ABSTRACT - The Portuguese National Health Service (SNS), a universal, centralized and public owned health care system, exhibits an extraordinary record of equalization in the access to health care and health gains in the late thirty years. However, the most recent history of the Portuguese health reform is pervaded by the influence of decentralization and privatization. Decentralization has been present in the system design since the 1976 Constitution, at least in theory. Private ownership of health care suppliers and out-ofpocket expenditures, on the financing side, both have a long tradition of relevance in the NHS mix of services. The initial aim of this study was to demonstrate expected parallelism between health reforms and public administration reforms, where a common pattern of joint decentralization and privatization was observed in many countries. Observers would be tempted to consider these two movements as common signs of new public management (NPM) developments. They have common objectives, are established around the core concepts of gains in effectiveness, efficiency, equity and quality of public services, through improved accountability. However, in practice, in Portugal, each movement was developed in a totally separated way. Besides those rooted in the NPM theory, there are few visible signs of association between decentralization and privatization. Decentralization, in the Portuguese SNS, was never intended to be followed by a privatization movement; it was seen merely as a public administration tool. Private management of health services, as stated in the most recent SNS legislation, was never intended to have decentralization as a condition or as a consequence. Paradoxically, in the Portuguese context, it has led invariably to centralized control. While presented as separate instruments for a common purpose, the association between decentralization and privatization still lacks a convincing demonstration. Many common health care management stereotypes remain to be checked out if we want to look for eventual associations between these two organizational tools.
ABSTRACT - The Portuguese National Health Service (SNS), a universal, centralized and public owned health care system, exhibits an extraordinary record of equalization in the access to health care and health gains in the late thirty years. However, the most recent history of the Portuguese health reform is pervaded by the influence of decentralization and privatization. Decentralization has been present in the system design since the 1976 Constitution, at least in theory. Private ownership of health care suppliers and out-ofpocket expenditures, on the financing side, both have a long tradition of relevance in the NHS mix of services. The initial aim of this study was to demonstrate expected parallelism between health reforms and public administration reforms, where a common pattern of joint decentralization and privatization was observed in many countries. Observers would be tempted to consider these two movements as common signs of new public management (NPM) developments. They have common objectives, are established around the core concepts of gains in effectiveness, efficiency, equity and quality of public services, through improved accountability. However, in practice, in Portugal, each movement was developed in a totally separated way. Besides those rooted in the NPM theory, there are few visible signs of association between decentralization and privatization. Decentralization, in the Portuguese SNS, was never intended to be followed by a privatization movement; it was seen merely as a public administration tool. Private management of health services, as stated in the most recent SNS legislation, was never intended to have decentralization as a condition or as a consequence. Paradoxically, in the Portuguese context, it has led invariably to centralized control. While presented as separate instruments for a common purpose, the association between decentralization and privatization still lacks a convincing demonstration. Many common health care management stereotypes remain to be checked out if we want to look for eventual associations between these two organizational tools.
