The DutchAlgemene Rekenkamer and its role in light of practical experience

TheAlgemene Rekenkamer functions in the area around government and parliament. This chapter focuses on two questions: How does theRekenkamer ascertain loss of efficiency and effectiveness within government, and how does theRekenkamer restrict loss of efficiency and effectiveness within its own organization?

The goal of theRekenkamer is to provide parliament with reasonable assurances of the validity of expenses incurred and to promote the efficiency of the ministries and the effective spending of state funds. TheRekenkamer pursues a policy aimed at achieving these goals. Some central elements in this active policy are

• ? An independent position,

• ? Optimum reliability,

• ? Strategic planning,

• ? Both regularity and performance audits.

• ? The political and social relevance of research subjects, and

• ? Dialogue between parliament and theRekenkamer.

With regard to the audit theory of W.J. Van Braband, some suggestions for improvement are given.

     

Information for action: the Clearinghouse project

This document summarizes the activities of the American Public Health Association International Clearinghouse that operated with funding from the US Agency for International Development for 16 years beginning in 1979. The Clearinghouse was established to improve access to information on infant feeding and maternal nutrition for health practitioners and decision-makers in Africa, Asia, and Latin America. By 1996, the Clearinghouse had created a substantial and accessible resource for USAID, and its activities included 1) developing an international center for information and materials on maternal and child nutrition and related issues in developing countries, 2) sharing lessons learned through a publication of a regular bulletin ("Mothers and Children"), 3) training staff from field-based organizations on information production and management, and 4) establishing a network of national and regional nutrition and health-related resource centers to increase access to locally published and unpublished information. Thus, the Clearinghouse was more than a library or distribution center; it identified key materials, repackaged information to increase accessibility, and monitored information use. Although the Clearinghouse project ended in 1996, the website on women's rights to maternity protection continues to provide access to information and to encourage dialogue and networking. The lessons learned from the project lead to the conclusions that users' needs must be the basis for increasing information access, that local capacity must be increased through new technologies and traditional methods, and that information resources must be used strategically to ensure equitable access.     

Fatal decompression sickness following therapeutic hyperbaric environment (author's transl)

In Hannover/Germany in 1976 a so called "Society for Regenerative Hyperbaric Therapy" (Gesellschaft für Regenerative Uberdruck-Therapie) subjected 20 patients within two coupled multi-place chambers to a simulated hyperbaric environment, equivalent to a maximum of 4 ata, followed usually by gradual reductions of the pressure. The patients were of an average age of 67.2 years and were afflicted by various disorders. During one of the "dives" a patient developed air embolism of the central nervous system. During ensuing confusion of the chamber was opened suddenly, with resultant explosive reduction of the high pressure. This resulted in five letal accidents of decompression sickness. Post mortem examination revealed diffuse distribution of gas bubbles throughout the entire body. By elecronmicroscopy each bubble was covered by an osmiophilic coat. Post mortem findings are discussed and correlated with well-known and new clinical symptomes. These observations present for the first time fatal accidents of decompression sickness in humans, associated with hyperbaric air-therapy.