to have complex of participation urban In forms of have in the important on local state policy in movements have participatory local institutions by the neoliberal In both and the of neoliberal state forms with the transition from has been a in this still be to In the of argues that in the the transition to a neoliberal urban governance was as was the to be to a new state the of economic and In the of the transition from of its with the of has also with with and as and and is is In neoliberalism in the 1980s in the crisis of an and but the neoliberal with local participatory to its was to the changes of which the neoliberal to the of democratic processes the The a of from those neoliberalism characterized by an of political and has been able to a degree of from its with the transition to democracy, to those its with democracy is and its more It is also as for similar to from political strategies by states with different and in social democratic and have similar participation as of and similar competitive economic The to are in at to the influence of the state in the form of the in neoliberal urban economic and social different social democratic of the countries and cities in the degree of decentralization of political power to the local level governance and in terms of is for example, with the of and based on from across America, of the complex between neoliberalism, democratization and and the that decentralization is associated with either neoliberalism or there is a between the decentralization of power in which has more for local in to the position in the urban has been to with and this local governance in both and is well and In the of local is into the but the to local in in to the of means that the of local governance arrangements is more contested in cities local state is of or are complex and of are much In (Geddes, this local across the in the and constraints have been especially The in the the and of the state at both and local levels. It is also important to recognize the role of state institutions and now an increasingly important role in policy and such as the and its the the of Europe, and international have been important in the of and neoliberal policies different global regions example under the of the which from the neoliberal in and The of governance principles by is for many countries to of the which and to is upon with the neoliberal economic principles which 2007). the key points of have in of what is between and the and in and more participatory forms of democracy and political emphasizing the principles of and local democracy similar with forms of participation, to promote of participation 2007). there is growing recognition of the which frequently between the of participatory institutions and and 2005). The some contributions to for more to how democratically local are and to the issues by Beaumont and Nicholls frictions and distinctions between participation and democratization and the need for deepening democratic engagement of marginalized movements and have been key in local governance, as was the with the in during the and the in one perspective, the of social movements in more recent is a to the of social movements have the political of the by neoliberalism to of the neoliberal state and politics et al., 2007). the of neoliberalism, local strategies have been and social capital to be as a to state and in which and are are in neoliberal local (2005: the is the extent to which social movements have become into a of neoliberal state argues — with many others — that participatory processes such as those in and well more as for the of social as means of that much of the governance literature on a of power an in the power of a in state power, argues that engagement with the literature is the of power beyond a and emphasizing the continuing of in governance is at to that such for participation, be what was on The latter a neoliberal forms of engagement well more social democratic local is also is to such local participatory initiatives the of neoliberalism and neoliberal local In for example, on such initiatives is with that on economic In the context of the UK, the New for across by the New have no on the economic context of economic in one such participatory processes can be as one in a ‘social neoliberalism’ primarily class to social be more to the of state policy in with on the of the neoliberal state, in to which such participatory social are of be from and In this the of the latter for a local state are The of and are also of the way in which social can be local state which are to and by the central state, in a relationship as et is . . . are to to of but are to to neoliberal A very different is in the local social movements of the and are in and at from the assumption that is by the state, to influence local state policy is in a context of social and at the of the local and (2007) the of of and engagement in as to both and the These very different be the for local social movements of a position which is both and the state — in a position in which can influence the state in The challenge to social movements has (2007) to that should to participation in institutions such as local which that such an engagement is — such as participatory in — to have on the of local social movements with a local to and with or in the of from in countries the UK, social demands to be into a and increasingly by the local state there are still important — such as in and — of participation in a range of forms of across local and global which or by the In the of many social movements both in communities and in urban both with a of to the state, has not social movements to but has to form the for of the neoliberal and 2007). governance has the on social movements to to the of partnerships and forms of neoliberal participation, and in so has to the participation of the 1980s in countries such as and beyond 2005; 