Reply to Justin D’Arms

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43371/1/11098_2005_Article_2319.pd

The Right Wrong‐Makers

Right- and wrong-making features ("moral grounds") are widely believed to play important normative roles, e.g. in morally apt or virtuous motivation. This paper argues that moral grounds have been systematically misidentified. Canonical statements of our moral theories tend to summarize, rather than directly state, the full range of moral grounds posited by the theory. Further work is required to "unpack" a theory's criterion of rightness and identify the features that are of ground-level moral significance. As a result, it is not actually true that maximizing value is the relevant right-making feature even for maximizing consequentialists. Focusing on the simple example of utilitarianism, I show how careful attention to the ground level can drastically influence how we think about our moral theories

Delivering HIV services in partnership: factors affecting collaborative working in a South African HIV programme

Abstract Background The involvement of Global Health Initiatives (GHIs) in delivering health services in low and middle income countries (LMICs) depends on effective collaborative working at scales from the local to the international, and a single GHI is effectively constructed of multiple collaborations. Research is needed focusing on how collaboration functions in GHIs at the level of health service management. Here, collaboration between local implementing agencies and departments of health involves distinct power dynamics and tensions. Using qualitative data from an evaluation of a health partnership in South Africa, this article examines how organisational power dynamics affected the operation of the partnership across five dimensions of collaboration: governance, administration, organisational autonomy, mutuality, and norms of trust and reciprocity. Results Managing the tension between the power to provide resources held by the implementing agency and the local Departments’ of Health power to access the populations in need of these resources proved critical to ensuring that the collaboration achieved its aims and shaped the way that each domain of collaboration functioned in the partnership. Conclusions These findings suggest that it is important for public health practitioners to critically examine the ways in which collaboration functions across the scales in which they work and to pay particular attention to how local power dynamics between partner organisations affect programme implementation

Responsibility and appropriate blame: The no difference view

How do the fact that an agent is morally responsible for a certain morally objectionable action and the fact that she is an appropriate target of blame for it relate to each other? Many authors inspired by Peter Strawson say that they necessarily co‐occur. Standard answers to the question of why they co‐occur say that the occurrence of one of the facts explains that the other obtains. This article presents a third option: that they are one and the same fact. There is no difference between the fact that a person is an appropriate target of blame for an objectionable action and the fact that she is morally responsible for it. This view has the advantage of being metaphysically more parsimonious and of answering, in an elegant and plausible way, an interesting question about which many standard theories of responsibility keep silent: what is it to be morally responsible simpliciter

Fidelity of HIV programme implementation by community health workers in rural Mopani district, South Africa: a community survey

Background South Africa has implemented a community health programme delivered by community health workers (CHWs) to strengthen primary healthcare services. Provision of community Human Immunodeficiency Virus (HIV) services constitutes an important component of this programme. To support effectiveness, we assessed fidelity of HIV programme implementation by CHWs from the community’s perspective in a rural South African setting. Methods A cross-sectional study was conducted targeting 900 randomly selected households in twelve wards of two sub-districts (Greater Giyani and Greater Letaba) of Mopani District (Limpopo Province, South Africa). Questionnaires were administered to the traditionally most appropriate adult member of the household. Included were questions related to the four standard components to measure implementation fidelity against local guidelines: coverage, frequency, duration and content of HIV programme implementation. Results Participants were enrolled at 534 households; in most other cases there was nobody or no adult member at home (n = 291). Reported coverage of 55% (141/253) and a frequency of 47% (66/140) were higher in Greater Giyani as compared to Greater Letaba (44%; 122/278 and 29%; 33/112, respectively, p = 0.007 for both comparisons). Coverage was not associated with the distance from the participant’s household to the facility (p = 0.93). Duration of programme delivery was reported to be high, where all CHW visits (253/253; 100%) were conducted within the last 6 months and the content delivered was adequate (242/253; 96%). Individuals reporting a CHW visit were more likely to know their HIV status than those not visited (OR = 2.0; 95% CI 1.06–3.8; p = 0.032). Among those visited by the CHW discussion of HIV was associated with knowing the HIV status (OR = 2.2; 95% CI 1.02–4.6; p = 0.044); in particular for women (OR = 2.9; 95% CI 1.5–5.4; p = 0.001). Conclusions This study demonstrates promising HIV programme implementation fidelity by CHWs in rural South Africa. Programme coverage and frequency should be improved whilst maintaining the good levels of duration and content. Resource investment, strengthening of operational structure, and research to identify other facilitators of programme implementation are warranted to improve programme effectiveness and impact

Hedonism and the experience machine

Money isn’t everything, so what is? Many government leaders, social policy theorists, and members of the general public have a ready answer: happiness. This paper examines an opposing view due to Robert Nozick, which centres on his experience-machine thought experiment. Despite the example's influence among philosophers, the argument behind it is riddled with difficulties. Dropping the example allows us to re-version Nozick's argument in a way that makes it far more forceful - and less dependent on people's often divergent intutions about the experience machine