WorldWideScience

Sample records for health system actors

  1. The international right to health: state obligations and private actors in the health care system.

    Science.gov (United States)

    O'Brien, Paula

    2013-09-01

    Most health systems have historically used a mix of public and private actors for financing and delivering care. But the last 30 years have seen many rich and middle-income countries moving to privatise parts of their health care systems. This phenomenon has generated concerns, especially about equitable access to health care. This article examines what the international right to the highest attainable standard of health in Art 12 of the International Covenant on Economic, Social and Cultural Rights says about the obligations of states which use private actors in health care. The article involves a close study of the primary documents of the key institutions responsible for interpreting and promoting Art 12. From this study, the article concludes that in mixed public-private health care systems, states not only retain primary responsibility for fulfilling the right to health but are subject to a range of additional specific responsibilities.

  2. Contracting private sector providers for public sector health services in Jalisco, Mexico: perspectives of system actors

    Directory of Open Access Journals (Sweden)

    González Luz

    2009-10-01

    Full Text Available Abstract Introduction Contracting out health services is a strategy that many health systems in the developing world are following, despite the lack of decisive evidence that this is the best way to improve quality, increase efficiency and expand coverage. A large body of literature has appeared in recent years focusing on the results of several contracting strategies, but very few papers have addressed aspects of the managerial process and how this can affect results. Case description This paper describes and analyses the perceptions and opinions of managers and workers about the benefits and challenges of the contracting model that has been in place for almost 10 years in the State of Jalisco, Mexico. Both qualitative and quantitative information was collected. An open-ended questionnaire was used to obtain information from a group of managers, while information provided by a self-selected group of workers was collected via a closed-ended questionnaire. The analysis contrasted the information obtained from each source. Discussion and Evaluation Findings show that perceptions of managers and workers vary for most of the items studied. For managers the model has been a success, as it has allowed for expansion of coverage based on a cost-effective strategy, while for workers the model also possesses positive elements but fails to provide fair labour relationships, which negatively affects their performance. Conclusion Perspectives of the two main groups of actors in Jalisco's contracting model are important in the design and adjustment of an adequate contracting model that includes managerial elements to give incentives to worker performance, a key element necessary to achieve the model's ultimate objectives. Lessons learnt from this study could be relevant for the experience of contracting models in other developing countries.

  3. Conceptualising the public health role of actors operating outside of formal health systems: The case of social enterprise.

    Science.gov (United States)

    Roy, Michael J; Baker, Rachel; Kerr, Susan

    2017-01-01

    This paper focuses on the role of actors that operate outside formal health systems, but nevertheless have a vital, if often under-recognised, role in supporting public health. The specific example used is the 'social enterprise', an organisation that seeks, through trading, to maximise social returns, rather than the distribution of profits to shareholders or owners. In this paper we advance empirical and theoretical understanding of the causal pathways at work in social enterprises, by considering them as a particularly complex form of public health 'intervention'. Data were generated through qualitative, in depth, semi-structured interviews and a focus group discussion, with a purposive, maximum variation sample of social enterprise practitioners (n = 13) in an urban setting in the west of Scotland. A method of analysis inspired by critical realism - Causation Coding - enabled the identification of a range of explanatory mechanisms and potential pathways of causation between engagement in social enterprise-led activity and various outcomes, which have been grouped into physical health, mental health and social determinants. The findings then informed the construction of an empirically-informed conceptual model to act as a platform upon which to develop a future research agenda. The results of this work are considered to not only encourage a broader and more imaginative consideration of what actually constitutes a public health intervention, but also reinforces arguments that actors within the Third Sector have an important role to play in addressing contemporary and future public health challenges. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  4. Integrating views on support for mid-level health worker performance: a concept mapping study with regional health system actors in rural Guatemala.

    Science.gov (United States)

    Hernández, Alison R; Hurtig, Anna-Karin; Dahlblom, Kjerstin; San Sebastián, Miguel

    2015-10-08

    Mid-level health workers are on the front-lines in underserved areas in many LMICs, and their performance is critical for improving the health of vulnerable populations. However, improving performance in low-resource settings is complex and highly dependent on the organizational context of local health systems. This study aims to examine the views of actors from different levels of a regional health system in Guatemala on actions to support the performance of auxiliary nurses, a cadre of mid-level health workers with a prominent role in public sector service delivery. A concept mapping study was carried out to develop an integrated view on organizational support and identify locally relevant strategies for strengthening performance. A total of 93 regional and district managers, and primary and secondary care health workers participated in generating ideas on actions needed to support auxiliary nurses' performance. Ideas were consolidated into 30 action items, which were structured through sorting and rating exercises, involving a total of 135 of managers and health workers. Maps depicting participants' integrated views on domains of action and dynamics in sub-groups' interests were generated using a sequence of multivariate statistical analyses, and interpreted by regional managers. The combined input of health system actors provided a multi-faceted view of actions needed to support performance, which were organized in six domains, including: Communication and coordination, Tools to orient work, Organizational climate of support, Motivation through recognition, Professional development and Skills development. The nature of relationships across hierarchical levels was identified as a cross-cutting theme. Pattern matching and go-zone maps indicated directions for action based on areas of consensus and difference across sub-groups of actors. This study indicates that auxiliary nurses' performance is interconnected with the performance of other health system actors who

  5. The Role of Non-State Actors in Strengthening Health Systems ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Home · What we do ... The services they provide vary immensely in complexity and national importance. ... for achieving universal health coverage in the form of quality health services that are accessible without the risk of financial hardship.

  6. Understanding Health Information Seeking from an Actor-Centric Perspective

    Directory of Open Access Journals (Sweden)

    Simon Batchelor

    2015-07-01

    Full Text Available This paper presents a conceptual approach for discussing health information seeking among poor households in Africa and Asia. This approach is part of a larger research endeavor aimed at understanding how health systems are adapting; with possibilities and constraints emerging. These health systems can be found in a context of the changing relationships between states, markets and civil society in low and middle income countries. The paper starts from an understanding of the health sector as a “health knowledge economy”, organized to provide people with access to knowledge and advice. The use of the term “health knowledge economy” draws attention to the ways the health sector is part of a broader knowledge economy changing the way individuals and households obtain and use specialist information. The paper integrates an actor centric approach with the theory of planned behavior. It seeks to identify the actors engaged in the health knowledge economy as a precursor to longer term studies on the uptake of innovations integrating health services with mobile phones, commonly designated as mHealth, contributing to an understanding of the potential vulnerabilities of poor people, and highlighting possible dangers if providers of health information and advice are strongly influenced by interest groups.

  7. Engaging Actors for Integrating Health Policy and Systems Research into Policy Making: Case Study from Haryana State in India

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    Shankar Prinja

    2017-09-01

    Full Text Available Background & objective: Good examples of evidence generation using Health Policy and Systems Research (HPSR in low and middle income countries (LMIC; and its application in policy making are scarce. In this paper, we describe the experience of establishing a system of HPSR from the Haryana state in India, outline how the HPSR is being utilized for policy making and programmatic decision making, and analyse the key factors which have been critical to the implementation and uptake of HPSR. Methods: Multiple methods are employed in this case study, ranging from unstructured in-depth interviews, review of the program and policy documents, and participatory notes from the meetings. The steps towards creation of a knowledge partnership between stakeholders are outlined. Four case studies i.e. development of a plan for universal health care (UHC, nutrition policy, centralized drug procurement system and use of RAPID appraisal method highlight the use of research evidence in agenda setting, policy formulation and policy implementation respectively. Results: Our analysis shows that the most important factor which contributed to Haryana model of HPSR was the presence of a dedicated and motivated team in National Rural Health Mission (NRHM at state level, many of whom were researchers by previous training. Overall, we conclude by highlighting the need for establishing an institutional mechanism at Central and State level where health service administrators and managers, academicians and researchers working in the field of health system from medical colleges, public health schools, management and technology institutions and social science universities can identify health system research priorities. Increased budgetary allocation for HPSR is required.

  8. Engaging Actors for Integrating Health Policy and Systems Research into Policy Making: Case Study from Haryana State in India

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    2017-09-01

    Full Text Available Background & objective: Good examples of evidence generation using Health Policy and Systems Research (HPSR in low and middle income countries (LMIC; and its application in policy making are scarce. In this paper, we describe the experience of establishing a system of HPSR from the Haryana state in India, outline how the HPSR is being utilized for policy making and programmatic decision making, and analyse the key factors which have been critical to the implementation and uptake of HPSR. Methods: Multiple methods are employed in this case study, ranging from unstructured in-depth interviews, review of the program and policy documents, and participatory notes from the meetings. The steps towards creation of a knowledge partnership between stakeholders are outlined. Four case studies i.e. development of a plan for universal health care (UHC, nutrition policy, centralized drug procurement system and use of RAPID appraisal method highlight the use of research evidence in agenda setting, policy formulation and policy implementation respectively. Results: Our analysis shows that the most important factor which contributed to Haryana model of HPSR was the presence of a dedicated and motivated team in National Rural Health Mission (NRHM at state level, many of whom were researchers by previous training. Overall, we conclude by highlighting the need for establishing an institutional mechanism at Central and State level where health service administrators and managers, academicians and researchers working in the field of health system from medical colleges, public health schools, management and technology institutions and social science universities can identify health system research priorities. Increased budgetary allocation for HPSR is required.

  9. [Indicators of governance in mental health policies and programmes in Mexico: a perspective of key actors].