Background: Health account is one method to acquire information about financial situation in the district or the state. Based on the information, the analysis on the policy can be made, such as priority setting and equity. The information is also used for policy decision and financial planning. Complete health finance data can be acquired in condition when there is a district health account.\nObjective: To describe health financial before and after the decentralization was implemented (1998 to 2002) in Sinjai District.\nMethod: This research is a quasi experiment research with before and after design. Method of health account development, is adopted from National Health Account.\nResult: This research showed that there was an increase of health funding since 1998 to 2002 in Sinjai District obtained from the government. Before decentralization central government role in health finance was high (11,6% to 60%), but after decentralization, the role of central government decreased and district government role increased (24% to 83%). From finance intermediary site the role of hospital as finance intermediary increased since 1999 to 2002 (11% to 40%). District Health Official still! took prominent finance intermediary point in Sinjai District. From health provider site, health expenditure allocation at community health center showed a trend to decrease. Health care administration and investment function showed escalation trend. Public health action constantly decreased since 1998 to 20002.\nConclusions: Sinjai District Health Finance increased since 1998 to 2002. Due to the increase of hospital health financial allodation, hospital finance intermediary also increased. On the other hand, the financial allocation in public health programs decreased. This pattern of health finance should be reserved for a pro-poor resource allocation.\n\nKeywords: health finance, District Health Account
If the political climate is stable, local elections in Croatia take place every four years. Budgets are planned for three years, while strategic development programmes cover periods of five to ten years. Technically, the political, financial and developmental programming cycles can be matched, and implementation of the programmes ensured. However, political programmes are generally vague, budgets are every so often fictive and revised mid year and development programmes grow into visionary shopping lists. Reality shows that programmes and plans are elaborated, presented in public and then neatly put into drawers. In the aftermath, local politicians are concerned mainly about the financing flows and this is what they are usually fighting for at council meetings and in various ministries. Regularly, local administration proceeds according to the wishes of the political decision makers, without referring to any program in the end. Consequently, political accountability is lacking, fiscal management is not transparent and development is lagging behind. The main aim of this paper is to show how strategic development programmes, budgetary plans and political programmes can be linked in the Croatian socio-economic and institutional environment. Also, in line with the initiated process of decentralization in Croatia, local governments have to improve their fiscal management in order to be able to take over new functions and responsibilities. Since by now a number of local development programmes exist in Croatia, where a participatory and strategic development planning approach was applied, an analysis of the political programmes, local budgets and development programmes can be done. The purpose of this research is to demonstrate that if local governments better understood the interdependencies between these three segments, they could create reference points for their actions visible in their programmes and budgets. In this way a platform could be created to enhance the political accountability, improve fiscal capacity and fulfil developmental goals in line with real needs and potentials of the local population.
Average citizens, working-class and low-income individuals in particular, have little, if any, impact on the formulation of educational policies that affect the schools in which their children are enrolled.Yet there are instances in which these typically disenfranchised citizens become politically active and are able to effect change in the educational policy arena.This study will focus on the process of transformation of marginalized and politically disempowered parents into citizens active in the formulation of educational policy. BACKGROUNDSchools tend to be the governmental institution with which the average citizen has the most contact.Ironically, most community members have little voice in the day-to-day operations of schools and tend to have insignificant influence on educational policy at the district, state, or federal level.In Tinkering Toward Utopia, Tyack and Cuban (1995) explain that a variety of groups have entered school politics, but that this apparent pluralism is misleading.They feel the politics of education has not been conducted on a level playing field.Members of the policy elite-people who manage the economy, who have privileged access to the media and to political officials, who control foundations, and who lead our city and state education agencies and universities-have disproportionate authority over educational reform.The authors go on to say: Policy elites often claimed to be "taking the schools out of politics."They sought to do this by centralizing control of schools and delegating decisions about education, wherever possible, to "experts."In the process they did not, of course, eliminate politics, but they acquired formidable powers: to set the agenda of reform, to diagnose problems, to prescribe solutions, and often to influence what should not [italics in original] be on the agenda of reform.