BUREAUCRATS AS PURCHASERS OF HEALTH SERVICES: LIMITATIONS OF THE PUBLIC SECTOR FOR CONTRACTING

Contracting out of health services increasingly involves a new role for governments as purchasers of services. To date, emphasis has been on contractual outcomes and the contracting process, which may benefit from improvements in developing countries, has been understudied. This article uses evidence from wide scale NGO contracting in Pakistan and examines the performance of government purchasers in managing the contracting process; draws comparisons with NGO managed contracting; and identifies purchaser skills needed for contracting NGOs. We found that the contracting process is complex and government purchasers struggled to manage the contracting process despite the provision of well‐designed contracts and guidelines. Weaknesses were seen in three areas: (i) poor capacity for managing tendering; (ii) weak public sector governance resulting in slow processes, low interest and rent seeking pressures; and (iii) mistrust between government and the NGO sector. In comparison parallel contracting ventures managed by large NGOs generally resulted in faster implementation, closer contractual relationships, drew wider participation of NGOs and often provided technical support. Our findings do not dilute the importance of government in contracting but front the case for an independent purchasing agency, for example an experienced NGO, to manage public sector contracts for community based services with the government role instead being one of larger oversight. Copyright © 2011 John Wiley & Sons, Ltd.     

Audience Costs and Interstate Crises: An Empirical Assessment of Fearon's Model of Dispute Outcomes

In a recent article, James Fearon advances an innovative approach to the study of interstate crises. He adds to the traditional view (that crisis outcomes are influenced by the balance of capability and the balance of resolve) the notion that domestic political audiences exert a strong influence over which state in a crisis is likely to achieve a successful outcome. His game-theoretic analysis yields a number of interesting hypotheses, which are tested in this study using data on militarized disputes, the structure of polities, and national capability. In general the results strongly support Fearon's model, though we find that relative national capabilities do tend to affect the outcomes of crises. This study highlights the importance of combining formal models of political events with large-N empirical tests.     

Fatal brodifacoum rodenticide poisoning: autopsy and toxicologic findings.

This report details the pathologic and toxicologic findings in the case of a 15-year-old girl who deliberately and fatally ingested brodifacoum, a commonly used rodenticide. The mechanism of death, massive pulmonary hemorrhage, has not been previously reported. Brodifacoum was quantitated in liver, spleen, lung, brain, bile, vitreous humor, heart blood, and femoral blood using HPLC with fluorescence detection. The highest brodifacoum concentrations were detected in bile (4276 ng/mL) and femoral blood (3919 ng/mL). No brodifacoum was detected in brain or vitreous humor. A brodifacoum concentration of 50 ng/g was observed in frozen liver while formalin fixed liver exhibited a concentration of 820 ng/g. A very high blood:liver brodifacoum concentration ratio suggested acute poisoning but the historical and pathologic findings suggested a longer period of anticoagulation. Though most cases of brodifacoum poisoning in humans are non-fatal, this compound can be deadly because of its very long half-life. Forensic pathologists and toxicologists should suspect superwarfarin rodenticides when confronted with cases of unexplained bleeding. Anticoagulant poisoning can mimic fatal leukemia or infectious diseases such as bacterial sepsis, rickettsioses, plague, and leptospirosis. A thorough death scene investigation may provide clues that a person has ingested these substances.     

Perpetrators of sexual assault continuing to have sex with their victims following the initial assault: evidence for evolved reproductive strategies

Among a sample of college students, roughly 30% of the women and 12% of the men reported having been the victim of a sexual assault sometime in their lives. Of the assault victims, approximately 23% of both sexes stated that they had sexual intercourse with their assaulters on at least one subsequent occasion. Female victims of a completed sexual assault were significantly more likely to continue being sexually active with their assailants than were female victims who managed to block the assault, while no such difference was found for male victims. This would imply that some men are using assaultive tactics to secure sex partners beyond a single sexual episode, thereby enhancing their potential reproductive success in evolutionary terms. Also, men who committed sexual assault reported having had more lifetime sex partners than did sexually experienced men with no sexual assault history. Overall, the idea that sexual assault is part of an evolved reproductive strategy is consistent with findings from this study.