2007). others 2005; and Farthing, and the not but to forms of and to forms of political participation by the not an neoliberal practices of the of neoliberal institutions by in very different by different or local governance has increasingly the of the has been the of the power and of local and political The of and political parties via local has been by and has been with participative and forms of local democratic The of partnerships has to local to the of one many the primary in local political leaders have been on the one to become more and on the other to new based on the of political and more on or in a In countries such as the UK, local political is increasingly concerned with in the of the different a the and of local political has been as important in and to from of and 2005). local is not to the political leaders in cities in and have also this to power et al., with as and The of and in have local and public to with the creation of new forms of and such as and participation There is much though, of by political leaders in the by and the of which have the of also local of is the local of the literature on local suggests in the context of a neoliberal local politics of governance, should be or the contributions of local leaders from and In some countries has been that local political has to from a to a range of different in a more democratic (Melo and Baiocchi, can also be the that and of old have of in many of America, the of leaders still remains In for example, the of as has the of and that remains between the of political and of a politics in which and in some countries such as the UK, policies have to promote the importance of in one as a way to local democratic and and 2005). the which is one in which local and parties — of both and and in countries — have to of the new of local governance, but in the process different and to governance such as the by of political parties of partnerships in which theoretical of and the and competitive of local this through the example of the in which in the 1980s a more for the of the the city the and as the the that has been to the city and the urban the political of the by the in In America, both and parties have been concerned with and effective While is the that the of has been more in including and social and the that neoliberal can local participatory structures which new to local not be The of the and policies in and how the process of a between the of a a social and the social as well as across and can have for the of local the of a policy or either the or to a different can also a in the of governance of the political in The of the participatory process from to other but also to many cities is the example of how local can the of a governance et al., 2008). and the global urban the important spatial of the economic and social across the by the neoliberal a set of that local that by the the urban of In that the of Europe, North and and the be the and be with and the and the regions the in between and 2007). In the of and These are local governance in an increasingly and has been with urban governance an of the extension and of urban as a of and with the of in strategies to a global competitive are a more competitive and local have to place and new forms of local but have also for new strategies of social and place policies have been by the creation of and and with other cities the and the Southern et al., 2006). cities are the international and are not at the of the global urban but are cities at the level of the that is a dominated by the city of the and important at a level the power of of the global and the initiatives which have been are a continuing of local governance In and in a context of strategies have the a city and of old the for the of 2006). the urban influence the extent to which different cities strategies the local governance in terms of the of institutions and from and beyond and the of and across different the of local governance institutions to to is also by the of the other three which cities have example, of of between the and levels. the of and have as much in with the of as with the in to global changes in and which of and that level cities have and social and are highly in and and have governance the of in and is much in the of urban governance to such is more and some strategies of social by the state — such as participatory participation, partnerships and social — have become to urban social 2004; and many of have been by social movements and forms of other more and also the of the and in cities and of in the the of communities in and 2004; 2004; and increasing in the North are other such as in the UK, which have and spatial on marginalized 2004; this is a that has been associated with and the economic and social The has the role of as a to the of the at the as the has to policies in political in have to institutions and of as a way of a democratic and and this In and political of both and have in the of based on to partnerships and in this symposium are emphasizing the urban is also important to recognize the of In the between the and many of the social movements of should that the is not with social The of movements in in the 1990s and of this have been central to to neoliberalism, and have in structures in urban as a of (Kohl and Farthing, 2006). the of as well as urban local governance the importance of of the of the of has been to a in which very different and urban have been to to a political that and have become of ‘new and the processes change in both how and to local governance in city in and ways. The key between the two cities was the political context in by the transition from the to a democratic that of urban governance, characterized by decentralization and a of participation, was from The on of to two the governance that a of state and and across to a of not a of state that an in participation not an in on and the for local governance of a at the urban those related to issues such as or urban which call and to the on the of the for the urban and the of neoliberalism in the to with the state, a more especially for cities in to a more for In this the importance of as the of public at the subnational and the central place of or in the urban and for In the Geddes suggests that is to the of two of local governance — neoliberal and is not to or the diversity of existing but to to the terms of He reflects on local governance in in the 1980s and 1990s a for the new neoliberal but now a of as a of the recent of the the of the neoliberal on He suggests a of and of neoliberalism is in the tensions and complex temporalities of the between neoliberalism and to in and