(p.8) Stone, Henig, Jones and Pierannunzi (2001) explain that in addition to being controled by elites, educational policy occurs in subsystems and is decentralized, taking place "out of the limelight of public opinion" (p.100).This type of decentralization (toward the elites) occurs despite vocal support for parental involvement (decentralization toward the community) from the U.S. Department of Education and many state departments of education (Epstein, 2001).In Stone et al.'s (2001) words: "urban parents are scarcely visible as active [italics in original] stakeholders in the current school improvement movement" (p.83).Not only do the elites control the policymaking environment, but they also perceive problems differently.For example, the author's research determined that, in some cities, elites are likely to say that no educational problems exist while in others they may identify poor teaching and governance as concerns while other groups cite financing and social issues as key school problems.Issues of race, class, gender, education, and political knowledge further exacerbate this lack of power (Conway, 2000;Gee, 2001).In addition, the democratic environment in which these citizens live also affects their ability to act.As Greider (1992) points out, American democracy is in much deeper trouble than most people wish to acknowledge.Behind the reassuring faade, the regular election contests and so forth, the substantive meaning of self-government has been hollowed out.What exists behind the formal shell is a systemic breakdown of the shared civic values we call democracy.(p.11)
Innocent Semali, Don de Savigny, M Tanner, C. Akim
Following successful establishment of Expanded Program on Immunization (EPI) in the 1970's as vertical program, the burden of disease for many of the vaccine preventable diseases was pushed to low levels. The current round of health reforms in Tanzania calls for decentralization and integration of vertical programs. This has the potential to assist or erode generally good performance of EPI. Reforms on the programme have been undertaken in Tanzania since 1996, and have included 1) integration of the procurement, storage, and distribution of vaccine and related equipment into the operations of a quasi-autonomous drug procurement agency. 2) government financing of procurement of the oral polio vaccine, cold chain kerosene, and 3) the integration of kerosene and vaccine distribution, supervision and monitoring to district health system. Our analysis shows that the integration of the procurement and distribution of vaccines into the operations of the drug procurement agency, and privatization of the distribution of the cold chain kerosene initially stalled EPI reforms for several reasons and had an adverse effect on EPI decentralization and coverage. The major cause of the problems was opposition from the EPI providers at district level who had to accept decreased income consequent to the reforms. We conclude that greater involvement of all stakeholders in the planning of the programme, would have presented an opportunity for forecasting the opposition and developing mitigating strategies.
The Baltic countriesâ local governments have been functioned during the last decade in a permanently changing environment. Like other transition countries, they inherited from the past extremely centralized administrative system. Along with radical reforms, administrative system was decentralized and various functions were devolved from central to lower levels of government. Despite that, municipalities are still fiscally strongly dependent from central authorities. Often their fiscal capacity is not adequate to act in accordance with functions stipulated by laws. Many local governmentsâ revenues from taxes and user-charges are insufficient to finance efficiently their expenditures. Disparities in municipalitiesâ fiscal situation are correlated with unbalanced regional growth, social degradation in the low-income regions and growing differentiation by municipalitiesâ residents on access to education and healthcare. Membership of the European Union brings new tasks and responsibilities for the Baltic local governments. Municipalities should increase their economic sustainability and enhance administrative capacity to explore EU accession funds and implement EU policies. Considering the above-mentioned problems, the paper focuses on current fiscal situation of local governments in the Baltic countries. The main interest is to analyze local municipalitiesâ revenue level and structure, expenditure composition and fiscal autonomy conditions
In this contribution, we analyse the pattern of the so-called PIP (Partnerships and Public Initiatives) that have been approved between 2000 and mid-2003 in the POE1 framework. In particular, we will evaluate the extent of decentralisation that this new instrument has generated in competitiveness policy. Partnership approaches are a relatively recent phenomenon, but partnerships have received widespread attention and support from economic and political agents, including policy makers at national, regional and local levels. In fact, the term âpublic-private partnershipâ covers a wide range of concepts and practices. In our contribution, we will focus on partnerships in a competitiveness policy framework. In a first section, we discuss briefly the meaning and the extent of what we call competitiveness policy. Then, in a second section, we focus our attention in public-private partnerships as a specific instrument for policy. In particular, we make a first assessment on the distinctive principles that differentiate public-private partnerships from more traditional instruments such as direct investment in public agencies or direct subventions to firms. We follow the perspective that these principles, mainly decentralization of policy, may contribute to a greater effectiveness of policy, because a more decentralised policy is supposed to increase focus and accountability and to involve agencies with specialized skills and a more narrow range of objectives. But, also, we will refer that some inefficiencies and some lack of equity may arise from the use of private-public partnerships instrument. Finally, in the main section of this contribution, we will analyse the above-mentioned questions considering the case of the 131 PIP projects approved and financed by the POE between 2000 and mid-2003. As the major part of the variables used are nominal, and in order to define the decentralization pattern induced by this new instrument, we will use multivariate data analysis techniques in order to establish associations between several variables linked to decentralisation criteria and, also, to identify clusters of projects.
