International Organizations in Transfer of Infectious Diseases: Iterative Loops of Adoption, Adaptation, and Marketing

Over the past few years increasing attention has been given to the role of international organizations in the diffusion of policy ideas and promotion of particular macro-level policies. Much of the attention has been on the ideological driving forces behind such policies, and on the extent to which the policies are externally imposed. There has been limited discussion on the bread-and-butter, technical policies of international organizations, and how they devise, adopt, adapt, and then promote what come to be seen as policies of global "best practice." This paper seeks to redress this gap by looking at the process of transfer of two infectious disease policies between international and national levels. It demonstrates that international organizations play different roles in policy transfer at particular stages in the process. The paper suggests that health policy transfer is a long adaptive process, made up of several iterative loops, as research and clinical practices developed in one or more countries are adopted, adapted, and taken up by international organizations which then mobilize support for particular policies, market, and promote them. Assumptions that new ideas about policies flow "rationally" into existing decision making are challenged by the processes analyzed here. Policy transfer, given the experience of these infectious diseases policies, goes through separate, "bottom-up," research-oriented, and "top-down" marketing-oriented loops. Individuals and different configurations of networks play key roles linking these loops. In the process, complex, context-specific policies are repackaged into simplified guidelines for global best practice, leading to considerable contestation within the policy networks.     

Use of the MMPI-2 and the Inwald personality inventory to identify the personality characteristics of dropouts from a state police academy

The MMPI-2 and the Inwald Personality Inventory were employed to investigate the personality characteristics of dropouts from a state police academy. A traditional model of training borrowed from military models was used at the academy rather than a police generated model. Sensitive and independent individuals, more compatible with modern community policing methods may have rejected police work as a result of the experience. 15 academy completers and 9 dropouts were used in the sample. Analyses of the scales of the MMPI-2 and the Inwald Personality Inventory identified variables upon which the two groups differed. The hypothesis that more sensitive, empathic and independent individuals were leaving the academy appeared to be supported.     

Use of the MMPI-2 to predict the employment continuation and performance ratings of recently hired police officers

The MMPI-2 is one of the most frequently employed instruments for the selection of police officers. Serafino and Serafino (1997) collected data which involved information about employment continuation and ratings by supervisors of 32 police officers who had recently been hired and who had been given the MMPI-2 during the hiring process. In this study, the Paranoia Obvious (Pa) and Paranoia Subtle (Ps) scales proved to be the significant. Pa Subtle correlated with removal whereas Pa Obvious correlated with rating. Higher scores on Pa Subtle correlated significantly with being removed from the job, whereas low scores on the Pa Obvious correlated with higher ratings of performance by supervisors. Discussion of the results involved the fact that Subtle Pa scores would suggest paranoid tendencies not easily detected during the interview. Since most high Pa Obvious individuals would have been eliminated in the hiring process, expression of this tendency was at a low level after being hired but if present resulted in low ratings. Significant predictors were noted to be very much a function of the type of criterion variable employed in the study.     

Can ministries of health support primary health care? Some suggestions for structural reorganization and planning

Patrick Vaughan is Reader in health care epidemiology, Gill Walt is Lecturer in health policy and Anne Mills is Lecturer in health economics, at the Evaluation and Planning Centre for Health Care, London School of Hygiene and Tropical Medicine, Gower Street, London WC1, United Kingdom. A previous version of this paper was prepared for the Commonwealth Secretariat, London, for the Conference of Commonwealth Health Ministers held in Ottawa, Canada, in October 1983.     

Does a more participatory approach to reintegrating ex-combatants lead to better outcomes? Evidence from Sierra Leone and Liberia

Programmes for the disarmament, demobilisation, and reintegration (DDR) of ex-combatants are intended to support the peace process in which they are embedded. Yet their outcomes are not always clear. Calls for a more holistic approach with greater local ownership have often been made, but can be difficult to implement. This study of DDR in Sierra Leone and Liberia applies the concept of ‘participation’, which means genuinely involving intended beneficiaries in the process. It is based on semi-structured interviews with a range of stakeholders, and a survey and focus group discussions with ex-combatants. There is little indication of a participatory approach: ex-combatants reported serious problems with information, consultation and input into decision-making. However, where greater participation is seen, there are statistically significant associations with better outcomes in terms of work, economic status and community relations. The data illustrate how post-war social capital can be built up—or undermined—by the degree to which reintegration processes were participatory. Participation, social capital and loss of faith in the process are seen to be significant in the way DDR can contribute to the wider peace process.     

The Confluence of Domestic and International Interests: U.S. Policy Toward Cuba, 1998–2001

This article examines the confluence of forces at work to shape U.S. policy toward Cuba since the late 1990s. Our approach examines four key factors involved in policymaking toward Cuba in this period: (1) the entry of new interest groups into the Cuba policy process and an "entrepreneurial" Congress; (2) the executive's constitutionally based interests; (3) bureaucratic interests; and (4) pressure from outside the United States. We examine U.S.–Cuba policy by describing each determinant in isolation and then by looking at the dynamic interaction among them, showing how they are linked together. In doing so, we argue that an analysis including multiple factors better explains U.S. policy toward Cuba than one that focuses on a single factor such as the power of the Cuban-American community.     

Linking national and global population agendas: case studies from eight developing countries

This comparative study of the determinants of family planning policy initiation and implementation focuses on four pairs of countries: Zambia/Zimbabwe, Algeria/Tunisia, Pakistan/Bangladesh, and Philippines/Thailand. The conclusion is drawn that global efforts had an influence on national policy makers and on putting family planning issues on the policy agenda. Global impacts were affected by national economic and social conditions and the broader political and economic relations with Western countries. The absolute level of economic development was found to be unrelated to the timing of initiation of family planning on national policy agendas. Stronger national family planning programs occurred in countries where policy makers linked economic development at whatever level with the need to limit population growth. Pakistan and Thailand in the 1960s illustrated this commitment to family planning programs, and Zambia and Algeria illustrated the lack of connection between development and population growth at the policy level and the lack of family planning on the policy agenda. Affiliation with the West during the 1960s meant early initiation of family planning in Pakistan/Bangladesh and Philippines/Thailand. Stronger commitment to program implementation occurred only in Thailand during the 1970s and Zimbabwe during the 1980s. Commitment lessened in the Philippines and Pakistan. Program implementation and national support of family planning were viewed as also dependent upon domestic factors, such as sufficient resources. Algeria/Tunisia and Zambia/Zimbabwe were countries that promoted family planning only after national political ideology shifted and anti-imperialist sentiments subsided. The impact of the international Cairo conference on these countries was minimal in terms of policy change. Most of the countries however desired greater support from donors. Even objections from the Vatican and internal domestic pressures were insufficient to prevent countries such as the Philippines and Pakistan from supporting the Cairo Plan of Action and a family planning and reproductive health agenda. Bangladesh and Pakistan are given as examples of countries where differences in the focus of foreign aid impacted on the national support for social services.     

Death in birth

The number of women in poor countries who die in childbirth has barely changed in two decades--and this despite a host of medical breakthroughs. How can the incidence of this devastating human tragedy be reduced?