The need to improve the living conditions of women in Nuba Mountains,Southern Kordofan

ABSTRACT

The Comprehensive Peace Agreement (CPA) not only ended Africa's longest civil war, it aimed to transform Sudanese society. A critical element of this transformation is uplifting the status of women. This article surveys the conditions faced by women in two villages in Nuba Mountains/Southern Kordofan, principally their ability to access land for farming, credit facilities and barriers to education and health services, and whether the implementation of the CPA has resulted in any concrete changes.     

Economies of scale in Danish municipalities: Expenditure effects versus quality effects

A change in the cost structure in the Danish municipalities seems to have occurred bringing in a larger fixed element in the cost function and making unit costs higher in small municipalities than in large. The paper examines the hypothesis that small municipalities in their reaction to their higher unit costs for management make a trade-off between raising expenditures and the tax level, on the one hand, and reducing the quality of the production, on the other. Using accounting data for 1980, 1990 and 2000 it is shown that the expenditure structure has shifted since 1980 so that small municipalities now exhibit higher unit expenditures than larger municipalities. However, there also seems to be a quality substituting effect in the small municipalities as a reaction to the higher unit costs. From data based on a questionnaire to the chief executives in all municipalities indications of weak political and administrative leadership in the small municipalities are demonstrated. We find that population size and administrative capacity explain significant differences in municipal understanding of the consequences of the central government regulation defining the conditions for the local production of services.     

Territorialising Sustainable Development: The Politics of Land-use Planning in Laos

Since the emergence of the sustainable development paradigm in the late 1980s, land-use planning has become a key arena for political debates over society-environment interactions and, in practice, an important means for territorialisation projects. The paper reviews the main planning approaches that have been employed over the past three decades in the Lao People's Democratic Republic, a country that has long been viewed as a valuable policy testing ground for the proponents of sustainable development. It highlights three concurrent territorialisation projects that have shaped the history of land-use planning and have fuelled tensions between central and subnational governments and local actors, national and foreign institutions, and land suitability and sustainability approaches. The paper argues that the latter tensions reflect an important dynamism and reactivity in the planning arena. It concludes that the capacity of land-use planners to adapt to specific contexts and evolving socio-environmental challenges should be harnessed in order to reconcile conflicting approaches to planning and, perhaps, to achieve sustainable development.     

The historical evolution of settlement patterns and trends in South Africa: Unlocking the log-jam of the unsustainable settlements impasse

Abstract

This article ascertains the underlying causes of the persistence of unsustainable settlement patterns and trends in post-apartheid South Africa. Despite positive development planning policy intentions in the post-apartheid South Africa, glaring deprivation and spatial inequality has persisted. The article is grounded in a chronological analysis of demographic, functional and regional economic dynamics at the different epochs of South Africa's history as well as the settlement policy and planning intentions. Its main finding is that the persistence of unsustainable settlement patterns and trends in post-apartheid South Africa is largely a result of misplaced settlement policies and strategies. They give knee-jerk responses to global, regional, national and local dynamics shaping settlement patterns and trends. The recommendation is that development planning initiatives should be informed by the dialectics of settlement facets at local, regional, national and global levels for them to deal decisively with the historical problem of unsustainable patterns and trends.     

Toward Disorganized Governance in Public Service Provision? The Case of German Sickness Funds

Over many years now, the concept of “network” or “new governance” pervades the literature on public administration. It suggests a growing role for network-based governance downgrading both command-and-control bureaucracy and, if more implicitly, New Public Management (NPM). Challenging this reading, the article explores the relationship between network-based and (quasi-)market governance by investigating the policies of German health care insurance organizations, the so-called sickness funds, epitomizing the international movement towards focal agencies run at arm's length of Government. These policies reflect new forms of hybrid coordination in public service provision, leading into what can be coined disorganized governance and be characterized as a regime of hybrid coordination shaped by a nervous interplay of partnership-building and disruptive segregation, with important repercussions on the overall outcomes in the provision of health care.     

