Locally led adaptation recognizes that people closest to the effects of climate change, especially those facing structural marginalization, require the financing and decision-making power to ensure that adaptation investments reflect their priorities. Supporters of locally led adaptation can leverage monitoring, evaluation, and learning (MEL) processes to balance power, promote mutual accountability, elevate local knowledge and priorities, and create value for local actors. This paper recommends a systemic shift toward MEL that is locally led, context-aware, and itself adaptive. It provides steps throughout the MEL cycle and specific approaches, methods and tools that promote local agency in the interest of more effective and equitable locally led adaptation interventions. It builds on the recommendations of the Global Commission on Adaptation to increase decentralization of adaptation finance to the local level, and aims to support implementation of the eight Principles for Locally Led Adaptation that were developed for the Commission.
Decentralized finance has evolved as a major contender for traditional banking systems over the last few years. Evolution in blockchain and cryptography technologies are the driving forces for decentralized financeâs growth. The emergence of Bitcoin in the finance system was a major driving force toward the tremendous growth of decentralized finance. However, with various platforms merging every day, the decentralized finance sector is still in its early, unorganized stages. The current decentralized finance market is chaotic. With a new âcoinâ being introduced almost every month, standardization is highly lacking in the system. DeFi already has several different applications available. For instance, one can purchase stable coins, or assets pegged to a national currency, on decentralized exchanges, move the assets to a lending platform that is also decentralized to earn interest, and then add the interest-earning instruments to a decentralized liquidity pool or an on-chain investment fund. DeFi enterprises frequently aim at decentralized decision-making, or governance, in everything from the user fees to the products they provide. A decentralized program may be started by one person or a small number of individuals, but as the project gathers traction, its leaders frequently try to step down and cede control to the user base. A decentralized autonomous organization that has its rules and regulations written into computer code and that may issue governance tokens, which allow its holders a voice in decisions rather than allowing the decision-making to a centralized government authority as in case of traditional finance, could represent this transition. While on one side, world governments are still trying to grasp and regulate the sector, on the other side, the technologyâs reach has been very limited. Undoubtedly, the emergence of blockchain-based decentralized finance is massively influencing our current finance technology industry. In this chapter, we discuss the current growth in the FinTech industry and the blockchain-based decentralized finance sector. Furthermore, we discuss how decentralized finance can be used in the current FinTech industry.
Abstract Externalised service provision is now an embedded feature of Australia's service delivery architecture. However, the lessons drawn from two decades of contracted service delivery suggest that âcompetitionâ is an imperfect platform for the delivery of public services, especially where issues of trust in government come into play. Could the concept of a âsocial license to operateâ (SLO), which has been in use in the natural resources sector for over two decades, help to facilitate the conferral of greater trust, credibility and legitimacy upon governments, and externalised service providers in social policy spaces?
Gibraltar foundations have attracted a lot of interest in the charitable and financial services areas, most notably in the distributed ledger (or blockchain) technology (DLT) and initial coin offering space. Gibraltar is one of the first jurisdictions to embrace DLT technology and the financial services activity it has generated, whilst recognizing the risks inherent in those activities and moving to legislate against them. Given the combination of the interest recently generated in these areas, and the suitability of the Gibraltar foundation as a vehicle through which to engage in these activities, it is of little surprise that Gibraltar foundations are attracting an increasing amount of attention and interest.
