Blockchain Papers

Follow blockchain research across journals, conferences, and preprint repositories.

92,314 papersLast indexed Aug 16, 2026
Search papers

Paper index

92,314 results · page 3819 of 3,847

Nov 30, 1994·RePEc: Research Papers in Economics
8 cites
Fiscal decentralization and intergovernmental finances in the Republic of Albania

David Wallich Sewell

Economic decentralization emerged as an issue in Albania following the first election of a noncommunist government in Albania in 1992. It is one of many challenges in creating a fiscal system that supports reform. Decentralization has begun with the central government's transferring spending responsibilities primarily for some local infrastructure services to local governments. But, given Albania's small size, it is unclear whether"people"services such as education and health care need to be delegated to local governments. Although the destruction of local health and education facilities accompanying the demise of the old regime argues for giving communities a greater sense of ownership of these facilities, they should not be handed down without mechanisms to ensure uniform service standards. Draft laws focus on the transfer of assets (schools and clinics) to local jurisdictions but are vague about responsibilities for recurrent spending. And because local spending responsibilities are expanding, local governments need increased revenues to finance them. Providing an adequate social safety net is vital in Albania - the poorest of the economies in transition - and the government has taken steps to ensure that parts of it are locally administered, though centrally funded. The key to a well-designed intergovernmental financial system is to clearly define spending responsibilities so that a revenue system can be designed to accommodate them. Such a system would combine revenue-sharing, own-source revenues, and intergovernmental transfers. Tax-sharing of central government revenues based on district of origin cannot be the only means of local finance in Albania, as most revenues are collected in only a few districts. To meet financial needs, local governments need some authority over significant own-source revenues (such as user charges and property and vehicle taxes). Privatization revenues can also help local governments but only in the short run, as they are nonrecurrent. Matching grants with spillover effects may be appropriate. And for low-income regions incapable of meeting their spending needs alone, a transparent, equalizing transfer system should be developed. Albania's draft laws allow for this possibility, having established constituent and independent budgets for the local level.

Local Government Finance and Decentralization
Fiscal Policies and Political Economy
Fiscal Policy and Economic Growth
Original source
Nov 1, 1994·IEEE Communications Magazine
5 cites
Telecommunications' role in national development in Ghana

Emmanuel Salia

Ghana has recognized the need for efficient and reliable telecommunication services. The widespread availability of these services will promote the nation's economic advancement and the decentralization of the government's activities. To achieve the objective of bringing telecommunications to all the people of Ghana, private sector participation is considered essential as a source of management skills, technology, and financing that will be required for the provision of services. In order to attract such participation, Ghana is putting in place the necessary policy, institutional, and regulatory frameworks to create an enabling environment for private sector investment in the telecommunication sector.>

ICT Impact and Policies
Original source
Oct 1, 1994·Geographical Review
21 cites
Making the Socialist City of Zanzibar

