Developing economics expertise for the evaluation of primary health care

Given that government budgets are increasingly stretched in the face of competing demands, there is a pressing need for evidence on the costs and benefits of public sector investments. Nowhere is this need greater than in the health field, where the benefits of programmes are typically difficult to measure. Within the health sector a key area of interest is primary health care, which is generally regarded as a central function and the most important means by which the health of the population can be improved. This paper reports the results of a recent survey of Commonwealth countries which sought to establish the extent of economic evaluation of PHC programmes, the impact on decision-making and the level of health economics expertise available in Third World countries. Based on the results of the survey, suggestions are made for improving the commissioning and conduct of economic evaluations, for interpreting and implementing evaluation results, and for developing government expertise in economic evaluation.     

Reviews

African Historiographies: What History for Which Africa?edited by BOGUMIL Jewsiewicki and David Newbury SAGE Publications, Beverly Hills (California) and London, 1986. 320 pp. including figures, notes and bibliography. £33,00.

Rural‐Urban Migration: Aspects of Theory, Policy and Practice by FrançAlcois Theron and Johann F. Graaff University Publishers, Stellenbosch and Grahamstown, 1987. 64 pp. including tables, notes and bibliography. R7,50 paperback.

German Imperialism in Africa: From the Beginnings until the Second World War edited by Helmuth Stoecker C. Hurst and Co., London, 1986. 446 pp. including bibliography and index. £17,50.

Elections in Independent Africa edited by Fred M. Hayward Westview Press, Boulder (Colorado), 1987. xvii plus 318 pp. including maps, tables, figures, illustrations, notes, bibliography and index. $36,50 paperback.

Africa and Israel: Relations in Perspective by Olusola Ojo Westview Press, Boulder (Colorado) and London, 1988. xiv plus 181 pp. including tables, notes and index. $23,50 paperback.

Rural Transformation in Tropical Africa edited by Douglas Rimmer Ohio University Press, Athens (Ohio), and Belhaven Press, London, 1988. viii plus 177 pp. including tables, figures, references and index. $27,95.

Ethiopia: Transition and Development in the Horn of Africa by Mulatu Wubneh and Yohannis Abate Westview Press, Boulder (Colorado), and Avebury, London, 1988. xv plus 224 pp. including maps, tables, figures, illustrations, notes, appendix, select bibliography and index. $28,00.

Ethiopia: The United States and the Soviet Union, 1974–1985 by David A. Korn Croom Helm, London and Sydney, 1986. xvii plus 199 pp. including map, notes, appendices, select bibliography and index. £19,95.

Transformation and Continuity in Revolutionary Ethiopia by Christopher Clapham Cambridge University Press, Cambridge, New York and Sydney, 1988. xviii plus 284 pp. including map, tables, notes, bibliography and index. £30,00.

Politics and the Military in Uganda, 1890–1985 by Amii Omara‐Otunnu St. Martin's Press, New York, 1987. xx plus 218 pp. $35,00 paperback.

The Soviet Union, the Third World and Southern Africa by Jack Spence South African Institute of International Affairs, Johannesburg, 1988. vi plus 35 pp. including references. R10,00 paperback.

The Battlefronts of Southern Africa by Colin Legum Africana Publishing Co., New York and London, 1988. xxix plus 451 pp. including map, notes, appendices and indexes. $34,50 paperback.

The Politics of Development in Botswana: A Model for Success? By Louis A. Picard Lynne Rienner Publishers, Boulder (Colorado) and London, 1987. xiv plus 298 pp. including tables, figures, notes, select bibliography and index. $26,50.

Capitalism and Apartheid: South Africa, 1910–1986 by Merle Lipton Wildwood House, London, and David Philip, Cape Town, 1986. xi plus 473 pp. including map, tables, notes and index. $8,95 paperback.

Class, Community and Conflict: South African Perspectives edited by Belinda Bozzoli Ravan Press, Johannesburg, 1987. xx plus 573 pp. including tables, illustrations, notes and index. R35,00 paperback.

Growing Up in a Divided Society: The Contexts of Childhood in South Africa edited by Sandra Burman and Pamela Reynolds Ravan Press, Johannesburg, 1986. xvi plus 454 pp. including map, tables, figures, illustrations, references and index. R28,00 paperback.

South Africa under Apartheid: A Select and Annotated Bibliography by Jacqueline A. Kalley Shuter and Shooter, Pietermaritzburg, and Institute of Social and Economic Research, Rhodes University, Grahamstown, 1987. xiii plus 544 pp. including index. R39,00 paperback.     

Sustainability and local government: The case of the British Columbia Islands Trust