The Private Finance Initiative (PFI) is frequently portrayed as a vehicle for change for the UK construction sector. Significant change in the working practices of construction companies is predicted as new business models based on whole-life value creation emerge. This paper shifts the focus of discussion from projected ideals and possible developments to the current situation. More specifically, it focuses on the challenges that large firms participating in both PFI and traditional markets face. The analysis focuses on the relations between business units and on day-to-day challenges to greater long-term commitment, through life-service provision and increased integration between construction and service provision. The paper offers insights into the effects of PFI on construction practice and their implications for theorizing on organizational and strategic change. It suggests abandoning a simplistic model of the centralized, homogenous firm and instead capturing the dynamics of decentralized, large firms working in multiple markets on a variety of projects. This would assist in the provision of more realistic and fruitful models of how to realize the PFI vision. L'Initiative Financière Privée (Private Finance Initiative – PFI; contrats de concession d'ouvrages publics à paiements publics) est fréquemment dépeinte comme un moyen de faire évoluer l'industrie britannique du bâtiment. D'importants changements dans les pratiques de travail des entreprises du bâtiment sont à prévoir au fur et à mesure qu'apparaissent de nouveaux modèles d'entreprise basés sur la création de valeur pour toute la durée du cycle de vie. Cet article déplace le centre de la discussion des idéaux envisagés et des développements possibles à la situation actuelle. De manière plus précise, il se concentre sur les défis auxquels se trouvent confrontées les grandes entreprises qui participent à la fois aux marchés PFI et aux marchés traditionnels. L'article porte principalement sur les relations entre les Business Units et sur les défis qui se posent au quotidien par rapport à un engagement à long terme plus grand, au maintien de la qualité des prestations pendant la durée du cycle de vie, à une plus grande intégration entre la construction et les prestations fournies. L'étude de cas et l'analyse élargie qui sont présentées permettent une évaluation de l'effet des contrats PFI sur les pratiques du bâtiment et une théorisation sur les organisations et les changements stratégiques. L'article suggère d'abandonner le modèle simpliste de l'entreprise homogène, centralisée, et de s'inspirer plutôt de la dynamique des grandes entreprises décentralisées opérant dans de multiples marchés sur des projets variés. Cela contribuerait à fournir des modèles plus réalistes et féconds permettant de savoir comment concrétiser la vision PFI. Mots clés: travail collaboratif entreprises de construction solutions intégrées marchés multiples Initiative Financière Privée (PFI) initiative financière publique création de valeur
Stuart M. Allen, Gualtiero B. Colombo, Roger M. Whitaker
We address the problem of cooperation in decentralized systems, specifically looking at interactions between independent pairs of peers where mutual exchange of resources (e.g., updating or sharing content) is required. In the absence of any enforcement mechanism or protocol, there is no incentive for one party to directly reciprocate during a transaction with another. Consequently, for such decentralized systems to function, protocols for self-organization need to explicitly promote cooperation in a manner where adherence to the protocol is incentivized. In this article we introduce a new generic model to achieve this. The model is based on peers repeatedly interacting to build up and maintain a dynamic social network of others that they can trust based on similarity of cooperation. This mechanism effectively incentivizes unselfish behavior, where peers with higher levels of cooperation gain higher payoff. We examine the model's behavior and robustness in detail. This includes the effect of peers self-adapting their cooperation level in response to maximizing their payoff, representing a Nash-equilibrium of the system. The study shows that the formation of a social network based on reflexive cooperation levels can be a highly effective and robust incentive mechanism for autonomous decentralized systems.
Rural local governments in India provide essential services to over 70 percent of the national population. Yet, little is known about the efficacy of the financing system that supports these local governments, nor is there a fiscal information system that will allow a tracking of rural local government expenditures and revenues. In this article, we describe the role of rural local governments in India's; federal system, and use a database, newly gathered for West Bengal State, to present an analysis of rural local government financing patterns. We find that expenditures are significantly higher in less populated and more backward gram panchayats. At the margin, however, higher rates of literacy also are associated with higher levels of spending, suggesting an education effect.