    Science.gov (United States)

    Díaz-Castro, Lina; Arredondo, Armando; Pelcastre-Villafuerte, Blanca Estela; Hufty, Marc

    To analyse the role of Mexico's mental health system governance in the development of mental health policies and programmes, from the perspective of its own actors. A map was developed for identifying the actors in Mexico's mental health system. A guide was designed for in-depth interviews, which were recorded and arranged in categories for their analysis. The Atlas-ti v.7 software was used for the organisation of qualitative data and Policy Maker v.4 was used to determine the position and influence of actors within the health system. The actors were identified according to their level of influence in mental health policies: high, medium and low. Actors with a high level of influence participate in national policies, actors with medium influence are involved in regional or local policies and the participation of actors with a low level of influence is considered marginal. This study facilitated understanding of governance in mental health. The level of influence of the actors directly affects the scope of governance indicators. Relevant data were obtained to improve policies in mental health care. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. What Can We Learn About the Processes of Regulation of Tuberculosis Medicines From the Experiences of Health Policy and System Actors in India, Tanzania, and Zambia?

    Directory of Open Access Journals (Sweden)

    Kabir Sheikh

    2016-07-01

    Full Text Available Background: The unregulated availability and irrational use of tuberculosis (TB medicines is a major issue of public health concern globally. Governments of many low- and middle-income countries (LMICs have committed to regulating the quality and availability of TB medicines, but with variable success. Regulation of TB medicines remains an intractable challenge in many settings, but the reasons for this are poorly understood. The objective of this paper is to elaborate processes of regulation of quality and availability of TB medicines in three LMICs – India, Tanzania, and Zambia – and to understand the factors that constrain and enable these processes. Methods: We adopted the action-centred approach of policy implementation analysis that draws on the experiences of relevant policy and health system actors in order to understand regulatory processes. We drew on data from three case studies commissioned by the World Health Organization (WHO, on the regulation of TB medicines in India, Tanzania, and Zambia. Qualitative research methods were used, including in-depth interviews with 89 policy and health system actors and document review. Data were organized thematically into accounts of regulators’ authority and capacity; extent of policy implementation; and efficiency, transparency, and accountability. Results: In India, findings included the absence of a comprehensive policy framework for regulation of TB medicines, constraints of authority and capacity of regulators, and poor implementation of prescribing and dispensing norms in the majority private sector. Tanzania had a policy that restricted import, prescribing and dispensing of TB medicines to government operators. Zambia procured and dispensed TB medicines mainly through government services, albeit in the absence of a single policy for restriction of medicines. Three cross-cutting factors emerged as crucially influencing regulatory processes - political and stakeholder support for

  11. Private actors, global health and learning the lessons of history.

    Science.gov (United States)

    Youde, Jeremy

    2016-01-01

    Private business and philanthropic organizations have played a prominent role in the response to the Ebola outbreak in West Africa and the support of global health governance more broadly. While this involvement may appear to be novel or unprecedented, this article argues that this active role for private actors and philanthropies actually mirrors the historical experience of cross-border health governance in the first half of the twentieth century. By examining the experiences, roles and criticisms of the Rockefeller Foundation's International Health Division and the Bill and Melinda Gates Foundation, it is possible to identify potential opportunities for better cooperation between public and private actors in global health governance.

  12. Exploration of a Vision for Actor Database Systems

    DEFF Research Database (Denmark)

    Shah, Vivek

    of these services. Existing popular approaches to building these services either use an in-memory database system or an actor runtime. We observe that these approaches have complementary strengths and weaknesses. In this dissertation, we propose the integration of actor programming models in database systems....... In doing so, we lay down a vision for a new class of systems called actor database systems. To explore this vision, this dissertation crystallizes the notion of an actor database system by defining its feature set in light of current application and hardware trends. In order to explore the viability...... of the outlined vision, a new programming model named Reactors has been designed to enrich classic relational database programming models with logical actor programming constructs. To support the reactor programming model, a high-performance in-memory multi-core OLTP database system named REACTDB has been built...

  13. Linkage Mechanisms among key Actors in Rice Innovation System ...

    African Journals Online (AJOL)

    In assessment of linkage mechanisms among key actors in rice innovation system in southeast Nigeria, actors were classified into six major groups according to their main activity in the system namely research agency, policy personnel, technology transfer agencies, farmers, marketers and consumers. These constituted the ...

  14. Policy analysis of multi-actor systems

    CERN Document Server

    Enserink, Bert; Kwakkel, Jan; Thissen, Wil; Koppenjan, Joop; Bots, Pieter

    2010-01-01

    Policy analysts love solving complex problems. Their favorite problems are not just technically complex but also characterized by the presence of many different social actors that hold conflicting interests, objectives, and perceptions and act strategically to get the best out of a problem situation. This book offers guidance for policy analysts who want to assess if and how their analysis could be of help, based on the premise that problem formulation is the cornerstone in addressing complex problems. This book positions policy analysis within the theories on processes of policy making, and f

  15. [Social and political actors in the formulation of health reform in Spain].

    Science.gov (United States)

    Etviti, J E; Leyva, R F

    1995-01-01

    An analysis of the participation of social and political actors in the process of formulating health policy allows one to understand the specific characteristics of the organization and operation of a health system. This study analyzes the drafting process for the General Health Act (LGS) in Spain with the purpose of establishing the relationship between social, political, and economic actors in both the formulation of the Act itself and the organization of the Spanish Health System. A case study was carried out from 1982 through 1986. Documentary parliamentary data, the medical press, national magazines and journals, and press reports by political, social, and public health actors were analyzed. The first version of the General Health Act presented by the Spanish Socialist Workers' Party (PSOE) proposed a health system with funding and public administration aimed at achieving universal health coverage, integrated care, community participation, and health education. This proposal was submitted to a complex negotiating process with business groups, unions, and health professionals. The General Health Act as finally approved excludes the principles of equity and incorporates private interests in health: "free choice of doctor and hospital", public funding and private administration of the health system, and the establishment of Social Security as the core of the entire health system.

  16. Actors: A Model of Concurrent Computation in Distributed Systems.

    Science.gov (United States)

    1985-06-01

    Artificial Intelligence Labora- tory of the Massachusetts Institute of Technology. Support for the labora- tory’s aritificial intelligence research is...RD-A157 917 ACTORS: A MODEL OF CONCURRENT COMPUTATION IN 1/3- DISTRIBUTED SY𔃿TEMS(U) MASSACHUSETTS INST OF TECH CRMBRIDGE ARTIFICIAL INTELLIGENCE ...Computation In Distributed Systems Gui A. Aghai MIT Artificial Intelligence Laboratory Thsdocument ha. been cipp-oved I= pblicrelease and sale; itsI

  17. Social health insurance without corporate actors: changes in self-regulation in Germany, Poland and Turkey.

    Science.gov (United States)

    Wendt, Claus; Agartan, Tuba I; Kaminska, Monika Ewa

    2013-06-01

    Social health insurance in Western Europe has for many years been characterized by self-regulation in which specific conditions of healthcare financing and provision have been regulated by social-insurance institutions through mutual self-governance. However, the principle of self-regulation has recently been weakened by increased state regulation and market competition, which were introduced in response to economic and social changes. Even in Germany, which has been regarded as an "ideal-type" health insurance system and in which self-regulation remains at the core of healthcare governance, more direct state intervention has gained in importance. On the other hand, in countries such as Poland and Turkey, where this tradition of self-regulation is missing, social health insurance is deemed a financing instrument but not an instrument of governance and corporate actors are not accorded a significant role in regulation. This article investigates how social health insurance systems are regulated in contexts in which corporate actors' role is either diminishing or absent by focusing on three crucial areas of regulation: financing, the remuneration of medical doctors, and the definition of the healthcare benefit package. In Germany, state regulation has increased in healthcare financing and remuneration while the role of corporate actors has grown in the definition of the benefits package. In Poland and Turkey, on the other hand, reforms have maintained the status quo in terms of the strong regulatory, budgetary, and managerial powers of the state and very limited involvement of corporate actors. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Visualising Actor Network for Cooperative Systems in Marine Technology

    DEFF Research Database (Denmark)

    Pan, Yushan; Finken, Sisse

    2016-01-01

    Awareness is a concept familiar to specialists within the field of Computer Supported Cooperative Work (CSCW). It is superior for analysing and describing some of the ad hoc work activities that unfold in cooperation. Such informal activities are outside the scope of engineers’ formal models, whi...... that shape computer systems. The aim, thus, is to portray cooperative work in a way that can be valuable for engineers implementing marine technology. We do so by way of presenting a transferring technique (2T) using insights from the CSCW field and Actor Network Theory (ANT)....

  19. A Low-cost System for Generating Near-realistic Virtual Actors

    Science.gov (United States)

    Afifi, Mahmoud; Hussain, Khaled F.; Ibrahim, Hosny M.; Omar, Nagwa M.

    2015-06-01

    Generating virtual actors is one of the most challenging fields in computer graphics. The reconstruction of a realistic virtual actor has been paid attention by the academic research and the film industry to generate human-like virtual actors. Many movies were acted by human-like virtual actors, where the audience cannot distinguish between real and virtual actors. The synthesis of realistic virtual actors is considered a complex process. Many techniques are used to generate a realistic virtual actor; however they usually require expensive hardware equipment. In this paper, a low-cost system that generates near-realistic virtual actors is presented. The facial features of the real actor are blended with a virtual head that is attached to the actor's body. Comparing with other techniques that generate virtual actors, the proposed system is considered a low-cost system that requires only one camera that records the scene without using any expensive hardware equipment. The results of our system show that the system generates good near-realistic virtual actors that can be used on many applications.

