Cost-utility assessment: Planning with local decisionmakers in developing countries

In the past decade countries and donor agencies have endorsed health policies which (1) give a very broad definition of health, (2) see the pursuit of health as part of the development process, and (3) emphasize the local community's and local decision-maker's participation in the planning of health projects. Despite these broad principles, health delivery systems in developing countries have access to a very limited set of resources. Health planners are faced with the dilemma of creating cost-effective programmes while recognizing the need to take into account the broad definition of health and the importance of local participation in planning. This dilemma has led to a division between those planners who put greater emphasis on the use of cost analysis techniques in which the decision-making process rests more with professional planners (often outside consultants) vs those who emphasize greater local control of the decision-making process. The purpose of this paper is to present a study in which two alternative approaches to cost utility analysis were used. Consideration was given both to the actual cost analysis strategy and to the integration of the cost variable into the total decision-making process. Finally, major emphasis was placed on including local decision-makers in the planning process and providing them with feasible and understandable decision-making tools.     

Reviews

Martin McCauley, Who's Who in Russia since 1900. London: Routledge, 1997, xxiv + 268 pp., £12.99 p/b.

Michael McFaul, Russia's 1996 Presidential Election. The End of Polarized Politics. Stanford: Hoover Institution Press, 1997, xiii + 170 pp., $17.95.

Laura Belin & Robert W. Orttung, with Ralph S. Clem and Peter R. Craumer, The Russian Parliamentary Elections of 1995: The Battle for the Duma. London: M. E. Sharpe, 1997, xii + 203 pp., $62.95.

Stephen White, Alex Pravda & Zvi Gitelman (eds), Developments in Russian Politics 4. Durham, NC: Duke University Press, 1997, xvi + 304 pp., £42.50 h/b, £13.99 p/b.

Adrian Karatnycky, Alexander Motyl & Boris Shor (eds), Nations in Transit 1997. Civil Society, Democracy and Markets in East Central Europe and the Newly Independent States. New Brunswick: Transaction, 1997, 418 pp., $49.95.

Oskar Krejci, History of Elections in Bohemia and Moravia. Boulder, CO: East European Monographs CDXXXIII, 1995, xliv + 425 pp.

Anne Lorentz & Marianne Rostgaard (eds), The Aftermath of Real Existing Socialism in Eastern Europe. Volume 2. People and Technology in the Process of Transition. Basingstoke: Macmillan, 1997, ix + 309 pp., £50.00.

Yudit Kiss, The Defence Industry in East‐Central Europe: Restructuring and Conversion. Oxford: Oxford University Press/Stockholm International Peace Research Institute, 1997, vii + 237 pp., £22.50.

Shiping Zheng, Party vs. State in Post‐1949 China: The Institutional Dilemma. Cambridge: Cambridge University Press, 1997, xiv + 294 pp., £40.00 h/b, £14.95 p/b.

John Lewis Gaddis, We Now Know: Rethinking Cold War History. Oxford: Clarendon Press, 1997, x +425 pp., £25.00.

David Christian, Imperial and Soviet Russia: Power, Privilege and the Challenge of Modernity. Basingstoke: Macmillan, 1997, viii + 478 pp., £15.99.

Edward Acton, Vladimir Iu. Cherniaev & William G. Rosenberg (eds), Critical Companion to the Russian Revolution, 1914–1921. London: Edward Arnold, 1997, xviii + 782 pp., £59.99.

Michael David‐Fox, Revolution of the Mind: Higher Learning among the Bolsheviks, 1918–1929. Ithaca: Cornell University Press, 1997, xvii + 298 pp., £33.50. >Alexander Etkind, Eros of the Impossible: The History of Psychoanalysis in Russia, trans. Noah and Maria Rubins, Oxford: Westview, 1997, vii + 408 pp., £25.50.

Bernice Glatzer Rosenthal (ed.), The Occult in Russian and Soviet Culture. Ithaca: Cornell University Press, 1997, ix + 468 pp., £47.00 h/b, £19.50 p/b.

Knut Andreas Grimstad & Ingunn Lunde (eds), Celebrating Creativity: Essays in Honour of Jostein B0rtnes. Bergen: University of Bergen, 1997, 350 pp.     

The Role of “Very Important” Nonparental Adults in Adolescent Development

Two hundred one adolescents of diverse ethnic backgrounds (mean age = 16.7 years) reported whether they considered any adult other than their parents to be a very important person (VIP) in their lives, and described various attributes of the VIP and their relationship with this individual. Perceived VIP characteristics—especially perceived involvement of the VIP in behavior that is uniformly illegal (e.g., theft) or illegal for adolescents (e.g., alcohol use)— were robust predictors of boys' self-reported misconduct and had modest links with their level of self-reported depressive symptomatology. In contrast, VIP attributes showed their strongest linkages to girls' depressive symptoms, with perceived VIP warmth and acceptance related to a lower incidence of depressed mood. Regression analyses indicated that these VIP attributes contributed uniquely to the explanation of misconduct and depressive symptoms even when analogous parental and friend attributes were included in the models. In view of the findings of this exploratory study, several future research directions are suggested, including research on the mechanisms through which VIP effects may be transmitted.     