Garth Myers

The urban-planning strategy of the revolutionary government for the Ng'ambo neighborhoods of Zanzibar City was dominated by a grand vision. Ng'ambo, which literally means Other Side, was slated to become the physical embodiment of the revolution's social experiment. However, the socialist grand vision fared no better in Zanzibar than did its weaker version on the Tanzanian mainland in creating an egalitarian urbanism. Specifically, I examine the attempted reconstruction of Ng'ambo as a vast public-housing project, which was the principal urban program and most enduring legacy of the revolutionary era (1964 to 1977). I contend that this program was not so much a means of bettering Ng'ambo for its residents as it was a way for revolutionary elites to define the area in their new ideological framework of understanding. Denied participation in official planning channels, Ng'ambo residents utilized their own customs and practices to remake the area as best they could, albeit under a set of authoritarian constraints. This study of the Zanzibari socialist experiment in its urban-geographical dimension contributes to the expanding literature on the political and ideological content of cultural landscapes (Western 1985; Constantin 1987; Roweis 1988; Duncan 1990). My interpretation of the Zanzibar cityscape differs from that in several previous studies (Martin 1978; Clayton 1981; Sheriff and Ferguson 1991). The premise is that it is necessary both to understand how the state has utilized space in tactics and strategies deployed through implantations, distributions, demarcations, control of territories and organization of domains (Foucault 1980, 77) and to examine how the residents of Ng'ambo used urban space in political and cultural expression. SOCIALIST URBAN PLANNING IN ZANZIBAR A practical question is whether the program of urban development for Zanzibar between 1964 and 1977 was really socialist. A socialist development program should have five characteristics: state ownership of means of production, absence of a free market for land and real estate, a centrally planned economy, effective one-party rule, and socialist goals prominent in public and state documents (Forbes and Thrift 1987, 2). The stress on common socialist goals in urban policy should involve both a redistribution of goods and services to create egalitarian cities and a decentralization of urbanization to prevent primate-city dominance of the urban hierarchy and to promote regional, rather than specific urban, growth. Socialist goals in the city have obviously varied somewhat according to regime, but the five listed above have broad application. According to these characteristics Tanzania was a marginal example of third-world socialism, because of the steep rise in overall urbanization and the tremendous growth of Dar es Salaam, the primate city of the country. This categorization of Tanzanian socialist experimentation dovetails with other, more detailed critiques (Hill 1975; Shivji 1976; Samoff 1979, 1982; Saul 1979; Coulson 1982). Under ujamaa, the collective term for Tanzanian socialist policies, urban policy called for the establishment of eight regional-growth centers to redistribute and balance development between urban and rural areas (Freund 1989). At best ujamaa was wishful thinking, and at worst a co-optation of socialism as a strategy through which the bureaucratic party elite controlled the economy for their own benefit (Shivji 1976; Mueller 1980). However, these critiques may not be relevant to Zanzibar. The mixture of autonomously derived policies that Abeid Amani Karume, the first president of Zanzibar, adopted seemingly hewed much more closely to the mainstream of socialist planning than was the case on the mainland. Centralized planning and proclamation of socialist goals were accomplished within a year of his taking power. The first postcolonial master plan for Zanzibar City was written by a planning team from the German Democratic Republic (GDR) in 1968; the second was produced by a team from the People's Republic of China. 


Global Maritime and Colonial Histories
African history and culture studies
Postcolonial and Cultural Literary Studies
Original source
Oct 1, 1994·Journal of International Financial Management and Accounting
134 cites
The Influence of Culture on Organizational Design and Planning and Control in Australia and the United States Compared with Singapore and Hong Kong

Graeme Harrison, Jill McKinnon, Sarala Panchapakesan, Mitzi Leung

Abstract This study draws on the national cultural dimensions of power distance, individualism, and Confucian dynamism to predict and explain differences in philosophies for, and approaches to organizational design and management planning and control systems in Australia and the US, representing Anglo‐American nations, and Singapore and Hong Kong, representing the ‘five dragons' of East Asia. Data were gathered by survey questionnaires mailed to senior accounting and finance executives in 800 organizations. The results were largely as predicted and, in general, provide support for the importance of national culture in influencing organizational design and management planning and control systems. In particular, the cultural values of Anglo‐American society relative to East Asian society are associated with a greater emphasis on decentralization and responsibility centres in organizational design, and a greater emphasis on quantitative and analytical techniques in planning and control. By contrast, the cultural values of East Asian society are associated with a greater emphasis on long‐term planning and on group centred decision‐making. The results are important to managers in global organizations who need to understand the cultural bases of observed differences in organizational and management planning and control practices in Anglo‐American and East Asian nations.