  20. Lone-Actor Terrorism. Toolkit Paper 1 : Practical Guidance for Mental Health Practitioners and Social Workers

    NARCIS (Netherlands)

    Bakker, E.; Roy, de van Zuijdewijn J.

    2016-01-01

    The aim of this paper is to draw out practical implications for mental health practitioners and social workers in dealing with Lone-Actor Terrorism. It is not intended to provide a profile of lone-actor terrorists, but rather to offer guidance that may be of use to practitioners in Europe (and

  1. How institutional forces, ideas and actors shaped population health planning in Australian regional primary health care organisations.

    Science.gov (United States)

    Javanparast, Sara; Freeman, Toby; Baum, Fran; Labonté, Ronald; Ziersch, Anna; Mackean, Tamara; Reed, Richard; Sanders, David

    2018-03-20

    Worldwide, there are competing norms driving health system changes and reorganisation. One such norm is that of health systems' responsibilities for population health as distinct from a focus on clinical services. In this paper we report on a case study of population health planning in Australian primary health care (PHC) organisations (Medicare Locals, 2011-2015). Drawing on institutional theory, we describe how institutional forces, ideas and actors shaped such planning. We reviewed the planning documents of the 61 Medicare Locals and rated population health activities in each Medicare Local. We also conducted an online survey and 50 interviews with Medicare Local senior staff, and an interview and focus group with Federal Department of Health staff. Despite policy emphasis on population health, Medicare Locals reported higher levels of effort and capacity in providing clinical services. Health promotion and social determinants of health activities were undertaken on an ad hoc basis. Regulatory conditions imposed by the federal government including funding priorities and time schedules, were the predominant forces constraining population health planning. In some Medicare Locals, this was in conflict with the normative values and what Medicare Locals felt ought to be done. The alignment between the governmental and the cultural-cognitive forces of a narrow biomedical approach privileged clinical practice and ascribed less legitimacy to action on social determinants of health. Our study also shed light on the range of PHC actors and how their agency influenced Medicare Locals' performance in population health. The presence of senior staff or community boards with a strong commitment to population health were important in directing action towards population health and equity. There are numerous institutional, normative and cultural factors influencing population health planning. The experience of Australian Medicare Locals highlights the difficulties of planning in

  2. Public Health Knowledge Utilisation by Policy Actors: An Evaluation Study in Midden-Holland, the Netherlands

    Science.gov (United States)

    de Goede, Joyce; Steenkamer, Betty; Treurniet, Henriëtte; Putters, Kim; van Oers, Hans

    2011-01-01

    A comprehensive report has been prepared on the state of public health and healthcare in the Midden-Holland region of the Netherlands. This study describes the development of the report and the mechanisms behind public health knowledge utilisation by three groups of health policy actors: local authorities, public health professionals and regional…

  3. Control del cáncer cervicouterino en Colombia: la perspectiva de los actores del sistema de salud Control of cervical cancer in Colombia: the perspective of the health system

    Directory of Open Access Journals (Sweden)

    Carolina Wiesner-Ceballos

    2009-01-01

    tamizaje. Se requiere un programa integrado y mejor organizado en el que participen los diferentes actores del sistema de salud.OBJECTIVES: To characterize the health system stakeholder's perspective on the basics of the political, economic, and sanitary context, as well as the ways in which control activities are being realized in four of Colombia's health departments. METHODS: This was a qualitative study of four Colombian health departments chosen for their differing cervical cancer mortality rates and their planned disease control efforts (Boyacá, Caldas, Magdalena, and Tolima. Semistructured interviews were conducted of health care managers, insurance coordinators, and public and private health institutions at the departmental and municipals levels. Focus groups comprised of professionals from health insurance companies and health care services providers were convened. Data analysis was based on the grounded theory with open codes related to the roles of health care managers, insurance companies, and heath care services provided. The technical reports were compared to the testimonies of interviewees. RESULTS: Thirty-eight interviews and 14 focus groups (70.9% response rate were conducted and 12 technical reports reviewed. Cervical cancer is not perceived to be a public health priority. Interest centers on the flow of financial resources within the health system. Findings indicated unsatisfactory communication among the stakeholders and no consensus on the subject. Planning is limited to meeting the status quo. Staffing is inadequate. Cases with positive outcomes are lost to follow-up due to the fragmentation that results from affiliation with different health care systems. CONCLUSIONS: The financial situation, normative planning, and the challenges of decentralization affect the skill-building, at-risk coverage, and the control activities needed for effective screening programs. What is needed is an integrated, more efficiently organized program in which all the

  4. Lone-Actor Terrorism. Toolkit Paper 1: Practical Guidance for Mental Health Practitioners and Social Workers

    OpenAIRE

    Bakker, E.; Roy, de, van Zuijdewijn J.

    2016-01-01

    The aim of this paper is to draw out practical implications for mental health practitioners and social workers in dealing with Lone-Actor Terrorism. It is not intended to provide a profile of lone-actor terrorists, but rather to offer guidance that may be of use to practitioners in Europe (and beyond), supporting the development of strategies to detect and deal with potential lone-actor terrorists and to understand the possible risk posed by persons of interest. This paper presents three sets...

  5. Robust Actor-Critic Contextual Bandit for Mobile Health (mHealth) Interventions

    OpenAIRE

    Zhu, Feiyun; Guo, Jun; Li, Ruoyu; Huang, Junzhou

    2018-01-01

    We consider the actor-critic contextual bandit for the mobile health (mHealth) intervention. State-of-the-art decision-making algorithms generally ignore the outliers in the dataset. In this paper, we propose a novel robust contextual bandit method for the mHealth. It can achieve the conflicting goal of reducing the influence of outliers while seeking for a similar solution compared with the state-of-the-art contextual bandit methods on the datasets without outliers. Such performance relies o...

  6. Politics, class actors, and health sector reform in Brazil and Venezuela.

    Science.gov (United States)

    Mahmood, Qamar; Muntaner, Carles

    2013-03-01

    Universal access to healthcare has assumed renewed importance in global health discourse, along with a focus on strengthening health systems. These developments are taking place in the backdrop of concerted efforts to advocate moving away from vertical, disease-based approaches to tackling health problems. While this approach to addressing public health problems is a step in the right direction, there is still insufficient emphasis on understanding the socio-political context of health systems. Reforms to strengthen health systems and achieve universal access to healthcare should be cognizant of the importance of the socio-political context, especially state-society relations. That context determines the nature and trajectory of reforms promoting universality or any pro-equity change. Brazil and Venezuela in recent years have made progress in developing healthcare systems that aim to achieve universal access. These achievements are noteworthy given that, historically, both countries had a long tradition of healthcare systems which were highly privatized and geared towards access to healthcare for a small segment of the population while the majority was excluded. These achievements are also remarkable since they took place in an era of neoliberalism when many states, even those with universally-based healthcare systems, were moving in the opposite direction. We analyze the socio-political context in each of these countries and look specifically at how the changing state-society relations resulted in health being constitutionally recognized as a social right. We describe the challenges that each faced in developing and implementing healthcare systems embracing universality. Our contention is that achieving the principle of universality in healthcare systems is less of a technical matter and more a political project. It involves opposition from the socially conservative elements in the society. Navigation to achieve this goal requires a political strategy that

  7. Banking for health: the role of financial sector actors in investing in global health.

    Science.gov (United States)

    Krech, Rüdiger; Kickbusch, Ilona; Franz, Christian; Wells, Nadya

    2018-01-01

    The world faces multiple health financing challenges as the global health burden evolves. Countries have set an ambitious health policy agenda for the next 15 years with prioritisation of universal health coverage under the Sustainable Development Goals. The scale of investment needed for equitable access to health services means global health is one of the key economic opportunities for decades to come. New financing partnerships with the private sector are vital. The aim of this study is to unlock additional financing sources, acknowledging the imperative to link financial returns to the providers of capital, and create profitable, sustainable financing structures. This paper outlines the global health investment opportunity exploring intersections of financial and health sector interests, and the role investment in health can play in economic development. Considering increasing demand for impact investments, the paper explores responsible financing initiatives and expansion of the global movement for sustainable capital markets. Adding an explicit health component (H) to the Environmental, Social and Governance (ESG) investment criteria, creating the ESG+H initiative, could serve as catalyst for the inclusion of health criteria into mainstream financial actors' business practices and investment objectives. The conclusion finds that health considerations directly impact profitability of the firm and therefore should be incorporated into financial analysis. Positive assessment of health impact, at a broad societal or environmental level, as well as for a firm's employees can become a value enhancing competitive advantage. An ESG+H framework could incorporate this into mainstream financial decision-making and into scalable investment products.

  8. Actor Network Theory Approach and its Application in Investigating Agricultural Climate Information System

    Directory of Open Access Journals (Sweden)

    Maryam Sharifzadeh

    2013-03-01

    Full Text Available Actor network theory as a qualitative approach to study complex social factors and process of socio-technical interaction provides new concepts and ideas to understand socio-technical nature of information systems. From the actor network theory viewpoint, agricultural climate information system is a network consisting of actors, actions and information related processes (production, transformation, storage, retrieval, integration, diffusion and utilization, control and management, and system mechanisms (interfaces and networks. Analysis of such systemsembody the identification of basic components and structure of the system (nodes –thedifferent sources of information production, extension, and users, and the understanding of how successfully the system works (interaction and links – in order to promote climate knowledge content and improve system performance to reach agricultural development. The present research attempted to introduce actor network theory as research framework based on network view of agricultural climate information system.

