74 research outputs found
Cultural specificity versus institutional universalism: a critique of the National Integrity System (NIS) methodology
This article provides an assessment and critique of the National Integrity System approach and methodology, informed by the experience of conducting an NIS review in Cambodia. It explores four key issues that potentially undermine the relevance and value of NIS reports for developing democracies: the narrowly conceived institutional approach underpinning the NIS methodology; the insufficient appreciation of cultural distinctiveness; a failure properly to conceptualise and articulate the very notion of ‘integrity’; and an over emphasis on compliance-based approaches to combating corruption at the expense of the positive promotion of integrity. The article seeks to offer some pointers to how the NIS approach could be adapted to broaden its conceptualisation of institutions and integrity, and thereby provide reports that are more theoretically informed as well as being more constructive and actionable
Designing stakeholder learning dialogues for effective global governance
A growing scholarship on multistakeholder learning dialogues suggests the importance of closely managing learning processes to help stakeholders anticipate which policies are likely to be effective. Much less work has focused on how to manage effective transnational multistakeholder learning dialogues, many of which aim to help address critical global environmental and social problems such as climate change or biodiversity loss. They face three central challenges. First, they rarely shape policies and behaviors directly, but work to ‘nudge’ or ‘tip the scales’ in domestic settings. Second, they run the risk of generating ‘compromise’ approaches incapable of ameliorating the original problem definition for which the dialogue was created. Third, they run the risk of being overly influenced, or captured, by powerful interests whose rationale for participating is to shift problem definitions or narrow instrument choices to those innocuous to their organizational or individual interests. Drawing on policy learning scholarship, we identify a six-stage learning process for anticipating effectiveness designed to minimize these risks while simultaneously fostering innovative approaches for meaningful and longlasting problem solving: Problem definition assessments; Problem framing; Developing coalition membership; Causal framework development; Scoping exercises; Knowledge institutionalization. We also identify six management techniques within each process for engaging transnational dialogues around problem solving. We show that doing so almost always requires anticipating multiple-step causal pathways through which influence of transnational and/or international actors and institutions might occur
Socioeconomic vulnerability and adaptation to environmental risk: A case study of climate change and flooding in Bangladesh
In this article we investigate the complex relationship between environmental risk, poverty, and vulnerability in a case study carried out in one of the poorest and most flood-prone countries in the world, focusing on household and community vulnerability and adaptive coping mechanisms. Based upon the steadily growing amount of literature in this field we develop and test our own analytical model. In a large-scale household survey carried out in southeast Bangladesh, we ask almost 700 floodplain residents living without any flood protection along the River Meghna about their flood risk exposure, flood problems, flood damage, and coping mechanisms. Novel in our study is the explicit testing of the effectiveness of adaptive coping strategies to reduce flood damage costs. We show that, households with lower income and less access to productive natural assets face higher exposure to risk of flooding. Disparity in income and asset distribution at community level furthermore tends to be higher at higher risk exposure levels, implying that individually vulnerable households are also collectively more vulnerable. Regarding the identification of coping mechanisms to deal with flood events, we look at both the ex ante household level preparedness for flood events and the ex post availability of community-level support and disaster relief. We find somewhat paradoxically that the people that face the highest risk of flooding are the least well prepared, both in terms of household-level ex ante preparedness and community-level ex post flood relief. © 2007 Society for Risk Analysis
Building system capacity for the integration of mental health at the level of primary care in Tunisia: a study protocol in global mental health
Food and beverage portion sizes in Australian children: a secondary analysis of 1995 and 2007 national data
Individualised treatment targets in patients with type-2 diabetes and hypertension