In this paper we describe and evaluate recent changes in the Spanish public programs that foster training among the Spanish active population. The analysis updates and complements the Martínez-Lucio and Stuart study of 2003 in this journal because it covers certain aspects related to training not considered there, especially those relating to public policy. Our analysis may also be useful for other countries that have similar characteristics to those of the Spanish training system, such as a high degree of administrative decentralization, a tripartite organization (involving public authorities and social agents) as well as a supply-driven and demand-driven training differentiation. Spain is located in southwestern Europe. Its mainland is bordered to the north by France and to the West by Portugal. In 2008 the population of Spain reached 46.2 million people. With the exception of Madrid, the capital area, the most populated areas lie around the coast. Life expectancy is 82.2 years for women and 77.8 years for men. The basic political units in the territorial distribution are the municipalities (there are 8,112), provinces (50) and regions (17).1 The last named have some political responsibilities because Spain is quite similar to a Federal State. In 2008 Spain was the eighth largest economy in the world, according to nominal gross domestic product (GDP). This was 1,095 million euros. GDP per capita was 24,020 euros. In fact, Spanish GDP per capita was 5.5 per cent above the average of the 27 states of the European Union (EU). The percentage of employed people by productive sector is as follows: agriculture (4 per cent), construction (12.1 per cent), industry (15.8 per cent) and services (68.1 per cent). The 2008 annual average rate of change in the Consumer Price Index was 1.4 per cent (being 1.6 per cent in the Euro area), but it has reached negative figures in 2009, as in most Western economies. Thus, Spain presents good figures in life expectancy, GDP and inflation. Its main economic problems are unemployment and current external deficit. Related to the former, in the second quarter of 2009, the active population was 23 million and the employed 18.9. Therefore, there were 4.1 million unemployed workers. The rate of unemployment was 17.9 per cent, more than double the EU average unemployment rate (8.3 per cent). Although Spain managed to reduce its unemployment level from 24 per cent in 1994 to 8 per cent in 2007, the rate of unemployment has increased sharply in the present economic crisis. With regard to the current external deficit, the accumulated deficit in 2008 increased to 104,664 million euros (9.6 per cent of GDP, one of the highest in the world in relative terms). The Spanish educational system has the following levels: pre-primary, primary, secondary education, which includes lower secondary (named Educación Secundaria Obligatoria) and upper-secondary education, either academic (bachillerato) or vocational [ciclos formativos de grado medio (CFGM)], and higher education [professional, named ciclos formativos de grado superior (CFGS) and university]. Compulsory education comprises primary and lower secondary (from 6 to 16 years old). Pre-primary education is organized in two cycles of 3 years each for children aged 0–6 years old. Primary education includes six academic courses (for students between the ages of 6 and 12). Lower secondary education has four courses, and it is expected that at the end, 16-year-old students finish compulsory education. However, in Spain, around 30 per cent of students fail to satisfactorily complete their compulsory education. Pupils who succeed in compulsory education may follow the academic track (bachillerato) for 2 years or vocational education (CFGM). To enter CFGS pupils must have satisfactorily finished bachillerato; however, there are specific exams to enter both vocational levels for those without the required academic degrees. Because of the implementation of the European higher education area, nowadays university studies (named grado) have a duration of four courses (with some exceptions) and substitute previous licenciatura (5 years) and diplomatura (3 years). Students have to pass a national exam to enter university, although for some groups there are also other ways to get in, such as for those over 25 or those who graduated from CFGS. Finally, university graduate students may attend masters and doctorate courses. In 2008 there were 7.2 million pupils in non-university studies, 36.4 per cent of whom were in private centers (around 80 per cent in private, publicly funded or ‘concerted’ schools). Thus, Spain is one of the countries with the highest percentage of students in private centers, especially because of the ‘concerted’ schools (Escardíbul & Villarroya, 2009). Moreover, there were 1.4 million university students (10 per cent in private institutions). In 2006, public expenditure on education amounted to 4.3 per cent of GDP (the EU average was 5.1 per cent). Training programs, together with vocational education, have constituted a unified system of vocational education and training since the 1990 Educational Act. The training system is made up of a scheme for training for the unemployed (traditionally called occupational training) and training for employed individuals (continuous training). The two types of training were originally independent, but they were merged in 2007 through the Royal Decree 395/2007. The merged system is governed by the Ministry of Labor and Immigration (MLI), which establishes a common legal framework for the whole country and has management responsibilities. Since the 1990s, however, regional governments known as Autonomous Communities (ACs) have also taken on some responsibilities for training. In addition, social agents also take part, especially in continuous training. The completion of vocational education leads to vocational degrees (títulos profesionales), whereas finishing occupational and continuous training may lead to professional certificates (certificados de profesionalidad). Both are linked through the National Catalog of Professional Qualifications (Catálogo Nacional de Cualificaciones Profesionales), which today contains 390 qualifications. Training for the unemployed comprises a general Plan for Training and Professional Insertion (Plan Nacional de Formación e Inserción Professional or ‘FIP’ Plan), established in 1993, as well as working/training programs (focused on services of social interest) such as school workshops (Escuelas Taller) and trades centers (Casas de Oficios) for younger unemployed individuals and employment workshops (Talleres de Empleo) for