  9. Mental health in France, policies and actors: developing administrative knowledge in a segmented world.

    Science.gov (United States)

    Mossé, Philippe; Maury, Caroline; Daumerie, Nicolas; Roelandt, Jean-Luc

    2013-01-01

    The new mental health care policy, which has been set up in France, involves a change of paradigm, which has been going on since the 2000s: the emphasis is shifting from psychiatry to mental health care. This shift mainly concerns the knowledge about mental health is produced and circulates among an increasingly large number of bodies. Mainly grounded on actor interview analysis, official reports and blueprints, this study shows that the results of this process are numerous. They include the development of ambulatory care and strong moves towards decentralization. More data and knowledge are therefore to be shared in this more complex system. However, the French State, in the form of the central administration, is taking advantage of this move and is still contributing significantly to the definition and implementation of the new policy. On the other hand, the new governance dynamic is not leading to standardization of medical practices, as the mental health field remains highly heterogeneous. Copyright © 2012 John Wiley & Sons, Ltd.

  10. 'Two clicks and I'm in!' Patients as co-actors in managing health data through a personal health record infrastructure.

    Science.gov (United States)

    Zanutto, Alberto

    2017-06-01

    One of the most significant changes in the healthcare field in the past 10 years has been the large-scale digitalization of patients' healthcare data, and an increasing emphasis on the importance of patients' roles in cooperating with healthcare professionals through digital infrastructures. A project carried out in the North of Italy with the aim of creating a personal health record has been evaluated over the course of 5 years by means of mixed method fieldwork. Two years after the infrastructure was put into regular service, the way in which patients are represented in the system and patient practices have been studied using surveys and qualitative interviews. The data show that, first, patients have become co-actors in describing their clinical histories; second, that they have become co-actors in the diagnosis process; and finally, they have become co-actors in the management of time and space as regards their specific state of health.

  11. Health care delivery systems.

    NARCIS (Netherlands)

    Stevens, F.; Zee, J. van der

    2007-01-01

    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,

  12. AN ANALYSIS OF THE ROLE OF ECONOMIC ACTORS IN THE WTO DISPUTE SETTLEMENT SYSTEM: LEGAL OR POLITICAL ISSUE?

    Directory of Open Access Journals (Sweden)

    Intan Soeparna

    2015-10-01

    Full Text Available Economic actors are the main trade player in the World Trade Organization, although, the relation between WTO and economic actor is built by trade regulation that is negotiated among the WTO Members. Nothing in the WTO regulates economic actors to involve directly in the WTO, especially in the WTO dispute settlement system. Nevertheless, the debate amongst experts regarding the involvement of economic actors in the WTO dispute settlement system is unavoidable. This article therefore discusses the possibility of the involvement of economic actors in the WTO dispute settlement system, whether there is legal and political point of views

  13. Pathways of undue influence in health policy-making: a main actor's perspective.

    Science.gov (United States)

    Hernández-Aguado, Ildefonso; Chilet-Rosell, Elisa

    2018-02-01

    It is crucial to know the extent to which influences lead to policy capture-by which the policy-making process is shifted away from the public interest towards narrow private interests. Using the case study of Spain, our aim was to identify interactions between public administration, civil society and private companies that could influence health policies. 54 semistructured interviews with key actors related to health policy. The interviews were used to gather information on main policy actors as well as on direct and subtle influences that could modify health policies. The analysis identified and described, from the interviewed persons' experiences, both the inappropriate influences exerted on the actors and those that they exerted. Inappropriate influences were identified at all levels of administration and policy. They included actions for personal benefits, pressure for blocking health policies and pressure from high levels of government in favour of private corporations. The private sector played a significant role in these strategies through bribery, personal gifts, revolving doors, negative campaigns and by blocking unfavourable political positions or determining the knowledge agenda. The interviewees reported subtle forms of influence (social events, offers of technical support, invitations, etc) that contributed to the intellectual and cultural capture of health officials. The health policy decision-making processes in Spain are subject to influences by stakeholders that determine a degree of policy capture, which is avoidable. The private sector uses different strategies, from subtle influences to outright corruption, taking advantage in many cases of flexible legislation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. From actors to agents in socio-ecological systems models.

    Science.gov (United States)

    Rounsevell, M D A; Robinson, D T; Murray-Rust, D

    2012-01-19

    The ecosystem service concept has emphasized the role of people within socio-ecological systems (SESs). In this paper, we review and discuss alternative ways of representing people, their behaviour and decision-making processes in SES models using an agent-based modelling (ABM) approach. We also explore how ABM can be empirically grounded using information from social survey. The capacity for ABM to be generalized beyond case studies represents a crucial next step in modelling SESs, although this comes with considerable intellectual challenges. We propose the notion of human functional types, as an analogy of plant functional types, to support the expansion (scaling) of ABM to larger areas. The expansion of scope also implies the need to represent institutional agents in SES models in order to account for alternative governance structures and policy feedbacks. Further development in the coupling of human-environment systems would contribute considerably to better application and use of the ecosystem service concept.

  15. Los actores políticos y sociales en la formulación de la reforma sanitaria, en España Social and political actors in the formulation of health reform in Spain

    Directory of Open Access Journals (Sweden)

    Joaquina E. Etviti

    1995-03-01

    Full Text Available Estudiar la participación de los actores sociales y políticos en el proceso de formulación de la politica de salud, permite comprender las características específicas de organización y funcionamiento de un sistema de salud. Este trabajo analiza el proceso de formulación de la Ley General de Salud (LGS en España con el propósito de conocer la relación entre la participación de actores sociales, políticos y económicos en la formulación de la LGS y la conformación del sistema sanitario español. Para ello, se realizó un estudio de caso durante 1982-1986. Se analizó información documental parlamentaria y prensa médica, principales diarios y revistas e informes y prensa de los actores políticos, sociales y sanitarios. La primera versión de LGS presentada por el PSOE propuso un sistema de salud con financiamiento y gestión pública para lograr cobertura universal, atención integral, participación comunitaria y educación sanitaria. Esta propuesta fue sometida a compleja negociación con grupos empresariales, sindicatos, profesionales de salud. La LGS aprobada excluye las principios de equidad e incorpora los intereses económicos privados alrededor de la salud: "libre elección" médico-hospitalaria, financiamiento público y la gestión privada del sistema de salud, y establece a la Seguridad Social como rector del sistema.An analysis of the participation of social and political actors in the process of formulating health policy allows one to understand the specific characteristics of the organization and operation of a health system. This study analyzes the drafting process for the General Health Act (LGS in Spain with the purpose of establishing the relationship between social, political, and economic actors in both the formulation of the Act itself and the organization of the Spanish Health System. A case study was carried out from 1982 through 1986. Documentary parliamentary data, the medical press, national magazines and

  16. Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors.

    Science.gov (United States)

    Supper, I; Catala, O; Lustman, M; Chemla, C; Bourgueil, Y; Letrilliart, L

    2015-12-01

    The epidemiological transition calls for redefining the roles of the various professionals involved in primary health care towards greater collaboration. We aimed to identify facilitators of, and barriers to, interprofessional collaboration in primary health care as perceived by the actors involved, other than nurses. Systematic review using synthetic thematic analysis of qualitative research. Articles were retrieved from Medline, Web of science, Psychinfo and The Cochrane library up to July 2013. Quality and relevance of the studies were assessed according to the Dixon-Woods criteria. The following stakeholders were targeted: general practitioners, pharmacists, mental health workers, midwives, physiotherapists, social workers and receptionists. Forty-four articles were included. The principal facilitator of interprofessional collaboration in primary care was the different actors' common interest in collaboration, perceiving opportunities to improve quality of care and to develop new professional fields. The main barriers were the challenges of definition and awareness of one another's roles and competences, shared information, confidentiality and responsibility, team building and interprofessional training, long-term funding and joint monitoring. Interprofessional organization and training based on appropriate models should support collaboration development. The active participation of the patient is required to go beyond professional boundaries and hierarchies. Multidisciplinary research projects are recommended. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Actor-network-theory perspective on a forestry decision support system design

    NARCIS (Netherlands)

    Boerboom, L.G.J.; Ferritti, V.

    2014-01-01

    Use of decision support systems (DSS) has thus far been framed as a social process of adoption or technical process of usability. We analyze the development of a DSS as a process of institutionalization of new as well as drift of existing practices. We write an Actor-Network-Theory (ANT) account,

  18. Harnessing the plurality of actor frames in social-ecological systems : Ecological sanitation in Bolivia

    NARCIS (Netherlands)

    Eelderink, M.; Vervoort, J.; Snel, D.; de Castro, F.

    2017-01-01

    This article uses a case study on ecological sanitation as a basis for lessons on identifying and harnessing the plurality of actor frames in social-ecological systems, thereby moving beyond the advocacy positions often taken by implementing NGOs. The study aimed to explore how perspectives between

  19. The greatest happiness of the greatest number? Policy actors' perspectives on the limits of economic evaluation as a tool for informing health care coverage decisions in Thailand.