Abstract Aim Patients with type-2 diabetes mellitus (T2DM) are at high risk of cardiovascular events, accentuated in the presence of hypertension. At present, it is unclear to what extent the guidelines for the management of T2DM, advocating reduction in HbA1c levels to below target levels, are being adhered to in clinical practice. Methods DIALOGUE was a prospective, observational, non‐interventional registry performed across multiple centres in Germany. Patients aged 18 years or older who had T2DM and hypertension for whom the treating physician considered blood glucose lowering medication as inadequate and/or not safe/tolerable and chose to add a further oral drug or switch drug treatment were included. Patients were assigned a treatment target HbA1c value (≤ 6.5% [strict]; > 6.5 to ≤ 7.0% [intermediate]; > 7.0 to ≤ 7.5% [lenient]). Results 8568 patients with T2DM and hypertension were enrolled. 6691 (78.1%) had 12-month follow-up. Patients who were assigned a strict HbA1c treatment target (n = 2644) were younger, had shorter diabetes duration, and less comorbidity in comparison to those with intermediate (n = 2912) or lenient targets (n = 1135). Only 53.1% of patients achieved their HbA1c treatment target (46.2% [strict], 56.8% [intermediate], 59.4% [lenient]). There was little sign of treatment intensification for patients that had not achieved their HbA1c target. Conclusions Achievement of treatment targets was poor, leaving many patients with sub-optimal blood glucose levels. The apparent reluctance of physicians to intensify antidiabetic drug therapy is alarming, especially considering the evidence pointing to an association of hyperglycaemia and microvascular complications in patients with T2DM
Social dialogue in the hospital sector at EU level
The increasing presence of the private sector in public health care systems has made social partners question the effectiveness of existing national social dialogue arrangements. The emergence of issues such as patient mobility, workers' mobility and cross-border health care, which all required action at European level, led social partners at European level to build an informal process of social dialogue. This article examines the process of developing an informal sectoral social dialogue committee for the hospital sector at EU level, from 2000 until 2006, drawing on an analysis of documents, key informant interviews and participant-observer reflections. The findings show that developing the content of social dialogue is as important as the process itself and adequate representation is central to success. The most outstanding achievement of the informal process of social dialogue was that partners became more articulate about developing shared positions and gradually gained access to European institutions.
[La présence grandissante du secteur privé dans les systèmes publics de soins de santé a conduit les partenaires sociaux à s'interroger sur l’efficacité des accords de dialogue social existant au niveau national. L’émergence de questions telles que la mobilité des patients, la mobilité des travailleurs et les soins de santé transfrontaliers, qui toutes exigent une action au niveau européen, a conduit les partenaires sociaux à construire un processus informel de dialogue social au niveau européen. Cet article examine le processus de développement, entre 2000 et 2006, d’un comité sectoriel informel pour le dialogue social dans le secteur hospitalier au niveau de l’UE. Il se base sur une analyse des documents, des entretiens avec des informateurs clés et des réflexions en tant que participant/observateur. Il montre que le développement du contenu du dialogue social est aussi important que le processus lui-même, et qu’une représentation adéquate est un facteur clé de succès. Le résultat le plus frappant de ce processus informel de dialogue social est que les partenaires sont devenus plus enclins à développer des positions communes et qu’ils ont obtenu progressivement accès aux institutions européennes.]
[Angesichts der zunehmenden Präsenz privater Leistungsanbieter in den öffentlichen Gesund-heitsversorgungssystemen haben die Sozialpartner die Wirksamkeit der bestehenden Regelungen für den sozialen Dialog auf nationaler Ebene hinterfragt. Das Aufkommen von Themen wie Patientenmobilität, Arbeitnehmermobilität und grenzüberschreitende Gesundheitsversorgung, die auf europäischer Ebene angegangen werden mussten, brachte die Sozialpartner dazu, auf europäischer Ebene einen informellen Prozess für den sozialen Dialog einzurichten. Dieser Beitrag untersucht anhand von Dokumenten, Interviews und Beobachtungen von Teilnehmern, wie der Ausschuss für den informellen sozialen Dialog im Krankenhaussektor auf europäischer Ebene im Zeitraum 2000 bis 2006 aufgebaut und entwickelt wurde. Diese Untersuchung zeigt, dass die inhaltliche Entwicklung des sozialen Dialogs ebenso wichtig ist wie der Aufbauprozess selbst und dass die Frage der angemessenen Interessensvertretung eine maßgebliche Rolle für den Erfolg dieses Dialogs spielt. Die wichtigste Errungenschaft des informellen sozialen Dialogs besteht darin, dass die Partner sich deutlicher für die Entwicklung gemeinsamer Positionen eingesetzt und schrittweise Zugang zu den europäischen Institutionen erlangt haben.
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