Declining reimbursement and financial incentives connected to quality and patient satisfaction outcomes are making finance a language requirement for every future nurse manager. If nurse leaders want to continue to have a seat at the strategic table and remain influential advocates in future healthcare decisions, they must become fluent in the language of finance. Finance as a second language The ability to be conversant in the language of finance is beginning to emerge in the clinical arena. One author highlights how a chief nurse executive's innovation in instilling financial awareness and accountability led to her staff having a broader perspective of the organization. She found this knowledge helped to take some of the emotion out of the budget process. The awareness of finance combined with the development of unique relationships among staffâa shared orientation about money and choiceâcontributed to the department saving $4.9 million in productivity while saving $7.6 million in reduced turnover costs.1 Financial knowledge is a concern of the American Nurses Association (ANA) and the Institute of Medicine (IOM).2,3 The 2010 IOM report suggests that RNs have a responsibility to become active participants in shaping healthcare and managing resources. The ANA's standard of âresource utilizationâ suggests that all RNs need to identify consumer care needs, the potential for harm, the complexity of the task, and the desired outcome when evaluating resource allocations. The first step to accomplish this goal is for nurses to understand the financial priorities behind healthcare business decisions. Finance is also a vital knowledge competency for graduate-level prepared specialty nurses and advanced practice RNs. These competencies suggest nurses need to use resources effectively and maintain quality design evaluation strategies that demonstrate cost-effectiveness, cost-benefit, and efficiency factors associated with nursing practice.3 It's clear that those establishing the profession's nursing practice standards expect nurses to maintain a strong advocacy role for their units, workspaces, and, most importantly, future patient needs. This requires nurses to actively pursue, understand, and be conversant in finance. Key financial definitions Languages don't come easy for most people, and the language of finance is no different. Although adventuresome nurse managers have a few guidebook phrases to navigate the landscape of budgets, variances, and staffing ratios, the future requires nurse leaders to more fully engage in the conversation of finance. Learning the financial language begins with understanding key words and definitions. Budget The operating budget tracks expected revenues and the related expenses that generate a bottom line (revenues minus expenses). Net income/loss is the money left after subtracting revenues and expenses. You can have a net loss on a unit and yet still have an overall net income if another unit makes more money than the first unit's losses. Budget variance is the difference between the expected budget (such as expense, revenue, number of patients, and number of exams) and the actual numbers, which may vary from month to month. Variance indicates whether adjustments to staff or supplies are necessary. Monitoring this number helps staff members understand the flexible nature of their units. A variance alerts the manager that there may need to be immediate adjustments to staffing to offset the loss of revenue that comes with not having the expected number of patients. Revenue Gross charges/revenue is the amount an organization/unit bills its patients if they paid in full for those charges. Being aware of this number helps nurses understand the revenue generated by their unit. Knowing that most patients don't pay full charges due to contractual discounts with Medicare, Medicaid, and insurance companies helps staff become more sensitive to expenses and operational efficiencies. What remains after subtracting total expenses from the collected revenues is the net revenue. This number is similar to the remaining amount of your paycheck after taxes. The point at which total revenues (organization or unit) equal total costs is called breakeven. This is when the money coming in equals the expenses to provide services on the specific unit. The revenue derived from joint ventures or services provided outside the scope of normal operations (such as durable medical equipment) is call nonoperating revenue. Although not a major source of income, this source is growing as hospitals begin to decentralize, diversify, and spin off certain self-contained ventures in search of additional revenue. The operating margin or product margin is the amount of money a service contributes to covering all its operating costs (after subtracting fixed costs). This metric monitors the total costs associated with providing the specific service. It helps assess if the unit is contributing to the financial mission, and it's also useful in evaluating operational efficiency. Costs Cost per stay is the amount of expenses generated from an individual patient stay. Knowing the cost per stay helps staff understand how supplies and other items contribute to the cost of treating a patient. The average cost per stay indicator verifies whether a unit is in line with the costs of delivering that specific care in a best practice benchmark hospital. The cost per stay/day includes fixed costsâexpenses that continue even if a building, bed, or piece of equipment isn't used. Those costs continue even if there are no patients. Variable costs are expenses that fluctuate with use. Food, medications, supplies, and even staff are often considered variable costs. Additional patients require more food, medications, and staff. Variable costs increase or decrease with the census. Fixed and variable costs are averaged together to get a cost per stay and cost per day, which is benchmarked with best practice facilities/units. As nurse managers become more accountable for these costs, as well as clinical outcomes, you'll learn how these fluctuations affect not only patient care, but