Even in the wake of the most sweeping campaign finance reform law to be enacted in three decades, further significant reform is inevitable. Special interest money continues to flow through loopholes in the Act, and the Presidential Election Campaign Fund is near collapse. The next reform should encourage broader participation in the political process by individual citizens, both to dilute the power of special interests and to serve independent democratic values that recent Supreme Court jurisprudence has identified as vital to meaningful reform. We propose adopting a refundable tax credit of $100/taxpayer for political contributions to federal candidates and national parties; the credit would be targeted to lowerand middle-income Americans. A refundable tax credit is equivalent to giving each eligible citizen up to $100 annually to use for political contributions. We also present data about the relative importance of political contributions by special interests (corporate, labor and other PACs) and individuals that undermine many of the assumptions on which past reform has been based and that have not been discussed in the legal literature. The data clearly show that small contributions by individuals are the dominant source of money in campaigns, and that the influence of special interest money is subtle, appearing to âpurchaseâ benefits like access, a place on the agenda, and minor policy details. Working from an accurate picture of who really pays for politics, and drawing from the experience at the federal and state levels with similar tax refund programs, we present the tax credit as a reform that is simple, easy to administer, and likely to improve political participation by average Americans. Thus, our proposal, unlike the complicated voucher plan with anonymity put forward by Ackerman and Ayres, is likely to be adopted by Congress; moreover, it will appeal to a bipartisan consensus because it mixes public funding with a decentralized allocation mechanism using a tax subsidy.
Many backtracking algorithms exhibit heavy-tailed distributions, in which their running time is often much longer than their median. We analyze the behavior of two natural variants of the Davis-Putnam-Logemann-Loveland (DPLL) algorithm for Graph 3-Coloring on sparse random graphs G(n,p=c/n). Let P_c(b) be the probability that DPLL backtracks b times. First, we calculate analytically the probability P_c(0) that these algorithms find a 3-coloring with no backtracking at all, and show that it goes to zero faster than any analytic function as c \to c^* = 3.847... Then we show that even in the ``easy'' phase 1 < c < c^* where P_c(0) > 0, including just above the emergence of the giant component, the expected number of backtracks is exponentially large with positive probability. To our knowledge this is the first rigorous proof that the running time of a natural backtracking algorithm has a heavy tail for graph coloring. Moreover, our results show that these algorithms take exponential time, not just below the 3-colorability threshold, but just above the degree c=1 at which the giant component first appears. In addition, we give experimental evidence and heuristic arguments that this tail takes the form P_c(b) ~ b^{-1} up to an exponential cutoff.
The Histoire de la Nouvelle-France (1609, 1611, 1612, 1617, 1618) by Marc Lescarbot (v. 1570--1641) is read as a symbolic foundation for the young colony of Port-Royal, Acadia (Annapolis, Nova Scotia), a construct which functions as a valid genesis for French America (thus, "New France" in the title refers specifically to this habitation as well as to the men who contributed to its making). Chapter I is devoted to a reading of the work's abundant paratext and identifies the topics at stake in the unfavourable rumours about the Acadian expeditions as well as about the lieutenant of Port-Royal, Jean de Biencourt, sieur de Poutrincourt. Moreover, this chapter explores the subjective marks, disseminated in the paratext, that build up the historian's ethos, which works as a proof of the validity of his object. This chapter investigates as well the metadiscursive comments on the writing of history and their incidence on the referentiality of the work. Chapter II compares the compilation of travel accounts contained in the Histoire with its sources. This comparison shows how the alteration of these accounts of travellers---who recorded themselves the result of their American expeditions---strengthens the division of the stereotyped dichotomy between the man of letters and the man of action, two functions respectively assigned to Lescarbot and Poutrincourt in the Histoire. The order of this compilation as well as the organisation of its various parts according to a diegetical logic shape specific places where a tension emerges between a reliable discourse, intended to a readership interested in the actual conditions of a colonial establishment, and the production of a textual "coating" aiming at attracting a courtly readership, to which the Jesuits, who challenged Poutrincourt's colonial project, addressed their requests. In chapter III, where are confronted the written and mapped representations of Port-Royal, this tension is even more manifest.