    Science.gov (United States)

    Teerawattananon, Yot; Russell, Steve

    2008-09-26

    This paper presents qualitative findings from an assessment of the acceptability of using economic evaluation among policy actors in Thailand. Using cost-utility data from two economic analyses a hypothetical case scenario was created in which policy actors had to choose between two competing interventions to include in a public health benefit package. The two competing interventions, laparoscopic cholecystectomy (LC) for gallbladder disease versus renal dialysis for chronic renal disease, were selected because they highlighted conflicting criteria influencing the allocation of healthcare resources. Semi-structured interviews were conducted with 36 policy actors who play a major role in resource allocation decisions within the Thai healthcare system. These included 14 policy makers at the national level, five hospital directors, ten health professionals and seven academics. Twenty six out of 36 (72%) respondents were not convinced by the presentation of economic evaluation findings and chose not to support the inclusion of a proven cost-effective intervention (LC) in the benefit package due to ethical, institutional and political considerations. There were only six respondents, including three policy makers at national level, one hospital director, one health professional and one academic, (6/36, 17%) whose decisions were influenced by economic evaluation evidence. This paper illustrates limitations of using economic evaluation information in decision making priorities of health care, perceived by different policy actors. It demonstrates that the concept of maximising health utility fails to recognise other important societal values in making health resource allocation decisions.

  20. The greatest happiness of the greatest number? Policy actors' perspectives on the limits of economic evaluation as a tool for informing health care coverage decisions in Thailand

    Directory of Open Access Journals (Sweden)

    Russell Steve

    2008-09-01

    Full Text Available Abstract Background This paper presents qualitative findings from an assessment of the acceptability of using economic evaluation among policy actors in Thailand. Using cost-utility data from two economic analyses a hypothetical case scenario was created in which policy actors had to choose between two competing interventions to include in a public health benefit package. The two competing interventions, laparoscopic cholecystectomy (LC for gallbladder disease versus renal dialysis for chronic renal disease, were selected because they highlighted conflicting criteria influencing the allocation of healthcare resources. Methods Semi-structured interviews were conducted with 36 policy actors who play a major role in resource allocation decisions within the Thai healthcare system. These included 14 policy makers at the national level, five hospital directors, ten health professionals and seven academics. Results Twenty six out of 36 (72% respondents were not convinced by the presentation of economic evaluation findings and chose not to support the inclusion of a proven cost-effective intervention (LC in the benefit package due to ethical, institutional and political considerations. There were only six respondents, including three policy makers at national level, one hospital director, one health professional and one academic, (6/36, 17% whose decisions were influenced by economic evaluation evidence. Conclusion This paper illustrates limitations of using economic evaluation information in decision making priorities of health care, perceived by different policy actors. It demonstrates that the concept of maximising health utility fails to recognise other important societal values in making health resource allocation decisions.

  1. Shaping the midwifery profession in Nepal - Uncovering actors' connections using a Complex Adaptive Systems framework.

    Science.gov (United States)

    Bogren, Malin Upper; Berg, Marie; Edgren, Lars; van Teijlingen, Edwin; Wigert, Helena

    2016-12-01

    To explore how actors connect in a system aiming at promoting the establishment of a midwifery profession in Nepal. A qualitative explorative study based on the framework of Complex Adaptive Systems. Semi-structured interviews were conducted with 17 key people representing eight different organisations (actors) promoting the development of the midwifery profession. The actors' connections can be described with a complex set of facilitators for and barriers to promoting the establishment of a midwifery profession. The identified facilitators for this establishment in Nepal are (1) a common goal and (2) a desire to collaborate, whilst the barriers are (1) different political interests and priorities, (2) competing interests of the nursing profession and societal views, (3) divergent academic opinions on a midwifery profession, and (4) insufficient communication. The results also showed that Nepalese society cannot distinguish between nursing and midwifery and that the public support for a midwifery profession was hence minimal. The move of midwifery from an occupation to a profession in Nepal is an on-going, challenging process. The study indicates the importance of understanding the motivations of, and barriers perceived by, actors that can promote or obstruct the establishment of the midwifery profession. It also points to the importance of informing the wider public about the role and responsibility of an autonomous midwifery profession. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. A difficult balancing act: policy actors' perspectives on using economic evaluation to inform health-care coverage decisions under the Universal Health Insurance Coverage scheme in Thailand.

    Science.gov (United States)

    Teerawattananon, Yot; Russell, Steve

    2008-03-01

    In Thailand, policymakers have come under increasing pressure to use economic evaluation to inform health-care resource allocation decisions, especially after the introduction of the Universal Health Insurance Coverage (UC) scheme. This article presents qualitative findings from research that assessed a range of policymakers' perspectives on the acceptability of using economic evaluation for the development of health-care benefit packages in Thailand. The policy analysis examined their opinions about existing decision-making processes for including health interventions in the UC benefit package, their understanding of health economic evaluation, and their attitudes, acceptance, and values relating to the use of the method. Semistructured interviews were conducted with 36 policy actors who play a major role or have some input into health resource allocation decisions within the Thai health-care system. These included 14 senior policymakers at the national level, 5 hospital directors, 10 health professionals, and 7 academics. Policy actors thought that economic evaluation information was relevant for decision-making because of the increasing need for rationing and more transparent criteria for making UC coverage decisions. Nevertheless, they raised several difficulties with using economic evaluation that would pose barriers to its introduction, including distrust in the method, conflicting philosophical positions and priorities compared to that of "health maximization," organizational allegiances, existing decision-making procedures that would be hard to change, and concerns about political pressure and acceptability.

  3. earGram Actors: An Interactive Audiovisual System Based on Social Behavior

    Directory of Open Access Journals (Sweden)

    Peter Beyls

    2015-11-01

    Full Text Available In multi-agent systems, local interactions among system components following relatively simple rules often result in complex overall systemic behavior. Complex behavioral and morphological patterns have been used to generate and organize audiovisual systems with artistic purposes. In this work, we propose to use the Actor model of social interactions to drive a concatenative synthesis engine called earGram in real time. The Actor model was originally developed to explore the emergence of complex visual patterns. On the other hand, earGram was originally developed to facilitate the creative exploration of concatenative sound synthesis. The integrated audiovisual system allows a human performer to interact with the system dynamics while receiving visual and auditory feedback. The interaction happens indirectly by disturbing the rules governing the social relationships amongst the actors, which results in a wide range of dynamic spatiotemporal patterns. A performer thus improvises within the behavioural scope of the system while evaluating the apparent connections between parameter values and actual complexity of the system output.

  4. CAPABILITIES AND ACTORS IN ERP SYSTEMS MANAGEMENT: AN EXPLORATORY STUDY IN CORPORATE USERS OF SAP ERP

    Directory of Open Access Journals (Sweden)

    Ronaldo Zwicker

    2007-10-01

    Full Text Available ERP systems are now an important component of information technology architecture in most large and medium sized companies. As such, it is inevitable that the activities undertaken to align this component to business requirements, conduct its evolution and ensure its performance and availability become increasingly important to companies’ IT areas. Success of these activities relies upon knowledge and participation of various actors inside and outside the IT area, imposing challenges not observed in internally developed systems. This paper proposes a model for the analysis of ERP systems management based on a previous work on the subject with the inclusion of the IT capabilities model and a description of the actors (stakeholders involved in the process of using an ERP system in a company. The proposed model is the basis for an exploratory survey conducted with 85 Brazilian companies whose results also comprise this text. The results suggest that only part of the capabilities is present and only part of the actors effectively participates on the ERP systems management effort.

  5. Study of Mobile Payment Services in India : Distribution of the roles, responsibilities and attitudes amongst actors of the payment systems

    OpenAIRE

    Singh Sambhy, Gurpreet

    2014-01-01

    Information technology and payment systems have witnessed the introduction, acceptance and wide scale deployment of electronic payment systems. The payment system ecosystem has now witnessed the introduction of mobile payment systems and their associated services. Major actors involved in mobile payment systems include telecom operators, banks, merchants and consumers. They need to aggregate their resources and develop a coherent ecosystem which would help the individual actors while also ben...

  6. Adaptive Inverse Optimal Control for Rehabilitation Robot Systems Using Actor-Critic Algorithm

    Directory of Open Access Journals (Sweden)

    Fancheng Meng

    2014-01-01

    Full Text Available The higher goal of rehabilitation robot is to aid a person to achieve a desired functional task (e.g., tracking trajectory based on assisted-as-needed principle. To this goal, a new adaptive inverse optimal hybrid control (AHC combining inverse optimal control and actor-critic learning is proposed. Specifically, an uncertain nonlinear rehabilitation robot model is firstly developed that includes human motor behavior dynamics. Then, based on this model, an open-loop error system is formed; thereafter, an inverse optimal control input is designed to minimize the cost functional and a NN-based actor-critic feedforward signal is responsible for the nonlinear dynamic part contaminated by uncertainties. Finally, the AHC controller is proven (through a Lyapunov-based stability analysis to yield a global uniformly ultimately bounded stability result, and the resulting cost functional is meaningful. Simulation and experiment on rehabilitation robot demonstrate the effectiveness of the proposed control scheme.

  7. Power structure among the actors of financial support to the poor to access health services: Social network analysis approach.