those over 25. Working/training programs last from 6 months to 2 years. Training programs for the employed started to be implemented in 1993, when the Foundation for Continuous Training (Fundación para la Formación Continua, FORCEM) was created as a result of the First National Agreement on Continuous Training. The foundation, although publicly funded by the MLI [and the European Social Fund (ESF)], had bipartite management bodies. On the one hand, there were the two main employers' organizations and, on the other, the main national trade unions. Training was regulated through two National Agreements on Continuous Training (covering the periods 1993–1996 and 1997–2000) reached by these social agents. The third agreement covered the 2001–2004 period and was administered by the Tripartite Foundation for In Service Training (Fundación Tripartita para la Formación en el Empleo), which was run by the social agents indicated above and the MLI through the National Employment Institute [Instituto Nacional de Empleo (INEM)], after some irregularities involving public funds had been uncovered. With the third agreement, a distinction was introduced between supply- and demand-driven training plans. The former has been aimed at the personal and professional development of workers (and it is mainly organized through sector and inter-sector plans, managed by social agents), whereas the latter has sought to address firms' needs (companies ask for subsidies for training and employees may demand training leave). The Royal Decree 1046/2003 altered the third agreement by introducing major changes to the system, such as changes to the demand-driven training system and to the role of ACs in supply-driven training. With respect to the first change, the Royal Decree enabled companies to secure training resources with much less bureaucracy because it eliminated the need to present projects annually to the Tripartite Foundation and allowed companies to finance their training by reducing the amount they pay to the Social Security Treasury if resources were devoted to the training of their employees. The calculation of the training ‘credit’ or ‘bonus’ for each company is based on the application of a percentage (set by the National Budget Act) of the amount paid by the company through the previous year's compulsory training levy. Companies with at least 10 employees also have to invest in training with their own funds (see details in next section). Firms have to keep the employees' legal representative (if one exists) informed about training matters, otherwise they lose their bonus, and there is a procedure in case of dispute where social agents are involved. With respect to the second change, AC governments with labor competences (16 out of 17) were allowed to supply and manage national centrally collected public resources (and their own) for supply-driven training activities within their regional boundaries. However, INEM still manage training activities developed in more than one AC. Finally, the fourth agreement (2006–2010) set out several aims that were developed in Royal Decree 395/2007, such as merging training for the employed and the unemployed and fostering professional certification (see next section). The funding structure for training is supported by the Public Treasury's collection of a training levy paid by employers and workers. The levy is 0.7 per cent of gross salary. Companies pay 0.6 per cent, whereas 0.1 per cent is covered by employees. Since 1997 the training levy is equally distributed between training for the unemployed and for the employed (0.35 per cent to each system). Resources are managed by the National Employment Institute (INEM) and those AC governments that assume this responsibility. They are mainly distributed to regions according to the number of unemployed. During the 2000–2003 period, the ‘FIP’ Plan accounted for around 700 million euros (around one third came from the ESF), whereas resources for the working/training programs were almost 480 million (30 per cent from the ESF). For continuous training, Tripartite Foundation's financial resources are provided annually by INEM. For the 1995–2005 period, the training levy accounted for approximately 75 per cent, whereas it was 81 per cent in 2006 (the rest was provided by the ESF). AC governments also spend their own funds. Funds to regions are allocated mainly on the basis of the average number of workers excluding public sector employees (who have their own training plans). The number of participants across all kinds of occupational training is shown in Table 1. More than 80 per cent of learners take part in training related to the FIP Plan. In addition, 15–20 per cent of all unemployed workers (based on the Active Population Survey) have received training since the beginning of this century. The small increase observed in the 2003–2006 period is due to the declining size of the unemployed population. Table 2 shows information related to continuous training since 2004, when the ‘credit’ system began. However, it has to be emphasized that since 1993 the number of employees trained and total funds for training have greatly increased, the first sixfold (it started with 0.3 million trainees), although the figure has been quite stable since the late 1990s, and the second figure 14-fold (in 1993, only 56 million euros were devoted to training). The overall percentage of women trained has reached 42 per cent (it was 30 per cent in 1993). There are more trainees in demand-driven activities than in supply-driven activities. However, the credit system administers less than 30 per cent of the total resources. With respect to demand-driven activities, the bonus used has increased sharply, though, as a percentage of available bonus it is below 60 per cent. In addition, the overall bonus percentage of training costs (including the wages of employees who train during working hours) is almost 60 per cent. Demand-driven training activities that are not in the workplace account for less than 30 per cent of the total, although this figure has increased each year. With respect to supply-driven activities, most trainees participate in sector plans. Regarding the distribution of funds between levels of administration, the contribution of the national authorities has decreased sharply (from 75.1 per cent in 2004 to 49.5 per cent in 2006) in favour of the ACs. Looking at the type of plan involved, roughly 85 per cent of total funds are devoted to sector plans. As previously indicated, the Royal Decree 395/2007 merged continuous and occupational training. It states that training may be provided as follows. Public administrations