Can Privatisation and Commercialisation of Public Services Help Achieve The MDGs? An Assessment

Basic services are essential to reducing poverty and improving quality of life. This working paper focuses on health, education, energy and water. These services contribute to achieving the Millennium Development Goals, as well as being goals in themselves. Over the past twenty years or so, the way in which these services are provided has been subject to considerable policy debate. There has been widespread questioning of the ability of the public sector to effectively deliver such services. Largely as a result, market-oriented solutions have been promoted as a means to overcome apparent constraints posed by state-provided services. Notwithstanding the weaknesses of state provision in many countries and localities, this working paper argues that reliance on private sector provision will fail to address the central challenges of public sector delivery. Furthermore, the process of privatisation creates an incentive framework that undermines, rather than strengthens, the accountability and capacity of the State to provide accessible and affordable services. In addition, the paper argues that the adoption of full cost recovery policies can seriously threaten achievement of the MDGs. This position does not constitute a blanket statement against private sector participation in public services or against user fees. Rather, it maintains that market-led policies fail to contribute to the MDGs and often reduce the likelihood of achieving them. Strengthening the State in assuming central responsibility for providing essential public services will help correct these setbacks.Privatisation, Millennium Development Goals, Public Services, Poverty

ASSESSING THE RISKS IN THE PRIVATE PROVISION OF ESSENTIAL SERVICES

The paper argues that private provision of water and electricity services requires a higher burden of proof than policies reforming existing state services. These utilities are public goods that must be universally affordable and accessible in order to achieve the Millennium Development Goals. In addition to considering productivity, policy-makers should assess social and "off-budget" fiscal impacts, as well as the feasibility of implementation in weak institutional environments. Benefits of better performance are often outweighed by risks in these other areas. The paper assesses four common rationales for private provision: Balancing budgets. Poor people need subsidies regardless of the provider, while incentives for attracting private investment can create off-budget fiscal liabilities. Investing capital. Private investment in utilities has been falling in developing countries, and is often contingent on contractual terms that guarantee profits or shift financial risk onto taxpayers. Improving performance. Private provision often fails to improve services because governments with limited resources cannot design and enforce contracts. Making reform irreversible. Policy-makers lack the information to anticipate the impacts of policies that cannot be reversed, such as commitments made under GATS.

Beyond market neutrality? Central banks and the problem of climate change

Starting with a landmark 2015 speech by Mark Carney on the ‘Tragedy of the Horizon’, climate change entered central banking discourse, causing some of its key convictions to come under new scrutiny. This article traces how initially climate change was firmly embedded in a conventional framework of ‘market completion’ that would allow financial markets to price in the negative externality. Yet, over the course of the last seven years, central banks have repositioned their role regarding this problem, taking on a much more active stance which calls into question the notion of ’market neutrality’. To trace these discursive changes, this article identifies three discursive layers formed around market-based mechanisms, responsible investment and monetary policy. We show that in the unfolding of the debate, the issue of climate change has altered the self-understanding of central bankers and driven them towards a more active stance where they acknowledge that central bankers shape and make, and not only ‘mirror’, market forces

Datenauswertungen kinderleicht gemacht

Sozialdienste verfügen über detaillierte Informationen zur Fall- und Kostenentwicklung. Die Analyse dieser Daten ist jedoch aufwändig und benötigt spezifisches Know-how. Mit einem von der BFH entwickelten Daten-Dashboard lassen sie sich rasch und ohne Vorkenntnisse aufbereiten und präsentieren

Native mass spectrometry can effectively predict PROTAC efficacy

Protein degraders, also known as proteolysis targeting chimeras (PROTACs), are bifunctional small molecules that promote cellular degradation of a protein of interest (POI). PROTACs act as molecular mediators, bringing an E3 ligase and a POI into proximity, thus promoting ubiquitination and degradation of the targeted POI. Despite their great promise as next-generation pharmaceutical drugs, the development of new PROTACs is challenged by the complexity of the system, which involves binary and ternary interactions between components. Here, we demonstrate the strength of native mass spectrometry (nMS), a label-free technique, to provide novel insight into PROTAC-mediated protein interactions. We show that nMS can monitor the formation of ternary E3-PROTAC-POI complexes and detect various intermediate species in a single experiment. A unique benefit of the method is its ability to reveal preferentially formed E3-PROTAC-POI combinations in competition experiments with multiple substrate proteins, thereby positioning it as an ideal high-throughput screening strategy during the development of new PROTACs

Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: follow-up of the CoBalT randomised controlled trial