Relationship of Parenting Style to Behavioral Adjustment in Graduating High School Seniors

Research on the four prototypic parenting styles has consistently demonstrated their relationship to psychosocial and behavioral adjustment in offspring ranging in age from preschool children to high school students. The present study used self-report surveys administered only to graduating high school (HS) seniors (2250 participants). Students indicated their levels of participation in a variety of problem behaviors and conventional behaviors, as well as rating their perceptions of their parents on three parenting dimensions: acceptance (responsiveness), behavioral control (demandingness), and democracy (psychological autonomy granting). Using these values, students could be assigned to 1 of 6 groups representing the parenting style with which they perceived they had been reared: authoritative plus, authoritative, authoritarian, midrange, indulgent, and neglectful. Parenting style was significantly related to older adolescent behavioral adjustment (p < .0001) in this HS Sr. sample even after statistically adjusting for the effects of gender, SES, and family structure. While parenting style did not moderate socioeconomic status and family structure, it was found to be a powerful mediator of these two independent variables. The democracy dimension, although an important component of parental attitude, was found to be unnecessary in effectively defining authoritative parenting after the other two dimensions, acceptance and behavioral control, were considered. This study expands the parenting style typology to include a fifth middle-range parenting style, and it demonstrates the significant mediating power of parenting style on SES and family structure. Previously established advantages and disadvantages of the four classic parenting styles, plus a middle-range style, persist even when they are extended to a sample comprised strictly of older adolescents at the brink of high school graduation.     

Perceived Social Environment and Adolescents’ Well-Being and Adjustment: Comparing a Foster Care Sample With a Matched Sample

Previous research has demonstrated that former foster care youth are at risk for poor outcomes (e.g., more problem behaviors, more depression, lower self-esteem, and poor social relationships). It is not clear, however, whether these findings reflect preemancipation developmental deficits. This study used 163 preemancipation foster care youth and a matched sample of 163 comparison youth. Results showed that foster-care youth did not differ from the comparison sample on measures of well-being, including depressed mood, problem behavior, and self-esteem. Foster care youth reported higher levels of work orientation, but lower levels of academic achievement, aspirations, and expectations. In addition, compared to the matched sample, foster care youth perceived better social environments with respect to their important nonparental adults (VIPs) and peers, but poorer social environments relating to their parents. These differences in social environments may have offset each other and resulted in similar levels of psychological well-being for the two groups of youth. Regression analyses further showed that social environments were linked to selected adolescent outcomes, and nonparental VIPs were especially important for the foster care sample.Department of Psychology and Social Behavior, School of Social Ecology, University of California, Irvine. Current interests: Cross-cultural study of adolescent well-being, at-risk youth.Received PhD in clinical psychology from Radcliffe College, Harvard University. Current interests: Role of culture, family, peers, and nonparental adults in adolescent developmentReceived PhD in developmental psychology from University of Michigan. Current interests: Cross-cultural human development; neural bases of language and mathematical learningReceived PhD in developmental psychology from University of Strathclyde. Current interests: Life-span development, motivation and developmental regulation, control and health     

Konfliktuelle Integration?

Seit den 1980er Jahren gehören Konflikte mit einem ethnischen Hintergrund zur Alltagsrealität in Frankreich. In Deutschland fehlen dagegen weitgehend solche Konflikte. Ausgehend von Unterschieden im institutionellen Kontext der Integration von Zuwanderern in Deutschland und Frankreich untersucht der vorliegende Artikel die soziale Lage der türkischen Immigranten in Deutschland und der maghrebinischen Immigranten in Frankreich anhand von Daten des Sozio-Ökonomischen Panels (SOEP) und des Europäischen Panels der Haushalte (ECHP). Dabei wird die Hypothese geprüft, ob das Fehlen von Konflikten in Deutschland zum Teil durch die bessere soziale Lage der türkischen Bevölkerung erklärt werden kann. Die Daten zeigen unter anderem, dass die Arbeitsmarktsituation und die ökonomische Lage der türkischen Bevölkerung in Deutschland im Vergleich zur Lage der maghrebinischen Bevölkerung in Frankreich weniger prekär sind. Sozialstrukturelle Unterschiede allein können allerdings die Entstehung von Konflikten nicht erklären. Abschließend wird deshalb untersucht, inwiefern das jeweilige Integrationsmodell die Entstehung von sozialen Konflikten fördert bzw. verhindert.     

The Importance of Social and Political Context: The Case of AIDS Activism

We utilize a 1992 survey of approximately, 2500 AIDS activists to analyze their degree of participation. Activity levels were affected by several traditional predictors, but the inclusion of contextual measures indicating the activists' connection with AIDS, especially the pain and loss incurred, led to a much fuller and more complex explanatory model. We argue that a richer comprehension of political participation requires more studies of issue-specific activists and the specification of contexual features that serve to motivate more intensive degrees of participation.     

Better than Raw: A Guide to Measuring Organizational Performance with Adjusted Performance Measures

Like oysters on the half shell, some things are better when they're raw. In evaluating the performance of organizations and providing guidance for improving performance, however, raw performance measures, such as test scores or success rates, are often inferior to performance measures adjusted for client and environmental characteristics, or adjusted performance measures (APMs). Using examples from a variety of public services and data on public schools in Georgia, we compare the performance data generated by raw scores and by APMs. We conclude with guidance for constructing and using adjusted performance measures.