with responsibility for training may provide training through their own centers or through agreements with public organizations or companies certified to train. A public administration's centers include National Centers of Excellence (Centros de Referencia Nacional), Integrated Centers (Centros Integrados), and other centers for vocational education (schools) and training (INEM's National Centers for Occupational Training, which may be transferred to ACs). Integrated Centers were regulated in 2005 (Royal Decree 155/2005) and, among other tasks, they are to provide all vocational education and and training in that they are to by Labor and Educational centers may be or from the of Integrated Centers has been quite and between ACs. The National Centers of Excellence were regulated in 2008 (Royal Decree They are to be centers for all Spain in a specific of vocational education and training. Thus, they have to the needs of the productive and training to these needs as well as to provide training to all agents in the training system in centers also have to be by and Labor of are to be created from INEM although it is not that they be to out the in the present centers for vocational education that have been by the public provide training professional In addition, other private centers provide training not related to professional certificates if they are in established by labor trade and other organizations from training provide training through their own centers or through other Companies that train their own employees or the unemployed with a to provide training in their own or through Training is for both the employed and the with to groups considered to have in in Royal Decree 395/2007 four types of training Although these all to 2007, the main between the Decree and previous was the of its It covered all training demand-driven activities, supply-driven activities, training involving a of training and and activities. In addition, the of of professional competences through is considered as a of the Although professional certificates were regulated in 2008 only the recent of has established the by which professional certificates or of a vocational degree be by those with competences through working or education. As in previous funds for training from the training levy paid by companies and the and other resources provided to INEM from the national The governments also funds. Funds by the MLI are in the of the National Employment Nacional de Empleo), which includes one representative from each number from the and from the main employers' organizations and trade The of each social the as the levels of in to the tripartite The the Tripartite Foundation and ACs manage the resources allocated to training, as in the previous Finally, is on the of training National and regional labor authorities may evaluate the training system at levels by participants on the training received and by the training centers, and the of training centers may be in the Moreover, centers have to per cent of the they to the of the training As shown in Table recent changes in the bonus system are related to the amount of credit available for training, the percentage of private funding required and the amount of per Thus, the credit available has increased for all is not required to companies with less than 10 employees 2007 it only to companies with up to and the of training per and of training has With regard to training by companies may finance the gross costs of participants through the bonus They have amount of per cent of annual Training is up to per academic or it must be on the and the not Since 2007 supply-driven training activities are aimed at the personal and of both workers and the unemployed of company They are by the labor at national with the and of the Tripartite Moreover, from ACs and social agents are considered through their in the of the National Employment Social agents also participate in the that are created through between employers' organizations and trade among other activities, the main and overall of sector training activities. In 2007, to 56 sector plans, 42 of which came out of ACs may have their own training plans, national training activities are set out as The employed must at least 60 per cent of overall may be sector or and public administrations the of each in each The Tripartite Foundation is mainly in of the and of the implementation of the training Thus, the the for subsidies and or of INEM the a plan is it is developed through agreements between INEM and the the main national employers' trade organizations in the social economy and as well as organizations created by and employers' through in sector plans. The to activities developed at regional level with regional In that organizations may be representative at national or regional training activities must run between six and in The unemployed must at least 60 per cent of overall include training for the of professional certificates in the National Catalog of Professional allowed to funds for this of training include employers' trade training centers and public In 2007, per cent of all participants were trained in centers by labor administrations or per cent by employers' trade and organizations related to the social per cent by and per cent by centers for training. these companies and employers' the unemployed to get professional as well as to at least 60 per cent of all Companies in the first may up to six euros per and training and participants may for and Firms in the second financial subsidies for which are to be This is for those with in the labor or in professional as well as training activities for those in those in the (with labor and (in their country of who This of training is provided by administrations and other public authorities as well as The first two kinds of are through public subsidies through a procedure from The rest are through There are two types of activities that training and within for training and the working/training programs indicated in the previous In for training, which have been in since the to training be less than per cent of total working and must be the education and working be in or must be between 16 and years (the is not and the is between 6 months and 2 years. a based on the agreement, but it must not be less than the to their to Firms the of education through the credit system, but in that case financial resources are linked to the employment of the Social Security Treasury and not from the training levy. activities mainly and aimed at training and information about the training system as well as to individuals to secure training, of and The recent changes provide