Performance-based partnership Agreements for the reconstruction of the health system in Afghanistan

The reconstruction of the health system in Afghanistan is in its early stages, and donors have proposed Performance-based Partnership Agreements (PPAs) through which to subcontract the delivery of health services to private organisations, both for-profit and not-for-profit. Beyond ideological debates, this article sets out to explain the model underlying the PPA initiative and sheds light on empirical data concerning the assumed benefits of such an approach. The article studies privatisation and the contracting-out of health services, though there is as yet no information that can demonstrate the superiority of private over public service provision. Similarly, the merits of subcontracting have not been fully proven and such arrangements raise several ethical issues. Where PPAs are to be attempted, it is important to remain cautious and to ensure that operations are organised in such a way as to permit proper comparison. The paper concludes with recommendations to organisations involved in or considering the advantages of PPAs.     

Children, women, and substance abuse: a look at recovery in a communal setting

This study explored the sense of community among women (n = 21) and women with children (n = 30) living in Oxford Houses, with emphasis on how the presence of children might affect the household. Sense of community did not vary between participants with more or less than three months residence. Residents reported very high levels of satisfaction with the home, possibly because of a ceiling effect of little room for increases in their sense of community over time. Participants reported that they were getting along with the children in the home, that mothers could count on babysitting help, and that the children had a positive effect on the household and their own recovery process. This effect did not differ between mothers and non-mothers, suggesting that non-mothers might view the children in the home with a sense of responsibility and sensitivity comparable to that of the mothers. Implications are discussed.     

Probability of exclusion in paternity testing: time to reassess

The average exclusion probability is a measure of efficiency in paternity testing; it refers to the a priori ability of a battery of tests to detect paternity inconsistencies. This parameter measures the capacity of the system to detect a false accusation of paternity. Traditionally, this average exclusion probability has been estimated as the probability of excluding a man who is not the father by an inconsistency in at least one of the studied loci. We suggest that this criterion should be corrected, as currently the presumed father is excluded when at least three genetic inconsistencies are found with the child being tested, not just one. This change of criterion has occurred because of the use of microsatellite loci, whose mutation rates are much greater than those of the coding genes used previously in paternity studies. We propose the use of the average probability of exclusion for at least three loci (not only one), as an honest measure of the combined probability of exclusion of several loci, and we propose an algebraic expression to calculate it.