also the financial health of the organization. Market share The financial health of any organization requires sufficient market shareâthe percentage of total procedures/admissions for a specific diagnosis that the hospital or unit has in comparison with competitors. For example, if there are 100 cardiac surgeries performed in the market and one facility provides 20, that facility would have a 20% market share. It's important to know the trends of market share data. If over the last 3 to 5 years the number is trending up, it suggests a positive benefit provided that the net revenue (after expenses) is positive. If the trend is a reduction in market share, it invariably means tighter budgets for those units not generating adequate revenue. Payor mix How do we project or know if our net revenue could go up? One way is to monitor and manage the hospital and unit payor mixâthe percentage breakdown of the revenue received from all payor sources. Having a balanced payor mix is crucial for the survival of any health facility. Many healthcare facilities contract with several insurance companies providing discounts for their services. Those contracts often have a different discount rate for each company; for example, reimbursements collected from Medicare, Medicaid, individual commercial insurance carriers, and self-pay patients. Although the facility attempts to maximize reimbursement, the insurance company attempts to minimize its outlay for services rendered. Knowing the payor mix, in combination with market share trends, can help nurses understand the revenue trends of their unit. This means that as their fluency increases, they become better at communicating their resource needs. This knowledge is especially relevant in a struggling economy with declining reimbursements and a growing number of people without access to insurance. Staffing Hours per patient day (HPPD) is the total amount of nursing time spent to care for a single patient in a 24-hours period. Monitoring this ratio allows management and staff to know if a unit is over- or understaffed compared with past activity and relevant best practice benchmarks. The ratio helps managers understand overall nursing costs and patient cost per day/discharge, and is often used to evaluate the efficiency of existing care structures. Although HPPD remains a staple for staffing determination, its exclusive use was being questioned more than 20 years ago.4 The financially fluent nurse manager in the 21st century must know HPPD, but must also become familiar with a number of other financial metrics. Relying only on HPPD is akin to having only four or five standard phrases to navigate a foreign countryâit restricts the conversation. It has been suggested that nurse leaders use HPPD in combination with salary expenses per patient day (SEPPD).5 In combination, SEPPD and HPPD deepen the awareness of not only how many people are needed to care for patients, but also what it costs to provide that care. Integrating financial knowledge into the clinical arena has been a long, arduous journey. In the last 20 years, the attitude has shifted from denial or grudging acceptance to fully embracing the value of financial knowledge as more nursing schools include it in their curricula. Older nurse leaders who are self-taught in the language of finance are at the forefront of exploring additional financial metrics, including on-unit financial dashboards and balanced scorecards that link with clinical indicators. Enrich the conversation By choosing to learn the financial vocabulary, leaders begin the process of building a common language, bridging the current language gap between nursing and finance. By integrating key financial measures into clinical dashboards, nurse leaders create additional tools for proactively managing their units. This knowledge enriches the conversation between nurses and the C-suite (CEO, CFO, CNO, CMO), allowing nurses to better advocate for their units, workspaces, and patient needs. Future nurse leaders can expect to monitor a wider array of financial indicators and by speaking the language of finance, they can remain at the center of conversations about the strategic direction of their organization.
Regina Birner, Kristin Davis, John Pender, Ephraim Nkonya · 11 authors
The article provides a conceptual framework and discusses research methods for analyzing pluralistic agricultural advisory services. The framework can also assist policy-makers in identifying reform options. It addresses the following question: Which forms of providing and financing agricultural advisory services work best in which situation? The framework âdisentanglesâ agricultural advisory services by distinguishing between (1) governance structures, (2) capacity, (3) management, and (4) advisory methods. The framework suggests an impact chain approach to analyze the performance and impact of agricultural advisory services and discusses theoretical and empirical research methods that can be used when applying the framework. The framework shows that reforms of agricultural advisory services can combine different reform elementsâsuch as decentralization, contracting out, using new advisory methods, and changing the management styleâin different ways so as to best fit local circumstances. Using a New Institutional Economics approach (transaction costs approach), the article shows that the following sets of contextual factors need to be considered in this regard: the policy environment; the capacity of potential service providers; the type of production systems and market access of farm households; and the characteristics of local communities. The framework can be used to develop assessment tools for agricultural advisory services, to inform processes of reforming of agricultural advisory services and to guide inter-disciplinary research. The framework is unique in combining the insights from different disciplines, which have, so far, been treated separately in the literature. The framework can help policy-makers and analysts to move from âideologicalâ discussions on reform models to an evidence-based âbest fitâ approach.