    Science.gov (United States)

    Etemadi, Manal; Gorji, Hasan Abolghasem; Kangarani, Hannaneh Mohammadi; Ashtarian, Kioomars

    2017-12-01

    The extent of universal health coverage in terms of financial protection is worrisome in Iran. There are challenges in health policies to guarantee financial accessibility to health services, especially for poor people. Various institutions offer support to ensure that the poor have financial access to health services. The aim of this study is to investigate the relationship network among the institutions active in this field. This study is a policy document analysis. It evaluates the country's legal documents in the field of financial support to the poor for healthcare after the Islamic Revolution in Iran. The researchers looked for the documents on the related websites and referred to the related organizations. The social network analysis approach was chosen for the analysis of the documents. Block-modelling and multi-dimensional scaling (MDS) was used to determine the network structures. The UCINET software was employed to analyse the data. Most the main actors of this network are chosen from the government budget. There is no legal communication and cooperation among some of the actors because of their improper position in the network. Seven blocks have been clustered by CONCOR in terms of the actor's degree of similarity. The social distance among the actors of the seven blocks is very short. Power distribution in the field of financial support to the poor has a fragmented structure; however, it is mainly run by a dominant block consisting of The Supreme Council of Welfare and Social Security, Health Insurance Organization, and the Ministry of Health and Medical Education. The financial support for the poor network involves multiple actors. This variety has created a series of confusions in terms of the type, level, and scope of responsibilities among the actors. The weak presence legislative and regulatory institutions and also non-governmental institutions are the main weak points of this network. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Local energy governance in vermont: an analysis of energy system transition strategies and actor capacity

    Science.gov (United States)

    Rowse, Tarah

    While global, national, and regional efforts to address climate and energy challenges remain essential, local governments and community groups are playing an increasingly stronger and vital role. As an active state in energy system policy, planning and innovation, Vermont offers a testing ground for research into energy governance at the local level. A baseline understanding of the energy planning and energy organizing activities initiated at the local level can support efforts to foster a transition to a sustainable energy system in Vermont. Following an inductive, applied and participatory approach, and grounded in the fields of sustainability transitions, energy planning, and community energy, this research project identifies conditions for change, including opportunities and challenges, within Vermont energy system decision-making and governance at the local level. The following questions are posed: What are the main opportunities and challenges for sustainable energy development at the town level? How are towns approaching energy planning? What are the triggers that will facilitate a faster transition to alternative energy systems, energy efficiency initiatives, and localized approaches? In an effort to answer these questions two studies were conducted: 1) an analysis of municipal energy plans, and 2) a survey of local energy actors. Study 1 examined Vermont energy planning at the state and local level through a review and comparison of 40 municipal plan energy chapters with the state 2011 Comprehensive Energy Plan. On average, municipal plans mentioned just over half of the 24 high-level strategies identified in the Comprehensive Energy Plan. Areas of strong and weak agreement were examined. Increased state and regional interaction with municipal energy planners would support more holistic and coordinated energy planning. The study concludes that while municipalities are keenly aware of the importance of education and partnerships, stronger policy mechanisms

  9. Denmark: Health system review

    DEFF Research Database (Denmark)

    Juul, Annegrete; Krasnik, Allan; Rudkjøbing, Andreas

    The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery...... of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health...... system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability)....

  10. Pharmaceutical digital marketing and governance: illicit actors and challenges to global patient safety and public health

    Science.gov (United States)

    2013-01-01

    Background Digital forms of direct-to-consumer pharmaceutical marketing (eDTCA) have globalized in an era of free and open information exchange. Yet, the unregulated expansion of eDTCA has resulted in unaddressed global public health threats. Specifically, illicit online pharmacies are engaged in the sale of purportedly safe, legitimate product that may in fact be counterfeit or substandard. These cybercriminal actors exploit available eDTCA mediums over the Internet to market their suspect products globally. Despite these risks, a detailed assessment of the public health, patient safety, and cybersecurity threats and governance mechanisms to address them has not been conducted. Discussion Illicit online pharmacies represent a significant global public health and patient safety risk. Existing governance mechanisms are insufficient and include lack of adequate adoption in national regulation, ineffective voluntary governance mechanisms, and uneven global law enforcement efforts that have allowed proliferation of these cybercriminals on the web. In order to effectively address this multistakeholder threat, inclusive global governance strategies that engage the information technology, law enforcement and public health sectors should be established. Summary Effective global “eHealth Governance” focused on cybercrime is needed in order to effectively combat illicit online pharmacies. This includes building upon existing Internet governance structures and coordinating partnership between the UN Office of Drugs and Crime that leads the global fight against transnational organized crime and the Internet Governance Forum that is shaping the future of Internet governance. Through a UNODC-IGF governance mechanism, investigation, detection and coordination of activities against illicit online pharmacies and their misuse of eDTCA can commence. PMID:24131576

  11. Pharmaceutical digital marketing and governance: illicit actors and challenges to global patient safety and public health.

    Science.gov (United States)

    Mackey, Tim K; Liang, Bryan A

    2013-10-16

    Digital forms of direct-to-consumer pharmaceutical marketing (eDTCA) have globalized in an era of free and open information exchange. Yet, the unregulated expansion of eDTCA has resulted in unaddressed global public health threats. Specifically, illicit online pharmacies are engaged in the sale of purportedly safe, legitimate product that may in fact be counterfeit or substandard. These cybercriminal actors exploit available eDTCA mediums over the Internet to market their suspect products globally. Despite these risks, a detailed assessment of the public health, patient safety, and cybersecurity threats and governance mechanisms to address them has not been conducted. Illicit online pharmacies represent a significant global public health and patient safety risk. Existing governance mechanisms are insufficient and include lack of adequate adoption in national regulation, ineffective voluntary governance mechanisms, and uneven global law enforcement efforts that have allowed proliferation of these cybercriminals on the web. In order to effectively address this multistakeholder threat, inclusive global governance strategies that engage the information technology, law enforcement and public health sectors should be established. Effective global "eHealth Governance" focused on cybercrime is needed in order to effectively combat illicit online pharmacies. This includes building upon existing Internet governance structures and coordinating partnership between the UN Office of Drugs and Crime that leads the global fight against transnational organized crime and the Internet Governance Forum that is shaping the future of Internet governance. Through a UNODC-IGF governance mechanism, investigation, detection and coordination of activities against illicit online pharmacies and their misuse of eDTCA can commence.

  12. Intermediaries as Innovating Actors in the Transition to a Sustainable Energy System

    Directory of Open Access Journals (Sweden)

    Julia Backhaus

    2010-07-01

    Full Text Available In transitions of large sociotechnical systems, intermediary organisations can emerge as mediators in between several actor groups and facilitate communication and collaboration towards common goals. They can support the establishment of new actor networks and the articulation and alignment of interests to bring about desired changes. In this article, current efforts towards a more sustainable energy system serve as an exemplary context of intermediary work. The field under scrutiny, demand side management, aims to decrease energy consumption. Unfortunately, the role and work of intermediaries as implementers of demand side management projects often remains underappreciated.
    Research into the reasons of successes and failures of intermediary work and a theoretical corroboration for their practical work can help intermediaries to improve their programme designs and implementation strategies. The EC FP7-funded Changing Behaviour project aims to support intermediaries with strategic activities to improve demand side management programmes and bring about lasting behavioural changes. Paying more attention to context, stakeholders, monitoring, evaluation and learning enables the development of tailor-made, widely supported projects with higher chances of success.
    In addition to practical support for their work, intermediaries can benefit from stronger policy support. Understanding and appreciation of their work as contribution to policy implementation, e.g. towards energy saving targets, could motivate such support. A stable policy and financial environment with long-term implementation plans and funding schemes provides a fertile ground for intermediary activities. Active participation of policy actors in demand side management programmes can create networks sustaining longer-lasting change.

  13. System of Interactions of Social Actors in Public Communication of Science and Technology

    Directory of Open Access Journals (Sweden)

    Miriam Graciela Miquilena

    2010-11-01

    Full Text Available This paper presents the results of a research aimed at explaining the system of interactions of social actors in Public Communication of Science and Technology (PCST, in the context of a social web defined by the novel systems of communication sustained on informational and communication technologies. The study’s theoretical framework highlights the strategic importance of a Public Communication  which focuses on promoting public appropriation of Science and Technology, going beyond the role of Journalism and Science Communication that informs a qualified public, to one that stablishes a bond with policies and decision making in the area, made with participation of international agencies, governments, producers of science and technology, journalists’ associations, educational institutions, and citizens. The research relies on Explicative Methodology. A revision of pertinent bibliography leads to the conclusion that the system of social interactions mediated by personal, interpersonal and grupal global communications, define the relationships in the communicational exchange of the social actor with regard to public communication of science and technology and policies aimed at its appropriation.

  14. Actor-critic-based optimal tracking for partially unknown nonlinear discrete-time systems.

    Science.gov (United States)

    Kiumarsi, Bahare; Lewis, Frank L

    2015-01-01

    This paper presents a partially model-free adaptive optimal control solution to the deterministic nonlinear discrete-time (DT) tracking control problem in the presence of input constraints. The tracking error dynamics and reference trajectory dynamics are first combined to form an augmented system. Then, a new discounted performance function based on the augmented system is presented for the optimal nonlinear tracking problem. In contrast to the standard solution, which finds the feedforward and feedback terms of the control input separately, the minimization of the proposed discounted performance function gives both feedback and feedforward parts of the control input simultaneously. This enables us to encode the input constraints into the optimization problem using a nonquadratic performance function. The DT tracking Bellman equation and tracking Hamilton-Jacobi-Bellman (HJB) are derived. An actor-critic-based reinforcement learning algorithm is used to learn the solution to the tracking HJB equation online without requiring knowledge of the system drift dynamics. That is, two neural networks (NNs), namely, actor NN and critic NN, are tuned online and simultaneously to generate the optimal bounded control policy. A simulation example is given to show the effectiveness of the proposed method.

