What motivates adherence to medical recommendations? The procedural justice approach to gaining deference in the medical arena

Although it is within their long‐term interest, patients often fail to follow health care recommendations made by medical experts. This failure results in the widespread occurrence of preventable health problems and a significant increase in health care costs. Taking a new approach to confronting this issue, this paper examines whether the procedural justice model, which has been useful in explaining cooperation with legal and managerial authorities, can provide a basis for increasing patients' willingness to voluntarily adhere to health care recommendations. Three studies tested and supported this proposition. Study 1 experimentally manipulated physicians' procedural fairness or unfairness to explore its influence on patients' acceptance of doctors' recommendations. Study 2 used patients' reports about the fairness of their personal physicians and linked those evaluations to their willingness to follow their doctor's recommendations. Finally, study 3 explored the role of general procedural justice judgments in promoting willingness to accept health policies when they are advocated by private doctors and government health care authorities. The results of all three studies support the argument that when health care authorities use fair procedures, patients are more likely to accept their recommendations. Importantly, this procedural justice effect is distinct from, and in some cases stronger than, the influence of competence.     

Reducing poverty in sub-Saharan Africa: the need for participatory governance

Traditional approaches to fighting poverty have yielded unsatisfactory results in some African countries, and have been positively damaging in others. Economic growth and social expenditure on the part of both national governments and international donors have been ineffective in some countries, while in others they have exacerbated poverty. The author considers that this is due to the absence of participatory governance. From a theoretical perspective, support for participatory governance stems from Amartya Sen's approach to understanding poverty, which conceptualises poverty as a lack of capabilities, leading to social exclusion. The lack of such governance has led to the failure of traditional approaches in the fight against poverty in sub-Saharan Africa. Finally, the author proposes a tool for assessing the quality of governance, and its application in Cameroon.     

Pattern and Trend of Deliberate Self-Harm in Western Nepal

Abstract:  Acts of deliberate self-harm (DSH) not only affect the people directly involved, but also have grave psychological and social impact on the family and community. In the present study, a cohort of 173 cases of DSH reported from April 2002 to March 2005 was retrospectively analyzed, by perusing the medicolegal register maintained by the Emergency Department at the Western Regional Hospital, Pokhara in the Western Development Region of Nepal. The data were entered and analyzed using SPSS Version 10.1. More than two-thirds of total cases were females. About 60% of cases were observed in the age group of 15–24 years. Poisoning (89.6%) was the most preferred method of deliberate self-harm. Organophosphate pesticides were consumed in nearly two-thirds of the poisoning cases. The majority of cases were reported during the months of May to July and had occurred during the last quarter of the day. More than a twofold increase was observed in the frequency of cases during the 3-year study period. The said observations were compared and contrasted with the available literature across the globe. The presentation is concluded by highlighting the limitations encountered in Nepal and the scope to overcome the same.     

Democracy and corruption: a complex relationship

We argue that an ‘electoral democracy’ is not sufficient to reduce corruption. Our contention is that the institutions associated with mature democracy are crucial to successfully deterring corrupt behaviour. At the core of our argument is the idea that with well-functioning institutions, the probability of detection and punishment is sufficiently high to deter most decision makers from choosing to act corruptly. The empirical evidence we present supports this idea. The nonlinearity of democracy variables is tested to confirm that an advanced stage of democracy is crucial for combating corruption.     

Learning from the ethnic conflict and the internal displacement in Tripura in Northeast India

Conclusion The ethnic conflict between tribals and non-tribals compounded by the insurgency has disturbed the peace in the state for more than 20 years and also resulted in the internal displacement of thousands of people. In order to restore peace and to prevent future internal displacement it would be necessary to give to the tribals their due share in governance.     

An empirical approach to the optimal size of the civil service

This article attempts a purely empirical approach to the issue of optimal civil service size by looking for a systematic relationship between observed size and underlying explanators. The residuals from such a fitted relationship then serve as a first approximation to whether the government in question is overstaffed or not. The data are from Indian subnational states, which as members of a single federation, follow the same definitional conventions with respect to the civil service. The contribution of the article is methodological, and addresses an issue of central importance, since staff downsizing conditionalities attached to externally funded structural adjustment programmes are not analytically underpinned. The article also explores issues surrounding the composition of the civil service. There is no evidence that overstaffing, as determined from the residuals of the estimated specification, is the joint outcome along with staff composition, as proxied by mean salary, of job creation pressures at the lower salary scales. This suggests that correction of overstaffing might be possible without political opposition, while at the same time leaving unexplained the variation in staff composition across states. Copyright © 2008 John Wiley & Sons, Ltd.     

Sudhir Kakar and the Socio‐Psychological Explanation of Hindu‐Muslim Communal Riots in India

Concentrated principally in four of twenty‐eight Indian states, there have been more than 33,000 Hindu‐Muslim riots since 1947. Scholars have differently explained communal violence. Some have argued that there are innate qualities in Indian society which encourage what Donald Horowitz calls “deadly ethnic riot”. Psychoanalysts have wondered if proneness to violence is ingrained in India's religion‐based culture. After assessing several existing explanatory paradigms, I examine the legitimacy of psychoanalysis and some selected aspects of other explanations, arguing that both the rational and psychological theories help explain Hindu‐Muslim conflict. I submit that Sudhir Kakar, who worked with Erik Erikson at Harvard and trained at the Sigmund Freud Institute in Frankfurt, unduly follows the elitist French social psychologist, Gustave Le Bon (1895), to present violent communities as undifferentiated masses. Specifically, Kakar's contention that Hindu males are psychologically socialized by confrontational religious values deserves close scrutiny. Methodologically, drawing on the postmodern thesis of the de‐centered subject and minimizing the significance of the master narrative, I conclude that primordial ancient hatred is not programmed in India, arguing that Kakar's insights do not speak to religion's truth, but do help us understand its manifestation and political psychology.     

Enhancing Excellence: Socially Motivated Private Schools of Nepal

Social motivation can promote efficiency of public service delivery though its role in providing schooling is little understood. We provide both theoretical and empirical insights as to why not-for-profit private schools could enhance excellence in schooling, using Nepal as a case study. Results suggest that socially motivated trust schools outperform all other types of schools irrespective of whether we consider standardised test scores, absolute or relative to school expenditure per student. Results are robust and highlight that trust school’s social objective, coupled with private financing, ownership, and management that minimises its agency costs, is key to their value for money.