Horizon 2020: Work Programme 2016 - 2017.

13. Europe in a changing world – inclusive, innovative and reflective Societie

Governing Outer Space as a Global Commons: Examining ‘Tragedy’ in Orbital Medium

The purpose of this research is to examine the outer space governance regime and to identify key governance deficits which are arguably the main reason for the far-reaching proliferation of space debris in the outer space commons. To this end, the research initially inspects two of the existing global commons – the maritime and polar regions – their governing regimes, and the regulatory, legal, and political challenges encountered in each. The discussion on the connection between global governance deficits and the environmental tragedies within these domains aims to establish the conceptual foundation of this study. Based on this foundation, the research discusses legislative and regulatory dimensions of outer space governance and international responses to the challenges facing the outer space commons. It concludes with the examination of the space debris problem and potential policy responses to address this global environmental tragedy. In this regard, in the light of Ostrom’s design principles, an international treaty on space environment protection, a financial programme in managing the cost of debris removal programmes and maintenance of spatial resources, and an international space agency to coordinate these fields and provide substantial cooperation between space actors, are offered as fundamental steps to prevent the tragedy in outer space – the common heritage of mankind. Therefore, this research intends to contribute to the understanding of the space debris problem and its consequences for global welfare

Free-Market Illusions: Health Sector Reforms In Uganda 1987–2007

Introduction: By the late 1980s, Uganda’s health system had been devastated by two decades of conflict and mismanagement. At the same time, public-funded and run health systems had begun to be viewed as inefficient and undesirable. Uganda’s attempt to rehabilitate its destroyed health infrastructure was blocked by donors in favour of reform. Introduced as pre-conditions of aid, market-based health sector reforms (HSRs) were eventually embraced by the government of Uganda as part of the wider globalized free-market policy to provide market solutions to health sector problems. The reforms were driven by ideology; they were untested and not based on evidence. Theoretical framework: The research develops a conceptual framework for critical analysis of HSRs as a policy of the free-market system, and uses policy analysis framework of Hogwood and Gunn, which starts from policy agenda setting and ends with policy maintenance, succession or termination. Where a policy fails or becomes irrelevant, it is succeeded by another policy and terminated. It also employs Raskin et al’s transition-and-trend prediction of the future; that uncontrolled free-market capitalism is hungry for markets, resources and investment opportunities with dire consequences of social polarization, terrorism, environmental degradation, climate change and breakdown of welfare, such as health care. Two possible scenario options are predicted: either to reform the free-market policy or develop a new civilization. Aim and objectives: The aim of the study was to explore the implications of market-based health sector reforms in Uganda for the development of sustainable health systems. The objectives were to 1) analyse the genesis, formulation and implementation of HSRs in Uganda; 2) to evaluate the performance of the health sector under HSRs; 3) to evaluate HSRs collectively and individually; and 4) recommend a framework for sustainable health systems. Methods: Four main methods were used in the study: a) Several evaluation studies of HSRs in Uganda were done. Ugandan studies were done in thirteen pilot health reform project districts. Evaluation studies included several separate thematic sub-studies. Most studies employed interviews, focus-group discussions, and structured observation; b) A study was done to compare Uganda’s reform with those in other countries under a bi-country study and through a review of multi-country studies; c) Systematic reviews and analyses of various household and health-facility surveys were carried out; and d) A sub-district health systems survey was carried out to assess health system inputs, functions, outcomes and efficiency. Results: Health indicators stagnated or deteriorated during the period under study. Only slight improvements have occurred recently but are associated factors outside the health sector. Of the twenty reforms, only two achieved success: setting up private facilities and community-based distribution of health commodities. Eight failed to achieve individual objectives (user-fees, pricing of health care, defining and implementing an essential health package, hospital autonomy, decentralization, contracting out, sector wide approaches, and restructuring of ministry of health). Seven reforms were not sustainable or feasible (revolving drug funds, prepayment schemes, social-health insurance, income generation for health care, payment incentives, hospital trusts and autonomy or privatization of National Medical Stores). Three reforms were found to undermine health sector objectives, especially that of equity (user-fees, privatization, and decentralization). Factors complicating HSRs include aid, macroeconomic Sam Okuonzi 12 policy, policy on economic growth, corruption, inadequate internal management capacity, and ad hoc nature of reforms in general. Discussion: The failure of market-based HSRs to achieve collective and individual objectives in Uganda is a trend also documented in other countries. The characteristics of a good health system (such as equity, solidarity, evidence-based decisions, government leadership and control, and regulation) cannot be achieved through privatization and market forces. Moreover, HSRs are linked to a much wider and entrenched socio-economic global system established and driven by free-market capitalism. Health systems crises cannot therefore be addressed independently of the wider global economic order. Either there has to be policy reform within the prevailing framework of the free-market, focussed on addressing perpetual crises as they emerge, or a new world order based on different values has to be defined and the human society has embark on the path of a new civilization. It is envisioned that only when the values upon which the free-market is based (such as materialism, winner-takes-it-all, individualism, and domination of others) are replaced with other values (such as equity, solidarity, mutual existence, and shared responsibility), will there be a suitable environment for sustainable and equitable health systems development. Conclusions, lessons and recommendations: The health system crisis in Uganda is due to freemarket policy, introduced through and driven by donor aid and its poor management. It was also due to poor leadership and governance in Uganda. Market-based approaches need close control and regulation to protect social welfare and the environment. To address the crisis caused by HSRs, Uganda requires counter-reforms in the economy, health policy, social services, leadership and governance. But globally, the market has to be controlled in favour of human development, peaceful coexistence and sustainable use of resources. Ultimately, a new civilization in which the market is fully controlled and is not the mechanism for health service delivery needs to be established