Abstract Higher education participation in Ethiopia is very low (about 1.5 per cent) and is the major source of the critical shortage of educated and skilled human resource. The higher education system in Ethiopia is moving away from exclusive and dismally low enrolments towards increasing participation. To expand access, to redress inequitable subsidies by taxpayers to a small proportion of the age cohort and to diversify revenue the introduction of cost sharing is necessitated to supplement public finance. Cost sharing serves as an alternative nonâgovernmental source supplementing revenue opening more opportunities and making students responsible citizens and customers. It also has a profound effect on improving the management and academic efficiency of the higher education institutions. In the expanding system, covering the full tuition and food and room cost for a small proportion of the age cohort from the taxpayersâ money is inappropriate and inequitable distribution of resources. A significant number of students are enrolled in feeâpaying programs in public and private institutions. A modified model of the Australian type Graduate Tax, as a more attractive, simple and manageable scheme is adopted in the Ethiopian higher education landscape. The scheme is expected to ensure equitable access to students of any background, as there is no need to stipulate income of parents to arrive at the repayment amounts. Immediate removal of all subsidies to food and room, calculating appropriate tuition fees and costs, provision of every citizen a tax identification number (TIN) and decentralization and strengthening the tax collection and information system are essential for successful implementation of cost sharing in Ethiopia. These improvements enhance the confidence of both public and university community and improves cost recovery.
This publication, Who has the yam and who has the knife, seeks to illustrate and address the creative tension needed to ensure an equitable distribution of power over the development process, by examining how putting the yam (resources) and the knife (the Financing Agreement) in the hands of the central, and district bureaucracies, and communities respectively can contribute to democratic decentralization. Three Social Action Funds (SAFs) in Africa are examined in this regard - in Malawi, Tanzania and Uganda. The Community Sub-project Cycle (CPSC), an integral part of the SAFs, is analyzed to show how a demand-driven process with in-built mutual accountability can result in communities realizing their aspirations while remaining accountable to government, and vice versa. The more formal way of capturing the issue would be to ask if governance can be broadened and deepened so that community needs become an intrinsic and measurable part of district and national plans. This"party line"on decentralization is that it is, in general, the way to go - all hindrances to it must be addressed and removed. The question that is very rarely asked is - how does this square with some of the Bank's other dominating approaches, such as Community-Driven Development ? This publication, based on experience from the field, outlines and responds to the challenges posed by this"dual"development. By putting some flesh on the bones of the"party line, "it provokes the intelligence without insulting it, and tells us that often, the real"poverty"is that of ideas and vision.
States and municipalities have privatized services in an effort to improve their costâeffectiveness and quality. Competition provides the logical foundation for an expectation of cost savings and quality improvements, but competition does not exist in many local marketplacesâespecially in the social services, where governments contract primarily with nonprofit organizations. As government increases its use of contracting, it simultaneously reduces its own publicâmanagement capacity, imperiling its ability to be a smart buyer of contracted goods and services. This article examines two questions about the privatization of social services based on interviews conducted with public and nonprofit managers in New York state: Does social services contracting exist in a competitive environment? And do county governments have enough publicâmanagement capacity to contract effectively for social services? The findings suggest an absence of competition and publicâmanagement capacity, raising the question of why governments contract when these conditions are not met.