a by training for the employed and the unemployed one This the of training activities in the structure of the Spanish vocational education and training. It is also that the credit system in activities has been because it the of training for However, the level of used bonus in respect to total bonus available per cent) that more is from public to foster The role of the Tripartite Foundation in small companies be to include on management (Escardíbul The role of social agents in training is through their in set up in the framework of the This is in with the of trade to the role of labor in areas such as training because much of their has been external to the workplace & In addition, are to keep the employees' legal representative informed about training matters, and there is a procedure in case of dispute where they take Resources to training activities, which has a role than a specific role in among employees. However, groups of people have to be such as and and there also needs to be a on the especially in the current of economic with unemployment rate of per cent in The over training centers and the of training This is much because the high of private centers has educational supply in courses and the of students more to enter the labor as because training that the to the labor for the of public funding However, other have to be to the training The of professional competences is to be a of the Professional be established in a that trainees and the unemployed not only information and from training social but also have a who professional that to training and their professional life & that it is of be developed to a of because at present it covers only Moreover, it be the to foster training for those less The role of ACs is not are their activities as regional authorities in There are between regional and national authorities that are taken to the for The role of social agents through be the the role of because these are to firms' training is linked for or the of employees to train Training have to the of training that training and for training). have some of to Thus, some between (and their and vocational education (and their is 2009). In addition, training not only but also are known as such as the to in a and all of which are required by Public funding of training centers on the by As in and be considered as a system, which increase in be among Although all recent have increased the number and of training as well as funds devoted to training, we that and the to training for employees (in per for Moreover, public training the to areas where private centers are not established More is to out these be Nacional de Tripartita para la Formación en el Empleo de Educación de e and Nacional de Empleo (INEM) de de la and de de de de Nacional de and
This paper presents the significance of the issues related to the activity of territorial self-government for the social and economic development of Ukraine. The efficient operation of self-government in any country is unfeasible without financial resources. Polish experience in the development of territorial self-government is particularly valuable in relation to the reform of Ukraine’s self-government. The paper outlines the differences in the structure and operation of territorial self-government in both countries. The paper is concluded with numerous observations on the direction of selected reforms of Ukrainian self-government. It shows the weaknesses of local self-government in Ukraine, which result from the lack of decentralization of finance and the small amount of state-collected taxes. The conclusions end with the observation that a consistent development of the Ukrainian state is required for Poland to develop well.
Regional planning is one of the functions most often affected by the dilemma of how to provide services and resolve conflicts that transcend municipal boundaries. Most existing solutions, while they accept the consensus that power should be decentralized, have limited applicability and the greatest need is for institutional innovations.-This report critically examines such an innovation — the regional districts introduced by British Columbia in 1965. The hew concept employs the identical institutional framework td provide regional services riot only in metropolitan alia non-metropolitan municipalities, but also in the unorganized areas which cover more than 98 percent of the province. A review of the literature led to the conclusion that before a province introduces regional institutions it should consider five key factors. These were: the selection of criteria to delimit administrative boundaries; participation by local governments and by citizens; coordination with other levels of government; the delegation of adequate powers; and the flexibility to adapt to different conditions. Regional districts were evaluated in this context. The inductive approach chosen to generate data documents the history of regional planning and regional districts in the province, then analyzes five of the districts in more detail, and finally solicits the views of the directors of the regional boards. The latter form a second tier or federation of local areas governed by locally elected representatives. The study concludes that the size or configuration of the districts is not always rational, that the provision for local participation is satisfactory but, with the exception of inter-municipal liason, the coordination of programs with provincial departments is not. Most of the power delegated to regional districts appears to be really a transfer of powers from local governments, with the exception of powers acquired by residents of unorganized areas. The flexibility of the new system was judged to be its outstanding feature. A conspicuous phenomenon was the speed with which regional districts were volutarily adopted. It was concluded the tactics employed by the province to "sell" the concept, together with the impetus provided by linking hospital financing to regional districts through complementary legislation were important contributing factors. The failure to provide any overall provincial planning policies with which the programs of the regional districts might have been integrated was perceived as a major weakness. A summary of legislation adopted by three other provinces is included to illustrate the diversity of potential solutions available within Canada's form of federation. The report does not consider regional economic planning, the property tax, the role of the planner, or liason between various levels of government are within its terms of reference, although brief comments on all of these are made on occasion.