Organizational Leadership and Management Strategies
Job Satisfaction and Organizational Behavior
Customer Service Quality and Loyalty
Original source
Sep 3, 1994·Algorithms and combinatorics
14 cites
Probabilistic Proof Systems

Oded Goldreich

A proof is whatever convinces me. Shimon Even (1935–2004) The glory attached to the creativity involved in finding proofs makes us forget that it is the less glorified process of verification that gives proofs their value. Conceptually speaking, proofs are secondary to the verification process, whereas technically speaking, proof systems are defined in terms of their verification procedures. The notion of a verification procedure presumes the notion of computation and furthermore the notion of efficient computation. This implicit stipulation is made explicit in the definition of NP , where efficient computation is associated with deterministic polynomial-time algorithms. However, as argued next, we can gain a lot if we are willing to take a somewhat non-traditional step and allow probabilistic verification procedures. In this chapter, we shall study three types of probabilistic proof systems, called interactive proofs, zero-knowledge proofs , and probabilistic checkable proofs . In each of these three cases, we shall present fascinating results that cannot be obtained when considering the analogous deterministic proof systems. Summary: The association of efficient procedures with deterministic polynomial-time procedures is the basis for viewing NP-proof systems as the canonical formulation of proof systems (with efficient verification procedures). Allowing probabilistic verification procedures and, moreover, ruling by statistical evidence gives rise to various types of probabilistic proof systems. Indeed, these probabilistic proof systems carry a probability of error (which is explicitly bounded and can be reduced by successive applications of the proof system), yet they offer various advantages over the traditional (deterministic and errorless) proof systems. [
]

Open access
4 source records
Logic, Reasoning, and Knowledge
Semantic Web and Ontologies
Advanced Database Systems and Queries
Original source
Sep 1, 1994·Psychology of Women Quarterly
80 cites
The Long-Term Impact Of Women's Studies on Students' Personal Lives and Political Activism

Jayne E. Stake, Suzanna Rose

Stake, Roades, Rose, Ellis, and West (1994) reported that women's studies classes led to more feminist activism and greater personal course-related changes than nonwomen's studies classes. The present study tested the durability of the positive changes observed in women studies students 9 months following the last week of class. Comparisons between students who participated at follow-up (26.3%) and students who did not participate indicated that the follow-up participants were representative of all students who completed the courses. In the follow-up sample, class impact reported in the last week of class was sustained at follow-up. Women's studies students continued to report substantial changes in their interactions with others and willingness to adopt new roles and behaviors. Ratings of positive effects were significantly higher than ratings of negative effects ( p

Sep 1, 1994·Canadian Geographies / Géographies canadiennes
12 cites
LA DÉCENTRALISATION DES SERVICES SUPÉRIEURS DANS LA RÉGION MÉTROPOLITAINE DE MONTRÉAL, 1981–1989

William J. Coffey, Réjean Drolet

Certaines activitĂ©s tertiaires ont la capacitĂ© de jouer un role de ‘moteur’économique. Ces activitĂ©s du ‘tertiaire moteur,’ ou ‘services supĂ©rieurs,’ constituent une partie importante de la base Ă©conomique des rĂ©gions mĂ©tropolitaines. RĂ©cemment, aux États‐Unis, des chercheurs ont commencéà remarquer la tendance de ces activitĂšs Ă  quitter leur ‘habitat naturel’ dans le centre d'affaires des grandes villes pour se relocaliser dans des ‘edge cities’ ou ‘magnet areas’ vers la pĂ©riphĂ©rie de la zone mĂ©tropolitaine. Le but principal de cet article est de vĂ©rifier si la rĂ©gion mĂ©tropolitaine de MontrĂ©al se caractĂ©rise, elle aussi, par des tendances semblables de dĂ©centralisation des services supĂ©rieurs. Nous utilisons la base de donnĂ©es longitudinales sur les entreprises canadiennes de Statistique Canada pour examiner la question de la dĂ©centralisation de ces activitĂ©s dans la rĂ©gion montrĂ©alaise. Nos rĂ©sultats indiquent que pour 11 des 17 secteurs d'activitĂ© compris dans les services supĂ©rieurs, la pĂ©riode 1981–1989 a vu un transfert du poids relatif de la ville de MontrĂ©al vers les deux couronnes pĂ©riphĂ©riques de la rĂ©gion mĂ©tropolitaine. Ce transfert Ă©tĂ© plus fort dans les services financiers, d'assurances et d'affaires immobiliĂšres que dans les services aux entreprises. Certain service activities have the capacity to play the role of a ‘motor’ of economic development. These ‘hight‐order services’ now form one of the principal components of the economic base of metropolitan areas. Recently, researchers in the U.S. have begun to notice a new propensity for these activities to leave their ‘natural habitat’ in the downtown business district of large cities and to relocate in ‘edge cities’ or ‘magnet areas’ toward the periphery of the metropolitan region. The purpose of this article is to verify if the Montreal metropolitan region is characterized by similar patterns of spatial decentralization of high‐order services. Our study uses Statistic Canada's Longitudinal Database on Businesses in the Canadian Economy to examine this issue. Our results indicate that for the period 1981‐1989, 11 of 17 high‐order service sectors were marked by a relative shift from the City of Montreal towards the periphery of the metropolitan area. This shift was more pronounced for the finance, insurance, and real estate group than for the business service group.