In order to strengthen the real ownership and leadership of the communities in rural water supply implementation the\nCommunity Development Fund (CDF) approach was developed in Rural Water Supply and Environmental Programme in\nAmhara Region. The purpose of the CDF approach is to create an alternative funding mechanism, which is separate from the\nconventional governmental funding mechanisms, which are many times slow and bureaucratic and cannot support natural\nprivate sector development. In this approach the funds for the water supply construction are not anymore channelled to\nthe implementing Water Office, instead the funds are transferred to the community using private credit institution in fund\nmanagement. In CDF the community elects an executive body called WATSANCO, which manages the funds, construction\nand material management as well as the management of the water point after construction. Amhara Credit and Savings\nInstitution (ACSI), a share company, which has branches in each Woreda (District) carries out the fund management with\n2% commission only. The CDF project coordination at the Woreda level is carried out by the Woreda Community Development\nFund Board (CDFB) having members from government offices and local organizations and private sector. CDF\napproach in funding will support the decentralization of responsibilities, i.e. initiating and implementing water supply\nprojects by communities and user groups themselves, which will have a significant impact on the ownership issue from the\nvery start. This approach has had enormous impact on the communityâs capacity and it has also increased the rural water\nsupply implementation pace. The approach builds the community capacity to take the lead of their own development with\nother sector development projects as well.
National governments often choose to delegate tasks and burdens to lower levels in a comprehensive system of administration. Local and regional governance thereby becomes an important factor in policy implementation. This paper focuses on the incentive problem that follows from such a delegation of competences to collect taxes and do lending at the local level in a multi-level geo-administrative system. The paper uses the Danish administrative system to illustrate the actual outcomes from such incentive problems. A two-step estimation procedure will be used to derive results on the importance of incentive problems in multi-level geo-administrative systems. Setting up elaborate administrative systems will introduce agency problems that lead to inefficiencies in both local and national governance.
Abstract. We propose the first distributed discrete-log key generation (DLKG) protocol from scratch which is adaptively-secure in the nonerasure model, and at the same time completely avoids the use of interactive zero-knowledge proofs. As a consequence, the protocol can be proven secure in a universally-composable (UC) like framework which prohibits rewinding. We prove the security in what we call the singleinconsistent-player UC model, which guarantees arbitrary composition as long as all protocols are executed by the same players. As an application, we propose a fully UC threshold Schnorr signature scheme. Our results are based on a new adaptively-secure Feldman VSS scheme. Although adaptive security was already addressed by Feldman in the original paper, the scheme requires secure communication, secure erasure, and either a linear number of rounds or digital signatures to resolve disputes. Our scheme overcomes all of these shortcomings, but on the other hand requires some restriction on the corruption behavior of the adversary, which however disappears in some applications including our new DLKG protocol. We also propose several new adaptively-secure protocols, which may find other applications, like a sender non-committing encryption scheme, a distributed trapdoor-key generation protocol for Pedersenâs commitment scheme, or distributed-verifier proofs for proving relations among commitments or even any NP relations in general. 1
In an era in which neo-liberalism has strong societal influences, it seems particularly indispensable to look into the efforts and achievements in Europe to create the social dimension of the integration. Particularly focusing upon the European social dialogue at the macro level, this article depicts its history, function and the challenges it faces.In the main section, the social dialogue at this level is examined in terms of (1) actors, (2) tripartite concertation, (3) consultation according to Articles 137 and 138 of the Treaty and (4) the bipartite, autonomous dialogue between the social partners. With regard to the actors, such problems as the decreasing density and legitimacy of trade union representation in some countries and the lack of a sectoral institution of employers are described, along with some recent organizational developments In the context of the Lisbon strategy adopted in March 2000, the tripartite concertation has taken a significant, albeit embryonic step towards the advent of the corporatist configuration that relates economic and social policies. The consultation processes have created three directives that set minimum standards in the EU. Together with the increasingly autonomous bipartite dialogue that began with a work programme in November 2002, the social dialogue now serves as the driving force of labour market regulation and social integration.Nevertheless, with the national corporatist systems being encroached upon, the European system has been facing some challenges In the last section, its major problems are classified into five categories: the legitimacy of interest representation, the effectiveness of social legislation, dim prospects as a means of macro-economic regulation, the decentralized systems of industrial relations in the CEE countries and an unclear position in the future associational democracy. The European social dialogue may open up a new possibility of formulating innovative policies based on participative democracy that was only available in each member state. Nevertheless, whether or not such a possibility will come true in the near future remains to be seen.
