Cost-utility assessment: Planning with local decisionmakers in developing countries

In the past decade countries and donor agencies have endorsed health policies which (1) give a very broad definition of health, (2) see the pursuit of health as part of the development process, and (3) emphasize the local community's and local decision-maker's participation in the planning of health projects. Despite these broad principles, health delivery systems in developing countries have access to a very limited set of resources. Health planners are faced with the dilemma of creating cost-effective programmes while recognizing the need to take into account the broad definition of health and the importance of local participation in planning. This dilemma has led to a division between those planners who put greater emphasis on the use of cost analysis techniques in which the decision-making process rests more with professional planners (often outside consultants) vs those who emphasize greater local control of the decision-making process. The purpose of this paper is to present a study in which two alternative approaches to cost utility analysis were used. Consideration was given both to the actual cost analysis strategy and to the integration of the cost variable into the total decision-making process. Finally, major emphasis was placed on including local decision-makers in the planning process and providing them with feasible and understandable decision-making tools.     

Participation and political protest: A causal model with Australian evidence

This paper examines a model of political participation and political protest that includes the several well-established modes of orthodox participation as well as a number of dimensions of political protest, and also takes account of the causal order between conventional participation and protest. The analysis indicates that previous findings demonstrating a substantial positive association between unidimensional measures of conventional and unconventional political behavior are incomplete and indeed somewhat misleading. The connection between orthodox participation and protest weakens as the style of protest becomes more unorthodox, to such an extent that none of the separate modes of conventional participation are directly related to radical protest. Using sheaf coefficients, the paper also tests the relative explanatory power of three sets of determinants of participation and protest: social background characteristics, general orientations toward politics, and attitudes toward issues. Issues are repeatedly weaker than the other two groups of variables in predicting conventional participation but have relatively strong effects on political protest, particularly compared with political orientations, while social structure is consistently influential.