Managing externally financed projects: the Integrated Primary Health Care Project in Bolivia. (33/396)

Bolivia is one of the poorest countries in Latin America. Health indicators are very poor, communicable diseases are prevalent and, coupled with malnutrition, remain the major killers of children under 5 years old. The Integrated Primary Health Care Project (PROISS) was a US$39 million project executed by the Ministry of Health (MOH), 50% financed by the World Bank and aimed at improving primary health care in the four largest Bolivian municipalities. The implementation of the project started in 1990 and ended in 1997. During implementation it went through three distinct phases: Phase 1 (1990-94) was a period characterized by conflict and confusion; Phase 2 (1995-mid-1996) documented major improvements in coverage and service quality; and Phase 3 (mid-1996-97) witnessed the decline of the project. This paper explores the factors that contributed to the success and the decline of the project, draws lessons for project managers and international agencies involved in the definition and implementation of social sector projects, and discusses the unlikelihood that externally financed projects can have a sustainable impact on the development of the health sector of recipient countries.  (+info)

The 'value case' for investment in occupational health. (34/396)

This paper introduces the problems facing occupational health departments in the current environment created by new legislation and changes in social attitudes. The problems of establishing the true costs and benefits of service provision are discussed. The paper also explains the employment of the 'value principle' in organizations and postulates its use in order to establish the appropriate position of occupational health in corporate thinking. A practical system is suggested, based on a four-step process of strategic planning, issues development, option establishment and plan implementation, which can be used to evaluate and justify investment in services. The problems of future risk are addressed. The paper concludes with the priority of establishing the strategic importance of occupational health services alongside other personnel issues and expresses the possibility of using the same principles outside the business world.  (+info)

Substance Abuse and Mental Health Services Administration; mental health and substance abuse emergency response criteria. Interim final rule. (35/396)

Section 3102 of the Children's Health Act of 2000, Pub. L. 106-310, amends section 501 of the Public Health Service (PHS) Act (42 U.S.C. 290 aa) to add a new subsection (m) entitled "Emergency Response." This newly enacted subsection 501(m) authorizes the Secretary to use up to, but no more than, 2.5% of all amounts appropriated under Title V of the PHS Act, other than those appropriated under Part C, in each fiscal year to make "noncompetitive grants, contracts or cooperative agreements to public entities to enable such entities to address emergency substance abuse or mental health needs in local communities." Because Congress believed the Secretary needed the ability to respond to emergencies, it exempted any grants,contracts, or cooperative agreements authorized under this section from the peer review process otherwise required by section 504 of the PHS Act. See section 501(m)(1) of the PHS Act. Instead, the Secretary is to use an objective review process by establishing objective criteria to review applications for funds under this authority. Pursuant to Public Law 106-310, the Secretary is required to establish, and publish in the Federal Register, criteria for determining when a mental health or substance abuse emergency exists. In this interim final rule, the Secretary sets out these criteria, as well as the intended approach for implementing this new mental health and substance abuse emergency response authority. The Secretary invites public comments on both the criteria and the approach described in this interim final rule.  (+info)

Attacks on science: the risks to evidence-based policy. (36/396)

As government agencies, academic centers, and researchers affiliated with them provide an increasing share of the science base for policy decisions, they are also subject to efforts to politicize or silence objective scientific research. Such actions increasingly use sophisticated and complex strategies that put evidence-based policy making at risk. To assure the appropriate use of scientific evidence and the protection of the scientists who provide it, institutions and individuals must grow more vigilant against these tactics. Maintaining the capacity for evidence-based policy requires differentiating between honest scientific challenge and evident vested interest and responding accordingly, building and diversifying partnerships, assuring the transparency of funding sources, agreeing on rules for publication, and distinguishing the point where science ends and policy begins.  (+info)

The health maintenance organization delivery system. A national study of attitudes of HMO project directors on HMO issues. (37/396)

A national survey of health maintenance organization project directors' attitudes on HMO delivery issues was conducted to gather data about HMO planning development and delivery areas. Questionnaire results revealed characteristics of the HMO project director, sponsoring institution, and developmental stage. Seven HMO issues (Prepayment Mechanism, Quality of Care, Degree of Federal Participation) Public and Private Funding, Physicians' Attitudes toward HMO, and Consumer Recruitment) were identified to measure the attitudes of directors. As a whole, responses were in the positive range. Scale 1 (Prepayment Mechanism) and Scale 2 (Quality of Care) received the lowest mean scores and were in the moderate agreement range. Scale 3 (Degree of Federal Regulation) and Scale 5 (Public and Private Funding) had the highest mean scores and fell between slight agreement and disagreement. Further research has been noted in various administrative features and issue areas of HMO. Most crucial is the outcome of HMO legislation which has a bearing on the policy and program of the HMO delivery system. On the basis of what appears to be a representative sample of directors of DHEW-funded HMO Planning and Development Projects, the study has assessed attitudes on important issues relevant to HMOs and determined areas of greatest agreement and disagreement.  (+info)

Financing North American medical libraries in the nineteenth century. (38/396)

Culture not only justifies the existence of libraries but also determines the level of funding libraries receive for development. Cultural appreciation of the importance of libraries encourages their funding; lack of such appreciation discourages it. Medical library development is driven by culture in general and the culture of physicians in particular. Nineteenth-century North American medical library funding reflected the impact of physician culture in three phases: (1) Before the dawn of anesthesia (1840s) and antisepsis (1860s), when the wisdom of elders contained in books was venerated, libraries were well supported. (2) In the last third of the nineteenth century, as modern medicine grew and as physicians emphasized the practical and the present, rather than books, support for medical libraries declined. (3) By the 1890s, this attitude had changed because physicians had come to realize that, without both old and new medical literature readily available, they could not keep up with rapidly changing current clinical practice or research. Thus, "The Medical Library Movement" heralded the turn of the century.  (+info)

The global HIV/AIDS pandemic, structural inequalities, and the politics of international health. (39/396)

In spite of recent advances in treatment and care available in most developed countries, the HIV/AIDS pandemic continues to spread throughout the developing world. Structural inequalities continue to fuel the epidemic in all societies, and HIV infection has increasingly been concentrated in the poorest, most marginalized sectors of society in all countries. The relationship between HIV/AIDS and social and economic development has therefore become a central point in policy discussions about the most effective responses to the epidemic. Important progress has been made in recent United Nations initiatives. Maintaining long-term commitment to initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria is especially important in the wake of September 11 and ensuing events, which threaten to redirect necessary resources to seemingly more urgent security concerns.  (+info)

Business planning for university health science programs: a case study. (40/396)

Many publicly funded education programs and organizations have developed business plans to enhance accountability. In the case of the Department of Dentistry at the University of Alberta, the main impetus for business planning was a persistent deficit in the annual operating fund since a merger of a stand-alone dental faculty with the Faculty of Medicine. The main challenges were to balance revenues with expenditures, to reduce expenditures without compromising quality of teaching, service delivery and research, to maintain adequate funding to ensure future competitiveness, and to repay the accumulated debt owed to the university. The business plan comprises key strategies in the areas of education, clinical practice and service, and research. One of the strategies for education was to start a BSc program in dental hygiene, which was accomplished in September 2000. In clinical practice, a key strategy was implementation of a clinic operations fee, which also occurred in September 2000. This student fee helps to offset the cost of clinical practice. In research, a key strategy has been to strengthen our emphasis on prevention technologies. In completing the business plan, we learned the importance of identifying clear goals and ensuring that the goals are reasonable and achievable; gaining access to high-quality data to support planning; and nurturing existing positive relationships with external stakeholders such as the provincial government and professional associations.  (+info)