Urbanization and City Planning
Regional Economics and Spatial Analysis
Urban Transport and Accessibility
Original source
Sep 1, 1994·Environment and Planning C Government and Policy
14 cites
Local Finance and Economic Reform in Eastern Europe

Richard M. Bird, Christine Wallich

Extensive decentralization, both political and fiscal, is taking place in many of the countries newly emerging from behind the socialist veil. Decentralization represents both a reaction from below to the previously tight political control from the center and an attempt from above to further the privatization of the economy and to relieve the strained fiscal situation of the central government. Although there are of course many variations in this process from country to country, some important common elements arise from the similar institutional starting point in all countries and the common transitional problems most of them are facing. The on-going reforms of subnational finance in the transitional economies are more important than seems generally to be recognized. The design of a well-functioning intergovernmental fiscal system is key to many of the major reform goals of the transition economies—macroeconomic stability, privatization, and the social safety net.

Local Government Finance and Decentralization
Economic and Fiscal Studies
Fiscal Policies and Political Economy
Original source
Jul 28, 1994·Cambridge University Press eBooks
27 cites
Dessins from a geometric point of view

Jean-Marc Couveignes, Louis Granboulan

In this paper we study the topological aspects of dessins (via analytic description) with two distinct goals. Firstly we are interested in fields of definition and fields of moduli. We give a topological proof that there exist some dessins with no model defined over their field of moduli. This answers explicitly a question asked in [Har87]. Our second motivation is to collect practical and theoretical data for the explicit computation of covers given by some topological description, following ideas of Atkin [ASD71] Oesterlé and ourselves. This leads to a method for the computation of the linear space associated to a divisor on a given dessin. Introduction This paper develops some practical applications of the archimedean analytic description of coverings through Puiseux series. In the second section, we recall a classical result due to Klein concerning the classification of genus zero Galois coverings, and related to the classification of regular polytopes. In the third section we give a review of many possible definitions of what a moduli field is. We do not claim to exhaust the list of various contradictory notions denoted by these words, but simply to avoid the frequent confusion about it. The fourth section is an illustration of what knowledge can be provided by local considerations at infinity. We show that such a study leads to interesting examples of coverings with strange rationality properties, which we can state by mere combinatorial considerations.

Homotopy and Cohomology in Algebraic Topology
Algebraic Geometry and Number Theory
Advanced Topology and Set Theory
Original source
Jul 1, 1994·RePEc: Research Papers in Economics
2 cites
Restructuring Rural Financial Institutions