This study explored decentralization and rural community participation in primary education in three woredas in Horro Gudurru Wollaga Zone of Oromia Regional State, Ethiopia. The study has illustrated how communities participate in their local schools and examined the successes and challenges in the implementation process. The main fieldwork was conducted in July and August 2009. Qualitative research approach was applied and focus group interview, qualitative interview, documents and field observation were used for data collection. The study majorly involved 24 informants that include woreda education officers, headmasters, Kebelle Education and Training Boards, Parent Teacher Associations and community members. \n\nThe study investigated that the decentralization in education has improved community participation in education. This has improved access and equity in education, sense of community ownership and school level disciplinary problems. Despite these encouraging outcomes, the implementation of decentralization and community participation in education is suffering from many challenges. Poverty in the community and fluctuation in households’ income were found to affect community capacity to finance schools. The block grant fund for schools was inadequate. Schools have no adequate infrastructure and the existing ones were intended to fix problems quickly and hence are of low quality. The PTA and KETB lack basic knowledge and experience for the position and were not succeeded in performing their functions effectively. These bodies have also limited power over control of teachers and performance of headmasters. Further, there is inequality between localities and weak relationship between actors and sectors. \n\nGenerally, the decentralization of education and community participation has brought great change in the way a school is financed, but little change in the way a school is managed and educational quality is improved. Hence, the decentralization of education is serving as a tool for lessening state responsibility for provision of education. Moreover, the lack of necessary resource and trained manpower at the local level are potential challenges for the successful implimetation of the decentralization of education and the promotion of community participation and hence for local educational development.
This paper is part ofa research program supported by the Health Research Institute for Health Security, with the objectives to monitor and evaluate the efficiency of health subdistrict offices in Thailand. Cost efficiency was empirically investigated based on primary surveyed data comprising 246 units operated in 12 provinces. First, descriptive statistics related to outputs (4 variables) and cost (3 variables inclusive of wages and salaries, compensation to officers, and operating expenses) are presented and discussed. All revenue and expense figures refer to fiscal year 2008. Two types of efficiency models (namely SCF and DEA) based an the input-orientation approach were applied to estimate the efficiency scores. We found that 45 units lied on the cost frontier and that represented 18 percent of the total units; in most cases, efficiency scores (DEA, VRS assumption) ranged from 0.60 to 0.75 and averaged to 0.69-implying that there was an ample room for cost-saving, specifically 31 percent, ifoutput slack or excess input were eliminated thus implying the scope for management improvement. Our estimates should be considered preliminary and an in-depth investigation needs to be taken in order further to understand the special circumstances and uncontrollable factors that might have affected the higher cost to those units, but our models failed to take note. The last section discusses policy implications and the health decentralization program in Thailand, which is a topic of policy interest. Improving the efficiency ofpublic agencies and effective public service delivery are among the goals of Thailand's public sector reform. Over the past decade, devolution of responsibilites from central agencies to local govemment units have fairly succeeded in areas of public infrastructure and social welfare-but have been less successful in primary education, public health, and environmental regulation. The transfer of the health subdistrict office is high on the national agenda, and the National Decentralization Committee strongly endorses this connection, it is important to disseminate information related to health subdistrict management, budgeting, and financing to the public, especially local administrators.
研究成果の概要 (英文) ：Quantum communication has been developed over the past 30 years based on a novel theory of quantum mechanics.To establish secure quantum communication, we need safe and efficient quantum cryptosystems.From a more realistic viewpoint, we discuss quantum cryptographic primitives whose bases are a more realistic model of quantum devices.In particular, we study the strengths and weaknesses of quantum zero-knowledge proof systems.We also study the quantum list decoding of error-correcting codes and the notion of advice given to the quantum devices. 交付決定額