Reconciling Expert Advice and Community Opinion in a Local Government Strategic Planning Process

This article proposes that the eventual outcomes of local government strategic policy deliberations can often reflect the interplay between “expert” administrative staff, democratically elected politicians, and the community they jointly serve. A multi-site case study approach, to examine the generation of local government strategy related to a niche economic activity concludes that broadly conceptualized opinion congruence can sometimes be threatened by substantial pockets of stakeholder vested interest. As such, “expert” and “political” opinion reflects a caution based on both historical experience and political expediency; while community opinion displays an optimism based on eager anticipation of an unknown future.     

The Learning Orientation of Primary Health Care Teams in the English National Health Service: Is This a Myth That Should Be Perpetuated?

A qualitative study of primary health care teams in the UK provides insight into their co-ordination or learning-orientation and how this affects member commitment, conceptions of ‘core’ and periphery, group identification and willingness to integrate roles. Even if the ideal of a learning-oriented primary health care team is viewed as a myth, it can still perform useful functions despite an apparent withdrawal of its official authorization by the Cameron-led government. The perpetuation of this myth maintains a tension between reality and potentiality in the hopes that inspire its pursuit as an ideal of team formation.     

Assessing Performance in Shelters for Abused Women: Can “Caring Citizenship” Be Measured in “Value for Money” Accountability Regimes?

Results are reported from a study of shelters for abused women in Ontario, Canada, suggesting that what clients, managers, and frontline workers value most in shelter services is based on a care perspective in which ongoing relational support is seen as essential to effective service delivery. Presently, government-required metrics used to assess shelter services not only reflect a narrow, justice perspective where “fairness” is defined as equal access to publicly supported services, but reveal a New Public Management emphasis on efficiency in which the focus is more on the “what” than the “how” of practice. Findings are discussed in terms of their implications for the design of accountability systems for evaluating government-contracted social services.     

Planning,Budgeting, and Health Care Performance in Ukraine

Abstract

The Government of Ukraine has not pursued health care reforms now commonplace in the rest of Europe and Central/Eastern Europe that rely less upon centralized, state delivery of services and more on decentralized operational responsibilities and competition for services that increase patient choice. The Ukrainian health sector suffers from personnel overspecialization and facility overcapacity, resulting in high-cost, low productivity services. Budget funds are unavailable for operations and maintenance resulting in poor quality services. The state provides health care as a constitutionally-protected monopoly, relying on the traditional command and control model which ignores cost/quality competition options and responsibilities to patients. Overall, the system which produces these results is over-centralized, requiring achievement of physical service norms without providing sufficient funds. The centralized system does not monitor or evaluate services beyond narrow financial accountability and control requirements. The health care system is paradoxically over-centralized but unable to regulate or control local health care official decisions to ensure compliance with national standards. Needed are reforms in the health care policy and operational areas to produce the supply of services needed for national economic recovery. In the short-term, the budgetary framework can be improved as an operational/management guide through development of comparative information on results. Most of this information can be based on the economic classification consistent with the chart of accounts. Funding stability can be increased to improve expenditure control by implementing a new fiscal transfer formula that provides discretion (i.e., block grants) and performance criteria (i.e., outcome measures). In the medium-term, building on the technical foundation of physical norms and statistical reporting, the health care budgeting and financial management system should shift emphasis to: program planning, policy and management analysis, and public communications. The results of these reforms should lead to decentralized health care operations, service analysis, and delivery responsibilities. At the same time, the reforms should lead to proper centralization of responsibilities for strategic policy decisions, safety regulation, national standards, and program evaluation.     

A Research Revolution in Women's Health

SUMMARY

Women's health research initiatives are emerging with evidence that there are unique diagnosis and intervention factors that provide a window into the specific health needs of women. The evidence of the need for this gender-specific research is being spurred by the establishment of The Office of Research on Women's Health by the National Institutes of Health (NIH). A review of some of the more current and salient research findings that apply to women's health and the health needs of women in different lifestyles, at different stages of the life cycle is discussed. Also considered are women's roles in the health service delivery system and where they fit into the provision of services within the context of women's styles of accessing and using health care. Self-help and other support programs will be described as they apply specifically to women and a case will be made for providing comprehensive, multi-systemic women's health services in one facility at the community level through an overview of some of the more current and successful models.