Abstract: In recent years environmental values have undergone a popular and political resurgence, one of the central components of which is a demand for greater public participation, especially enhanced local control. This development has important implications for theoretical thinking in public administration. The present article examines the experience of the British Columbia Islands Trust, an innovative example of local administration which is most relevant to the quest for new environmentally sustainable forms of administration as a result of its unusual mandate (“to preserve and protect”) and its locally based planning approach. The article describes the Trust area, reviews the genesis of the Trust in the 1960s and its history to the present, describes its structure, and assesses public attitudes to it. The article draws practical lessons from the Trust experience, noting in particular the powerful effect of merging a conservationist mandate with locally based planning even in the absence of more formal indicators of institutional authority (such as budget, scope of immunity). The article concludes with a consideration of the theoretical implications for public administration of the Trust experience, noting especially the potential role for greater decentralization and democratic participation in planning processes. Sommaire: Depuis quelques années, les problématiques environnementales ont connu un regain d'intérêt auprès du public et des gouvernements. L'une des principales composantes de ce phènomène, qui a d'importantes implications sur la réflexion théorique en matière d'administration publique, est une demande de plus grande participation du public, en particulier au niveau local. Cet article étudie le cas du British Columbia Islands Trust, exemple d'innovation dans l'administration décentraliée, mettant en cause un organisme qui s'efforce d'appliquer de nouvelles formes de gestion favorables à l'environnement dans le cadre d'un mandat particulier (“préserver et protéger”) et d'une approche locale de la planification. L'article décrit la structure et le cadre d'intervention de la société de fiducie, explique son évolution depuis les années 1960 jusqu‘à aujourd'hui, et évalue les attitudes du public à son égard. L'article tire des leçons pratiques de l'expérience de cette société, en particulier concernant l'impact important résultant de la rencontre d'un mandat de conservation de l'environnement avec une activité de planification décentralisée, même en l'absence d'indicateurs d'autorité institutionnelle très formels (budget et immunité entre autres). L'article conclut en étudiant les implications théoriques pour l'administration publique de l'expérience de la société de fiducie, notamment en ce qui touche le rôle possible d'une décentralisation plus poussée et d'une participation démocratique dans un processus de planification.     

Variables that discriminate bulimic from nonbulimic adolescent females

The present study identified variables that discriminated bulimic (N=71) from nonbulimic (N=71) adolescent females within a high school setting. A discriminant function analysis identified six variables that significantly differentiated these two groups. These variables included disturbed eating attitudes, negative perceptions of weight and body image, depressive symptomatology, and alcohol use. Post hoct tests indicated that, compared to the nonbulimic girls, the bulimic adolescents were significantly more depressed, viewed themselves as significantly more overweight, used alcohol significantly more frequently, possessed significantly more disturbed eating attitudes, had a significantly greater discrepancy between their current and ideal weight, and felt it was significantly more important to achieve this ideal weight. The implications of these findings for the etiology and early identification of bulimia in adolescence are discussed.Received Ph.D. from Kent State University. Research interest is applied clinical research.Received Ph.D. from University of Vermont. Research interest is behavioral medicine.     

The effects of delayed menarche in different contexts: Dance and nondance students

The premise that effects of maturational timing are mediated by social context is explored by comparing adolescent girls in dance and nondance schools. Because the dance student must maintain a relatively low body weight, being a late maturer (who is often leaner than an on-time maturer) is expected to be more advantageous to the dancer than to the student not required to meet a weight standard. Girls aged 14 to 18 were seen; 276 attended private schools and 69 attended national ballet company schools. AllSs were weighed and measured and asked questions about their secondary sexual development, weight-related concerns, eating concerns, adult sex-role expectancies, body image, emotional functioning, and family relationships. Menarcheal age was used to classify girls as early (before 11.5 years of age), on time (between 11.5 and 14 years), and late maturers (after 14 years). More dance than non-dance school students were late maturers (55% versus 29%). The dance students weighed less and were leaner, had higher eating scores, and had lower family relationship and impulse control scores than the comparison sample. Across groups, late maturing students weighed less, were leaner, and had lower diet and higher oral control scores than on-time maturers, with the differences more pronounced in the dance than nondance students. In addition, the on-time dancers had higher psychopathology, perfection, and bulimia scores and lower body image scores than the late maturing dancers. The findings are discussed in terms of a goodness of fit between the requirements of a social context and a person's physical and behavioral characteristics.This paper was prepared with the support of grants from the W. T. Grant Foundation and the National Institutes of Health.Ph.D. from the University of Pennsylvania. Research Interests: Girls' psychological adaptation to pubertal change, biosocial aspects of female reproductive events, development in at-risk children and adolescents.     

Family relationships and social competence during late adolescence

Data from a large sample of late adolescents was used to examine associations between family relationships (reported closeness to parents and siblings) and perceived social competence. Significant positive relationships were found between family bonds and the social competence measures, which included social self-esteem, instrumentality, expressiveness, shyness, and degree of satisfaction/ease in same- and opposite-sex peer relationships. There was no evidence of differential effects of sibling versus parent relationships upon adolescent social competence.This project was supported by NIMH Grant 5 R01 MH34570.Received Ph.D. from Northwestern University.     

Diffusion within Marcia's identity-status paradigm: Does it foreshadow academic problems?

The present investigation attempted to ascertain longitudinally whether diffuseness about academic goals and plans would predict subsequent underachievement. Identity-status interviews were administered to 98 firstsemester college students. Their grade point averages (GPA) were obtained for their first six semesters in college. SAT and conceptual-level scores were used to generate predicted GPAs. Underachievement was operationally defined as a positive discrepancy between predicted-minus-observed GPA: underachievement=predicted observed GPA. Evidence for the hypothesized relationship between diffusion and academic underachievement was not found. To the contrary, Diffusions during their freshman year showed a tendency for relativeoverachievement (predicted observed GPA). The possibility of heterogeneity within Marcia's diffusion status was considered. Some diffuselike individuals may see their current lack of commitment and concern as a hiatus, whereas others may be truly unconcerned and myopic about their lives. A significant association between foreclosure and underachievement was found when the subjects were freshmen. This relationship was not replicated with an independent sample of 90 high school students. A post hoc interpretation focused on differences between transient and long-term Foreclosures and the role that the college environment may potentially play in instigating personal identity crises. The need for longitudinal tests on this account is underscored.