Basu Shyamal K

This paper first identifies major proposals being considered now for restructuring rural financial institutions (RFIs). It then discusses main reasons which may have prompted these proposals. These are (1) inefficiencies of multi-agency approach, (2) dependency of RFIs, (3) autonomy of RFIs (in regard to reserve requirements, priority sector lending, loan appraisal, monitoring and recovery, and interest rates), and (4) explicit and implicit viability of RFIs. Various proposals are evaluated to find out whether they are suitable or not and if not, what alternatives are required to tackle the problems of RFIs. Based on this the paper shows that neither the upward revision in lending rates nor these restructuring proposals are required for improving viability of RFIs. An alternative proposal of restructuring RFIs is then suggested. This proposal discusses six strategic organizational principles of developing RFIs. These are (1) encouraging multiple institutions, (2) promoting appropriate forms of organization, (3) achieving vertically integrated organizational structure, (4) developing suitable density of field-offices, (5) enlarging reach or coverage of rural clients, and (6) accelerating diversified and multiple functions. Both systemic and procedural macro and micro innovations that stress the process aspect of institutional development are outlined. This restructuring proposal emphasizes the mission of decentralized institutional development of RFIs. Its vision is diversified, multiple and joint-products oriented rural banking that is autonomous but accountable. And it has a potential to make RFIs more viable and agricultural and rural growth-oriented.

Microfinance and Financial Inclusion
Original source
Jun 12, 1994·Proceedings of IEEE Workshop on Fault-Tolerant Parallel and Distributed Systems
46 cites
DEFINE: a distributed fault injection and monitoring environment

Wei-Lun Kao, R.K. Iyer

This paper presents a distributed fault injection and monitoring environment (DEFINE) as a tool to evaluate system dependability, to investigate fault propagation, and to validate fault-tolerant mechanisms. DEFINE can inject both hardware faults (hardware-induced software errors) and software faults into any process running in a distributed system, either in user mode or in supervisor mode, and monitor the fault impact and propagation in software systems and among machines. It employs two fault injection techniques: (i) using hardware clock interrupts to control the time of fault injection and activation, and (ii) using software traps to inject all the faults except communication faults and memory faults in the data/stack segment. Experiments on six Sun SPARCstations to study the system behavior under faults are conducted to demonstrate the application of DEFINE.

Radiation Effects in Electronics
Distributed systems and fault tolerance
Software System Performance and Reliability
Original source
May 2, 1994·Offshore Technology Conference
1 cites
Pile-Driven Plate Anchors For Fleet Moorings

Lora Bowman, J. B. Forrest, Robert J. Taylor, Bill Seelig

ABSTRACT A means of providing high efficiency driven plate anchors to satisfy Naval requirements for hurricane moorings in congested, confined or complex seafloor areas is under development. Driven plate anchors resist loading in any direction, including uplift, and offer extremely high holding capacity to size ratios. Where space is limited and drag or clump anchors or stake piles are unsuitable, small, inexpensive plate anchor configurations can provide very large holding capacities and be installed with readily available marine equipment. Driven plate anchors can be fabricated from common structural steel configurations and materials. Anchor installation is achieved by attaching the plate anchor to a structural member, called a follower, and driving it vertically into the seafloor using standard pile driving techniques. The follower is retrieved and the anchor is then loaded to properly position it in the seafloor and verify it's capacity. This paper describes plate anchor theory, installation techniques and the results of proof tests in a number of different seafloor soils. These include soft organic silts, over-consolidated clays, dense sands, glaciated soils and corals. Also included is a brief overview of completed installations and a design guide currently in development by the Navy. INTRODUCTION Downsizing of the Fleet is taxing the Navy's ability to provide secure moorings for the Inactive Fleet. These moorings must be designed for hurricane conditions, and often occur in congested areas and at sites with complex seafloor conditions. Conventional drag and pile anchors are either unsuitable for the site conditions or are extremely expensive. In light of today's shrinking economy and the urgent need to provide new moorings, technology for designing and installing simple plate anchors using common pile driving equipment and marine gear is being developed by the Navy. The technology is proven through many mooring installations, resulting in substantial savings to the Navy. Plate anchors installed using standard pile driving techniques (Pile-Driven Plate Anchors) provide an alternative to conventional anchors that can be used today by the offshore industry. This report is an effort to introduce this new technology to the Offshore Industry. PLATE ANCHOR THEORY Plate anchors are driven into the seafloor with the plate parallel to the direction of driving and then rotated or "keyed" by pulling on the anchor line (Figure 1). The anchor is connected to a structural member called a follower and driven vertically into the seafloor using a pile-driving hammer. The follower is retrieved and the anchor is proof loaded. This can be accomplished either vertically from the installation platform immediately after installation or later by pulling horizontally against another anchor leg. The proofing process keys or rotates the anchor plate to a more resistive position, near-normal to the loading direction. Fig. 1- Driven plate anchor - concept of operation.(Available in full paper) Current techniques for determining the holding capacity of plate anchors have been adapted from conventional foundation design practice. For cohesionless soils (c = O), static anchor holding capacity, F, can be determined by the simplified relationship. (Available in full paper)

