Performance-based financing in low-income and middle-income countries: isn't it time for a rethink?

This paper questions the view that performance-based financing (PBF) in the health sector is an effective, efficient and equitable approach to improving the performance of health systems in low-income and middle-income countries (LMICs). PBF was conceived as an open approach adapted to specific country needs, having the potential to foster system-wide reforms. However, as with many strategies and tools, there is a gap between what was planned and what is actually implemented. This paper argues that PBF as it is currently implemented in many contexts does not satisfy the promises. First, since the start of PBF implementation in LMICs, concerns have been raised on the basis of empirical evidence from different settings and disciplines that indicated the risks, cost and perverse effects. However, PBF implementation was rushed despite insufficient evidence of its effectiveness. Second, there is a lack of domestic ownership of PBF. Considering the amounts of time and money it now absorbs, and the lack of evidence of effectiveness and efficiency, PBF can be characterised as a donor fad. Third, by presenting itself as a comprehensive approach that makes it possible to address all aspects of the health system in any context, PBF monopolises attention and focuses policy dialogue on the short-term results of PBF programmes while diverting attention and resources from broader processes of change and necessary reforms. Too little care is given to system-wide and long-term effects, so that PBF can actually damage health services and systems. This paper ends by proposing entry points for alternative approaches

Description of causes of mortality in cattle over 2 years, foreseen interest for epidemiological surveillance

 Conference: International Conference on Animal Health Surveillance (ICAHS), Lyon, France, 17-20 May, 2011.International audienceWe are currently implementing a cattle mortality monitoring system in France. Building such a system requires a good knowledge of the baseline mortality and its determinants. Thanks to a database gathering data about more than 40 000 deaths of adult cattle that occurred in France from August 2000 to March 2001, we described the causes of mortality according to temporal and individual factors. Besides its interest for animal production science, this descriptive work will help us to define the baseline against which anomalies could be detected in the future mortality monitoring syste

Description of causes of mortality in cattle over 2 years, foreseen interest for epidemiological surveillance

 Conference: International Conference on Animal Health Surveillance (ICAHS), Lyon, France, 17-20 May, 2011.International audienceWe are currently implementing a cattle mortality monitoring system in France. Building such a system requires a good knowledge of the baseline mortality and its determinants. Thanks to a database gathering data about more than 40 000 deaths of adult cattle that occurred in France from August 2000 to March 2001, we described the causes of mortality according to temporal and individual factors. Besides its interest for animal production science, this descriptive work will help us to define the baseline against which anomalies could be detected in the future mortality monitoring syste

Defining syndromes using cattle meat inspection data for syndromic surveillance purposes: a statistical approach with the 2005-2010 data from ten French slaughterhouses.

International audienceBACKGROUND: The slaughterhouse is a central processing point for food animals and thus a source of both demographic data (age, breed, sex) and health-related data (reason for condemnation and condemned portions) that are not available through other sources. Using these data for syndromic surveillance is therefore tempting. However many possible reasons for condemnation and condemned portions exist, making the definition of relevant syndromes challenging.The objective of this study was to determine a typology of cattle with at least one portion of the carcass condemned in order to define syndromes. Multiple factor analysis (MFA) in combination with clustering methods was performed using both health-related data and demographic data. RESULTS: Analyses were performed on 381,186 cattle with at least one portion of the carcass condemned among the 1,937,917 cattle slaughtered in ten French abattoirs. Results of the MFA and clustering methods led to 12 clusters considered as stable according to year of slaughter and slaughterhouse. One cluster was specific to a disease of public health importance (cysticercosis). Two clusters were linked to the slaughtering process (fecal contamination of heart or lungs and deterioration lesions). Two clusters respectively characterized by chronic liver lesions and chronic peritonitis could be linked to diseases of economic importance to farmers. Three clusters could be linked respectively to reticulo-pericarditis, fatty liver syndrome and farmer's lung syndrome, which are related to both diseases of economic importance to farmers and herd management issues. Three clusters respectively characterized by arthritis, myopathy and Dark Firm Dry (DFD) meat could notably be linked to animal welfare issues. Finally, one cluster, characterized by bronchopneumonia, could be linked to both animal health and herd management issues. CONCLUSION: The statistical approach of combining multiple factor analysis with cluster analysis showed its relevance for the detection of syndromes using available large and complex slaughterhouse data. The advantages of this statistical approach are to i) define groups of reasons for condemnation based on meat inspection data, ii) help grouping reasons for condemnation among a list of various possible reasons for condemnation for which a consensus among experts could be difficult to reach, iii) assign each animal to a single syndrome which allows the detection of changes in trends of syndromes to detect unusual patterns in known diseases and emergence of new diseases

Delphi-like Compact Thermal Models Using Model Order Reduction

International audienc

Delphi-like Compact Thermal Models Using Model Order Reduction

International audienc