  15. Ideas, actors and institutions: lessons from South Australian Health in All Policies on what encourages other sectors’ involvement

    Directory of Open Access Journals (Sweden)

    Fran Baum

    2017-10-01

    Full Text Available Abstract Background This paper examines the extent to which actors from sectors other than health engaged with the South Australian Health in All Policies (HiAP initiative, determines why they were prepared to do so and explains the mechanisms by which successful engagement happened. This examination applies theories of policy development and implementation. Methods The paper draws on a five year study of the implementation of HiAP comprising document analysis, a log of key events, detailed interviews with 64 policy actors and two surveys of public servants. Results The findings are analysed within an institutional policy analysis framework and examine the extent to which ideas, institutional factors and actor agency influenced the willingness of actors from other sectors to work with Health sector staff under the HiAP initiative. In terms of ideas, there was wide acceptance of the role of social determinants in shaping health and the importance of action to promote health in all government agencies. The institutional environment was initially supportive, but support waned over the course of the study when the economy in South Australia became less buoyant and a health minister less supportive of health promotion took office. The existence of a HiAP Unit was very helpful for gaining support from other sectors. A new Public Health Act offered some promise of institutionalising the HiAP approach and ideas. The analysis concludes that a key factor was the operation of a supportive network of public servants who promoted HiAP, including some who were senior and influential. Conclusions The South Australian case study demonstrates that despite institutional constraints and shifting political support within the health sector, HiAP gained traction in other sectors. The key factors that encouraged the commitment of others sectors to HiAP were the existence of a supportive, knowledgeable policy network, political support, institutionalisation of the

  16. Ideas, actors and institutions: lessons from South Australian Health in All Policies on what encourages other sectors' involvement.

    Science.gov (United States)

    Baum, Fran; Delany-Crowe, Toni; MacDougall, Colin; Lawless, Angela; van Eyk, Helen; Williams, Carmel

    2017-10-16

    This paper examines the extent to which actors from sectors other than health engaged with the South Australian Health in All Policies (HiAP) initiative, determines why they were prepared to do so and explains the mechanisms by which successful engagement happened. This examination applies theories of policy development and implementation. The paper draws on a five year study of the implementation of HiAP comprising document analysis, a log of key events, detailed interviews with 64 policy actors and two surveys of public servants. The findings are analysed within an institutional policy analysis framework and examine the extent to which ideas, institutional factors and actor agency influenced the willingness of actors from other sectors to work with Health sector staff under the HiAP initiative. In terms of ideas, there was wide acceptance of the role of social determinants in shaping health and the importance of action to promote health in all government agencies. The institutional environment was initially supportive, but support waned over the course of the study when the economy in South Australia became less buoyant and a health minister less supportive of health promotion took office. The existence of a HiAP Unit was very helpful for gaining support from other sectors. A new Public Health Act offered some promise of institutionalising the HiAP approach and ideas. The analysis concludes that a key factor was the operation of a supportive network of public servants who promoted HiAP, including some who were senior and influential. The South Australian case study demonstrates that despite institutional constraints and shifting political support within the health sector, HiAP gained traction in other sectors. The key factors that encouraged the commitment of others sectors to HiAP were the existence of a supportive, knowledgeable policy network, political support, institutionalisation of the ideas and approach, and balancing of the economic and social goals of

  17. Actores Secundarios

    Directory of Open Access Journals (Sweden)

    Manuel Gárate

    2007-09-01

    Full Text Available Cámara digital en mano y provistos de los recuerdos y una sesuda investigación de 3 años, los realizadores de “Actores Secundarios” nos transportan al último periodo de la dictadura militar chilena. Pero esta vez no se trata de un relato épico sobre los actores tradicionales de la lucha por la democracia, sino de una generación prácticamente olvidada y que movilizó a miles de adolescentes contra un régimen que los ahogaba. “Actores Secundarios” es una crónica construida de los fragmentos de ...

  18. Banking for health: the role of financial sector actors in investing in global health

    Science.gov (United States)

    Kickbusch, Ilona; Franz, Christian; Wells, Nadya

    2018-01-01

    The world faces multiple health financing challenges as the global health burden evolves. Countries have set an ambitious health policy agenda for the next 15 years with prioritisation of universal health coverage under the Sustainable Development Goals. The scale of investment needed for equitable access to health services means global health is one of the key economic opportunities for decades to come. New financing partnerships with the private sector are vital. The aim of this study is to unlock additional financing sources, acknowledging the imperative to link financial returns to the providers of capital, and create profitable, sustainable financing structures. This paper outlines the global health investment opportunity exploring intersections of financial and health sector interests, and the role investment in health can play in economic development. Considering increasing demand for impact investments, the paper explores responsible financing initiatives and expansion of the global movement for sustainable capital markets. Adding an explicit health component (H) to the Environmental, Social and Governance (ESG) investment criteria, creating the ESG+H initiative, could serve as catalyst for the inclusion of health criteria into mainstream financial actors’ business practices and investment objectives. The conclusion finds that health considerations directly impact profitability of the firm and therefore should be incorporated into financial analysis. Positive assessment of health impact, at a broad societal or environmental level, as well as for a firm’s employees can become a value enhancing competitive advantage. An ESG+H framework could incorporate this into mainstream financial decision-making and into scalable investment products. PMID:29736278

  19. Oil market structures-strategies and performances of the actors of the international petroleum system

    International Nuclear Information System (INIS)

    Djermaine, Rebai

    1999-01-01

    The rises of petroleum prices as revealed by the oil crises of the 1970's are the consequences of a beside market perverse game between artificial factors. The public management and the intervention of public authorities have contributed to the unbalancing of oil markets and to the confusion of the actor's strategies in the international petroleum system. The chronical decay of the petroleum prices indicate the slow and silent come back of the economical forces (laws). The management of an exhaustible asset like petroleum, raises lot of intriguing problems. This work aims at exploring the problems linked with this type of management where the decisions of the profession, of private and public companies and of the governments are closely interfering. The study is largely inspired of the meso-economical approach which consists in examining the markets structure and their determining factors, and the strategies and results of the actors of the world petroleum system. The examination of the structures/strategies/results sequence does not neglect the relations and feedbacks between each of these elements. The economical theory of oligopoly and cartel markets is also used to examine the way how prices are determined in petroleum markets. A critical presentation of the energy models allows to show how it is possible to understand, foresee and control the evolution of these prices and the possible supply/demand equilibrium. The study takes also into consideration the debates and controversies about the 'green tax' and its impact of petroleum supply and demand. (J.S.)

  20. Integrating Water, Actors, and Structure to Study Socio-Hydro-Ecological Systems

    Science.gov (United States)

    Hale, R. L.; Armstrong, A.; Baker, M. A.; Bedingfield, S.; Betts, D.; Buahin, C. A.; Buchert, M.; Crowl, T.; Dupont, R.; Endter-Wada, J.; Flint, C.; Grant, J.; Hinners, S.; Horns, D.; Horsburgh, J. S.; Jackson-Smith, D.; Jones, A. S.; Licon, C.; Null, S. E.; Odame, A.; Pataki, D. E.; Rosenberg, D. E.; Runburg, M.; Stoker, P.; Strong, C.

    2014-12-01

    Urbanization, climate uncertainty, and ecosystem change represent major challenges for managing water resources. Water systems and the forces acting upon them are complex, and there is a need to understand and generically represent the most important system components and linkages. We developed a framework to facilitate understanding of water systems including potential vulnerabilities and opportunities for sustainability. Our goal was to produce an interdisciplinary framework for water resources research to address water issues across scales (e.g., city to region) and domains (e.g., water supply and quality, urban and transitioning landscapes). An interdisciplinary project (iUTAH - innovative Urban Transitions and Aridregion Hydro-sustainability) with a large (N=~100), diverse team having expertise spanning the hydrologic, biological, ecological, engineering, social, planning, and policy sciences motivated the development of this framework. The framework was developed through review of the literature, meetings with individual researchers, and workshops with participants. The Structure-Water-Actor Framework (SWAF) includes three main components: water (quality and quantity), structure (natural, built, and social), and actors (individual and organizational). Key linkages include: 1) ecological and hydrological processes, 2) ecosystem and geomorphic change, 3) planning, design, and policy, 4) perceptions, information, and experience, 5) resource access, and 6) operational water use and management. Our expansive view of structure includes natural, built, and social components, allowing us to examine a broad set of tools and levers for water managers and decision-makers to affect system sustainability and understand system outcomes. We validate the SWAF and illustrate its flexibility to generate insights for three research and management problems: green stormwater infrastructure in an arid environment, regional water supply and demand, and urban river restoration

  1. Global health actors no longer in favor of user fees: a documentary study.

    Science.gov (United States)