Wave and Wind Energy Systems
Engineering Structural Analysis Methods
Original source
May 1, 1994·Psychiatric Services
11 cites
Shifting the Responsibility for Payment for State Hospital Services to Community Mental Health Agencies

Brian J. Cuffel, David Wait, Tom Head

OBJECTIVE: In 1990 the state of Arkansas shifted financial responsibility for state hospital services to community mental health centers; through a policy known as "bed buy-back," centers now authorize all state hospital admissions and prospectively purchase bed days for their patients. Characteristics of patients hospitalized before and after implementation of the policy were examined to determine how the policy affected hospital admission rates, types of patients admitted, and the amount of contact between CMHC and hospital staff about admitted patients, as well as how these elements were affected differently in rural and urban areas. METHODS: Changes in the types of patients admitted over the 13 months before and 14 months after the change in financing were studied through retrospective chart review of 648 patients. Administrative data were used to examine changes in numbers of admissions for 30 months before and 26 months afterward. Data were analyzed by piecewise regression, least-squares, and logistic regression analyses. RESULTS: After financial decentralization, state hospital use was reduced in both urban and rural areas, although the reduction in urban areas was proportionally greater. Contrary to expectation, admissions were not limited to the most severely ill, disruptive, or substance-abusing patients, nor were they more likely to be readmitted. For patients who were admitted, communication between the community and the state hospital was greater than before financial decentralization. CONCLUSIONS: Shifting financial responsibility for patient care significantly reduced state hospital use, did not affect patient mix, and apparently increased coordination of care between community and hospital. Whether bed buy-back has affected the kind or quality of services delivered in the community awaits further study.

Healthcare Policy and Management
Primary Care and Health Outcomes
Emergency and Acute Care Studies
Original source
May 1, 1994·Romanic Review
1 cites
Changing Places: Marguerite Porete, Meister Eckhard and the Question of Perspective