Background: Cognitive behavioural therapy (CBT) is an effective treatment for people whose depression has not responded to antidepressants. However, the long-term outcome is unknown. In a long-term follow-up of the CoBalT trial, we examined the clinical and cost-effectiveness of cognitive behavioural therapy as an adjunct to usual care that included medication over 3–5 years in primary care patients with treatment-resistant depression. Methods: CoBalT was a randomised controlled trial done across 73 general practices in three UK centres. CoBalT recruited patients aged 18–75 years who had adhered to antidepressants for at least 6 weeks and had substantial depressive symptoms (Beck Depression Inventory [BDI-II] score ≥14 and met ICD-10 depression criteria). Participants were randomly assigned using a computer generated code, to receive either usual care or CBT in addition to usual care. Patients eligible for the long-term follow-up were those who had not withdrawn by the 12 month follow-up and had given their consent to being re-contacted. Those willing to participate were asked to return the postal questionnaire to the research team. One postal reminder was sent and non-responders were contacted by telephone to complete a brief questionnaire. Data were also collected from general practitioner notes. Follow-up took place at a variable interval after randomisation (3–5 years). The primary outcome was self-report of depressive symptoms assessed by BDI-II score (range 0–63), analysed by intention to treat. Cost-utility analysis compared health and social care costs with quality-adjusted life-years (QALYs). This study is registered with isrctn.com, number ISRCTN38231611. Findings: Between Nov 4, 2008, and Sept 30, 2010, 469 eligible participants were randomised into the CoBalT study. Of these, 248 individuals completed a long-term follow-up questionnaire and provided data for the primary outcome (136 in the intervention group vs 112 in the usual care group). At follow-up (median 45·5 months [IQR 42·5–51·1]), the intervention group had a mean BDI-II score of 19·2 (SD 13·8) compared with a mean BDI-II score of 23·4 (SD 13·2) for the usual care group (repeated measures analysis over the 46 months: difference in means −4·7 [95% CI −6·4 to −3·0, p<0·001]). Follow-up was, on average, 40 months after therapy ended. The average annual cost of trial CBT per participant was £343 (SD 129). The incremental cost-effectiveness ratio was £5374 per QALY gain. This represented a 92% probability of being cost effective at the National Institute for Health and Care Excellence QALY threshold of £20 000. Interpretation: CBT as an adjunct to usual care that includes antidepressants is clinically effective and cost effective over the long-term for individuals whose depression has not responded to pharmacotherapy. In view of this robust evidence of long-term effectiveness and the fact that the intervention represented good value-for-money, clinicians should discuss referral for CBT with all those for whom antidepressants are not effective

An expert consensus on the most effective components of cognitive behavioural therapy for adults with depression:a modified Delphi study

Designing new approaches to delivering cognitive behavioural therapy (CBT) requires an understanding of the key components. This study aimed to establish an expert consensus on the effective components of CBT for depressed adults. An international panel of 120 CBT experts was invited to participate in a modified Delphi study. Thirty-two experts participated in round 1; 21 also provided data in round 2. In round 1, experts rated the effectiveness of 35 content and process components. A priori rules identified components carried forward to round 2, in which experts re-rated items and final consensus items were identified. Consensus was achieved for nine content components (ensuring understanding; developing and maintaining a good therapeutic alliance; explaining the rationale for CBT; eliciting feedback; identifying and challenging avoidant behaviour; activity monitoring; undertaking an initial assessment; relapse prevention methods; homework assignments); and three process components (ensuring therapist competence; scheduling sessions flexibly; scheduling sessions for 45–60 mins). Five of the twelve components identified were generic therapeutic competences rather than specific CBT items. There was less agreement about the effectiveness of cognitive components of CBT. This is an important first step in the development of novel approaches to delivering CBT that may increase access to treatment for patients

Einsatz von Protein- und Metabolit-Profiling-Methoden zur Unterscheidung von ökologischem und konventionellem Weizen

The interest in methods to proof organic food authenticity increases with the steadily rising popularity of food labelled organic. Profiling techniques enable the detection of a wide range of substances in biological samples. Together with bioinformatics tools these techniques are useful for biomarker searching, e. g. in plant extracts. Metabolomic and proteomic profiling techniques were used to screen organic and conventional wheat, originating from the DOK field trial in Switzerland. Up to 11 wheat varieties from three harvest years were analysed. We were able to detect a number of metabolites and proteins with significant differences between samples of conventional and organic grown wheat of the variety “Runal”. Results viewed across all 11 varieties indicated a higher influence of both the variety and the seasonal effects than the cultivation form. Nevertheless, PCA performed on metabolite data for the individual varieties and for individual growing seasons revealed a clustering according to the cultivation forms. Further research is necessary to assess, whether these methods can be applied to distinguish organic and conventional wheat from agricultural practice