Good governance and market-based reforms : a study of Bangladesh

&lsquo;Good governance&rsquo; is increasingly regarded as pivotal to development in developing countries. The six indicators recognized as the most effective measurement tools of &lsquo;good governance&rsquo; across the world are: voice and accountability; political stability and absence of violence; government effectiveness; regulatory quality; rule of law and control of corruption (Kaufmann, Kraay and Lobaton, 2003: 8&ndash;9). This paper investigates how lack of &lsquo;good governance&rsquo; affects the success and sustainability of the market-based reforms undertaken in the agriculture sector of Bangladesh. The reforms have been associated with increased food grain production, improved food security conditions and easy access by farmers to agricultural inputs. However, a significant problem has arisen recently: the sale of low quality and underweight agricultural inputs sometimes at higher prices has become common. Not only is this problem undermining the positive impact of the reforms, it is also threatening their sustainability. The paper argues that the problems with regulatory quality, rule of law and control of corruption &ndash; indicators of good governance &ndash; are the underlying reasons for this problem. In the context of increasing pressures from donors to pursue market-based reforms, this paper stresses the need for integrated governance linking government, business and civil society as paramount for promoting good governance for the success and sustainability of the reforms. <br /

Neurosurgical Randomized Trials in Low- and Middle-Income Countries

BACKGROUND The setting of a randomized trial can determine whether its findings are generalizable and can therefore apply to different settings. The contribution of low- and middle-income countries (LMICs) to neurosurgical randomized trials has not been systematically described before. OBJECTIVE To perform a systematic analysis of design characteristics and methodology, funding source, and interventions studied between trials led by and/or conducted in high-income countries (HICs) vs LMICs. METHODS From January 2003 to July 2016, English-language trials with >5 patients assessing any one neurosurgical procedure against another procedure, nonsurgical treatment, or no treatment were retrieved from MEDLINE, Scopus, and Cochrane Library. Income classification for each country was assessed using the World Bank Atlas method. RESULTS A total of 73.3% of the 397 studies that met inclusion criteria were led by HICs, whereas 26.7% were led by LMICs. Of the 106 LMIC-led studies, 71 were led by China. If China is excluded, only 8.8% were led by LMICs. HIC-led trials enrolled a median of 92 patients vs a median of 65 patients in LMIC-led trials. HIC-led trials enrolled from 7.6 sites vs 1.8 sites in LMIC-led studies. Over half of LMIC-led trials were institutionally funded (54.7%). The majority of both HIC- and LMIC-led trials evaluated spinal neurosurgery, 68% and 71.7%, respectively. CONCLUSION We have established that there is a substantial disparity between HICs and LMICs in the number of published neurosurgical trials. A concerted effort to invest in research capacity building in LMICs is an essential step towards ensuring context- and resource-specific high-quality evidence is generated