Catharine Randall

I. Readings of Porete: Past and Present Marguerite Porete's critics, ecclesiastical and legal authorities in the main, adamantly misread her work. They took passages out of context, fracturing the unity of her work and distorting her confessional perspective. They then declared both her and her work to be heretical. Ultimately, they burned her, along with her book, at the stake. Such misinterpretation obviously abuses both Porete's theological import and her literary expertise. Similarly, modern assessments of Porete's work differ, either admitting to a sense of defeat before the disparate composition of her text Le Miroir des ames simples et aneanties, or asserting thematics based on the examination merely of a part of a whole. Peter Dronke and Robert Cottrell have performed the most provocative readings of Porete's work in recent years. Dronke postulates the significance of an emergent (and, to my mind, acontextual) feminism arising from incidents of what he calls in Le Miroir. He finds that Marguerite expresses personal concerns through the eruption of poetry embedded in prose: Marguerite... uses a 'bound' form... The canzone is her prologue, her first 'manifesto'; the rondeau comes near the close, and is perhaps the most effective crystallization of her thoughts. The other lyrical passages occur at high points, at the most climatic moments [This shows] a greatly increased subjectivity.(1) While such an interpretation importantly lobbies for a notion of 'selfhood' in her work, it does not grapple with the theological issues which so clearly motivate the construction of Porete's text. Robert Cottrell develops a sophisticated Lacanian reading of Le Miroir, taking as his emblem for the interpretive process an introductory allegorical incident. Porete describes a maiden yearning for her far-away lover. Attempting to capture his image and bring him closer, she commissions a painting. Through the contemplation of this painting, she not only succeeds in representing her lover, she actually effects his presence. Referring to the 'mirror stage,' Cottrell talks about the apprehension of the 'other.' Once totality with the 'other' is achieved, voice is extraneous; speech subsides into a non-Logos. Cottrell examines the structure of language in Porete, demonstrating that it enacts a form of linguistic via negativa. While Dronke spoke of selfhood, Cottrell obviates personal intervention in the text. He cites Porete: ... cette parole depasse nos ecritures, si bien que nous ne pouvons pas [la] comprendre.(2) Cottrell's stimulating study, however, still skims the surface of theological concerns. The theological dimension of the text is everywhere present, yet incessantly eludes critical focus.(3) Significantly, Marguerite Porete sent the first copies of Le Miroir to clerics and to the Bishop of Chalons-sur-Marne. The proof that a theological interpretation lies at the crux of her textual production is the irony that her self-selected readership should turn inquisitorial; they take her word as a confessional statement embodying distortion and heresy. Marguerite was called before the inquisitorial tribunal of Haute Lorraine, then remanded to the Inquisition in Paris; on May 30,1310 she was publicly burned. Her theological perspective was judged derivative of the teachings of Meister Eckhard, themselves labelled heretical in 1311, and also deemed representative of teachings of the heretical sect of the Free Spirits.(4) II. Theological Parameters One way to try to come to terms with the theological component of Porete's work is to examine traditional doctrine, applying it as an interpretive grid outlining the parameters which her work exceeds. My contention is that rather than producing an heretical document, Porete in fact entered into a prolonged and thoughtful dialogue with church doctrine, exercising literary techniques to illustrate, empower, and sometimes, to expand, traditional theological positions. 


Renaissance Literature and Culture
Medieval European Literature and History
Original source
Apr 30, 1994·BMJ
3 cites
Bad genes

T. Greenhalgh

<h3>ABSTRACT</h3> <h3>Introduction:</h3> Several countries have adopted integrated community case management (iCCM) as a strategy for improved health service delivery in areas with poor health facility coverage. Early implementation of iCCM is often run by nongovernmental organizations financed by donors through projects. Such projects risk failure to transition into programs run by the local health system upon project closure. Engagement of subnational health authorities such as district health teams (DHTs) is essential for a smooth transition. <h3>Methods:</h3> We used a repeated qualitative study design to assess the readiness of and progress made by DHTs in institutionalizing iCCM into the functions of locally decentralized health systems in 9 western Uganda districts. Readiness data were derived from structured group interviews with DHTs before iCCM policy adoption in 2010 and again in 2015. Progressive institutionalization achievements were assessed through key informant interviews with targeted DHT members and local government district planners in the same areas. <h3>Findings:</h3> In the readiness study, DHTs expressed commitment to institutionalize iCCM into the local health system through the development of district-specific iCCM activity work plans and budgets. The DHTs further suggested that they would implement district-led training, motivation, and supervision of community health workers; procurement of iCCM medicines and supplies; and advocacy activities for inclusion of iCCM indicators into the national health information systems. After iCCM policy adoption, follow-up study data findings showed that iCCM was largely not institutionalized into the local district health system functions. The poor institutionalization was attributed to lack of stewardship on how to transition from externally supported implementation to district-led programming, conflicting guidelines on community distribution of medicines, poor community-level accountability systems, and limited decision-making autonomy at the district level. <h3>Conclusion:</h3> Successful institutionalization of iCCM requires local ownership with increased coordination and cooperation among governmental and nongovernmental actors at both the national and district levels.

Global Maternal and Child Health
Healthcare Systems and Reforms
Global Public Health Policies and Epidemiology
Original source