The main research questions for this local study of Tarkett AB, a floor manufacturer, are based on the central characteristics of the third industrial revolution: globalization, technological development, and organizational change. As a background to the local development and change towards the end of the twentieth century, I have chosen to emphasize, on the one hand, the increasing need of the industry for internationalization, rationalization, and productivity development after fordism and the demise of the regulated âreal wages capitalismâ in the middle of the 1970s, and, on the other, the work rights offensive of the labor movement in the 1970s and its continued struggle for economic and industrial authority. The method to analyze the essential traits of the organizational change process has aimed to construe a field of organizational change whose ideal types are based on taylorism, toyotism, flexible specialization, just-in-time, and lean production. Methods used to analyze change from the perspective of social structuration are also related to the theories of dynamic contradictory class locations, local hegemony, and gender. Apart from traditional source material and interviews, the study builds on the results from a study group consisting of a number of factory workers from Tarkett. Technological change and development (IT) of the work process on the factory floor has been analyzed as technological rationalization, quality development, work environment improvement, and as issues of gender relations and class positions at the work place. As regards the management process, leadership and control, centralization and decentralization concepts are vital. In matters concerning working conditions, including salaries, working hours, and job profiles (qualifications required for employment) are central. The management process was subject to changes that entailed deviations from the principles of traditional tayloristic management philosophy. Instead a participant change strategy implemented decentralized leadership functions in the shape of management by objectives via autonomous groups according to principles of âresponsible autonomyâ. The investigation shows that computer-aided centralized control functions, competence improvement, and intensified ideological control worked together to change the management process. Decentralization of responsibility, the integration of white-collar like duties, the general competence development, and the higher demands on job qualifications, combined to render workersâ class locations more contradictory. This, together with ideological control and change, contributed to consolidate local hegemony.
We consider the problem of deploying and managing federated services that run on federated systems spanning multiple collaborative organizations. In particular, we present a peer-to-peer framework targeted to the construction of self-managing services that automatically adjust the number of service components and their placements in response to changes in the system or client loads. Our framework is completely decentralized, depending only on a modest amount of loosely synchronized global state. More specifically, our framework is comprised of a set of per-node monitoring agents and per-service-component management agents that periodically exchange information about the state of the system and of the service with each other using a gossiping protocol. Each management agent then periodically searches for configurations that are better than the current one according to an application model and explicit performance and availability targets. On finding a better configuration, an agent will enact the new configuration after a random delay to avoid possible collisions. We evaluate our framework by studying a prototype UDDI service. We show that while agents act autonomously, the service rapidly reaches a stable and appropriate configuration in response to system dynamics.
The cipher (or athbash, under which name Web3 defines it) is a Hebrew substitution cipher which replaces the first letter of the Hebrew alphabet (aleph, 1\) by the last (tav, ) the second (beth, J) by the last but one (shin, IJI), and so on, unti I we get to the last (ta , n), which i replaced by the first (aleph, 1\). Jan Anderson described it in Fledge Ledge Edge (WW 8. 1997229). Naturally, the idea can be applied to our alphabet; following the precedent set by atbash I name it the azby cipher.