    Robert, Emilie; Ridde, Valéry

    2013-07-26

    Since the advent of health user fees in low- and middle-income countries in the 1980s, the discourse of global health actors (GHAs) has changed to the disadvantage of this type of healthcare financing mechanism. The aim of the study was to identify and analyze the stance of GHAs in the debate on user fees. We conducted documentary research using public documents published by and officially attributed to GHAs from 2005 to 2011. We categorized GHAs into four groups: intergovernmental organizations, international non-governmental organizations, government agencies, and working groups and networks. We then classified the GHAs according to their stance relative to the abolition of user fees, and conducted a thematic analysis of their discourse to understand the arguments used by each GHA to justify its stance. We identified 56 GHAs, for which we analyzed 140 documents. Among them, 55% were in favor of the abolition of user fees or in favor of free care at the point of delivery. None of the GHAs stated that they were in favor of user fees; however, 30% did not take a stand. Only the World Bank declares that it is both in favor of user fees and in favor of free care at point of service. GHAs generally circumscribe their stance to specific populations (pregnant women, children under 5 years, etc.) or to specific health services (primary, basic, essential). Three types of arguments are used by GHAs to justify their stance: economic, moral and ethical, and pragmatic. The principle of "user pays" seems to have fizzled. Production and dissemination of evidence, as well as certain advocacy networks, may have contributed to this change in discourse. However, GHAs should go a step further and translate their words into action, so that free healthcare at the point of delivery becomes a reality in low- and middle-income countries. They should provide technical and financial support to those countries that have chosen to implement user fee exemption policies, sometimes influenced

  2. Maternal care of undocumented pregnant women under the Fees Act (Medical) for Foreigners 1951. Perspectives of health and non-health actors

    OpenAIRE

    Loo, Pei Shan

    2017-01-01

    With the unprecedented international migration around the world, policies that restrict immigrants' health care access have become prevailing. In 2014, the amendment to The Fees Act (Medical) for Foreigners 1951 had further hindered the health care access of undocumented pregnant women. This qualitative study aimed to obtain perspectives of health and non-health actors regarding the implications of the amendment to the undocumented pregnant women. Ten semi-structured interviews were conducted...

  3. Compositional schedulability analysis of real-time actor-based systems.

    Science.gov (United States)

    Jaghoori, Mohammad Mahdi; de Boer, Frank; Longuet, Delphine; Chothia, Tom; Sirjani, Marjan

    2017-01-01

    We present an extension of the actor model with real-time, including deadlines associated with messages, and explicit application-level scheduling policies, e.g.,"earliest deadline first" which can be associated with individual actors. Schedulability analysis in this setting amounts to checking whether, given a scheduling policy for each actor, every task is processed within its designated deadline. To check schedulability, we introduce a compositional automata-theoretic approach, based on maximal use of model checking combined with testing. Behavioral interfaces define what an actor expects from the environment, and the deadlines for messages given these assumptions. We use model checking to verify that actors match their behavioral interfaces. We extend timed automata refinement with the notion of deadlines and use it to define compatibility of actor environments with the behavioral interfaces. Model checking of compatibility is computationally hard, so we propose a special testing process. We show that the analyses are decidable and automate the process using the Uppaal model checker.

  4. Belgium: Health system review.

    Science.gov (United States)

    Gerkens, Sophie; Merkur, Sherry

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Belgian population continues to enjoy good health and long life expectancy. This is partly due to good access to health services of high quality. Financing is based mostly on proportional social security contributions and progressive direct taxation. The compulsory health insurance is combined with a mostly private system of health care delivery, based on independent medical practice, free choice of physician and predominantly fee-for-service payment. This Belgian HiT profile (2010) presents the evolution of the health system since 2007, including detailed information on new policies. While no drastic reforms were undertaken during this period, policy-makers have pursued the goals of improving access to good quality of care while making the system sustainable. Reforms to increase the accessibility of the health system include measures to reduce the out-of-pocket payments of more vulnerable populations (low-income families and individuals as well as the chronically ill). Quality of care related reforms have included incentives to better integrate different levels of care and the establishment of information systems, among others. Additionally, several measures on pharmaceutical products have aimed to reduce costs for both the National Institute for Health and Disability Insurance (NIHDI) and patients, while maintaining the quality of care. World Health Organization 2010, on behalf of the European Observatory on health systems and Policies.

  5. Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda.

    Science.gov (United States)

    Nabyonga-Orem, Juliet; Mijumbi, Rhona

    2015-03-08

    Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors' views regarding what evidence they deemed appropriate to guide health policy development. Using exploratory qualitative methods, we conducted interviews with 51 key informants using an in-depth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. What LICs like Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making. © 2015 by Kerman University of Medical Sciences.

  6. Performance of community health workers:situating their intermediary position within complex adaptive health systems

    OpenAIRE

    Kok, Maryse. C; Broerse, Jacqueline E.W; Theobald, Sally; Ormel, Hermen; Dieleman, Marjolein; Taegtmeyer, Miriam

    2017-01-01

    Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors. This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income countries. It examines their unique intermediary position between the communities they serve and actors in the health sector, and the complexity of the health systems in which they operate. The assessment...

  7. How do external donors influence national health policy processes? Experiences of domestic policy actors in Cambodia and Pakistan.

    Science.gov (United States)

    Khan, Mishal S; Meghani, Ankita; Liverani, Marco; Roychowdhury, Imara; Parkhurst, Justin

    2018-03-01

    Although concerns have historically been raised about the influence of external donors on health policy process in recipient countries, remarkably few studies have investigated perspectives and experiences of domestic policymakers and advisers. This study examines donor influence at different stages of the health policy process (priority setting, policy formulation, policy implementation and monitoring and evaluation) in two aid-dependent LMICs, Cambodia and Pakistan. It identifies mechanisms through which asymmetries in influence between donors and domestic policy actors emerge. We conducted 24 key informant interviews-14 in Pakistan and 10 in Cambodia-with high-level decision-makers who inform or authorize health priority setting, allocate resources and/or are responsible for policy implementation, identifying three routes of influence: financial resources, technical expertise and indirect financial and political incentives. We used both inductive and deductive approaches to analyse the data. Our findings indicate that different routes of influence emerged depending on the stage of the policy process. Control of financial resources was the most commonly identified route by which donors influenced priority setting and policy implementation. Greater (perceived) technical expertise played an important role in donor influence at the policy formulation stage. Donors' power in influencing decisions, particularly during the final (monitoring and evaluation) stage of the policy process, was mediated by their ability to control indirect financial and political incentives as well as direct control of financial resources. This study thus helps unpack the nuances of donor influence over health policymaking in these settings, and can potentially indicate areas that require attention to increase the ownership of domestic actors of their countries' health policy processes. © The Author(s) 2017. Published by Oxford University Press in association with The London School of

  8. The Urban Decision Room : A multi actor design engineering simulation system

    NARCIS (Netherlands)

    Van Loon, P.P.J.; Barendse, P.; Duerink, S.

    2012-01-01

    This paper deals with the definition and construction of a decision based multi actor urban design model which enables the integration of the allocation of a variety of urban land uses with the distribution of different urban functions: the Urban Decision Room. Urban design (and planning) is, among

  9. Mapping industrial systems - a supply network perspective on enabling technologies, processes and actors

    OpenAIRE

    Srai, Jagjit Singh

    2016-01-01

    This is the author accepted manuscript. The final version is available from InderScience Publishers via http://dx.doi.org/10.1504/IJMTM.2017.10002927 This paper develops a multi-layered multi-stage mapping approach to explore the characteristics of emerging industry supply networks (EI SNs), and how enabling production technologies and supply chain processes are supported by institutional, industrial and supply network actors. The mapping methodology involves the systematic capture of mate...

  10. Evidence for Informing Health Policy Development in Low- Income Countries (LICS: Perspectives of Policy Actors in Uganda

    Directory of Open Access Journals (Sweden)

    Juliet Nabyonga-Orem

    2015-05-01

    Full Text Available Background Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs, the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors’ views regarding what evidence they deemed appropriate to guide health policy development. Methods Using exploratory qualitative methods, we conducted interviews with 51 key informants using an indepth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Results Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. Conclusion What LICslike Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making.

  11. Informal value chain actors' knowledge and perceptions about zoonotic diseases and biosecurity in Kenya and the importance for food safety and public health.

    Science.gov (United States)

    Nyokabi, Simon; Birner, Regina; Bett, Bernard; Isuyi, Linda; Grace, Delia; Güttler, Denise; Lindahl, Johanna

    2018-03-01

    Zoonotic diseases, transmitted from animals to humans, are a public health challenge in developing countries. Livestock value chain actors have an important role to play as the first line of defence in safeguarding public health. However, although the livelihood and economic impacts of zoonoses are widely known, adoption of biosecurity measures aimed at preventing zoonoses is low, particularly among actors in informal livestock value chains in low and middle-income countries. The main objective of this study was to investigate knowledge of zoonoses and adoption of biosecurity measures by livestock and milk value chain actors in Bura, Tana River County, in Kenya, where cattle, camels, sheep and goats are the main livestock kept. The study utilised a mixed methods approach, with a questionnaire survey administered to 154 value chain actors. Additional information was elicited through key informant interviews and participatory methods with relevant stakeholders outside the value chain. Our results found low levels of knowledge of zoonoses and low levels of adherence to food safety standards, with only 37% of milk traders knowing about brucellosis, in spite of a sero-prevalence of 9% in the small ruminants tested in this study, and no slaughterhouse worker knew about Q fever. Actors had little formal education (between 0 and 10%) and lacked training in food safety and biosecurity measures. Adoption of biosecurity measures by value chain actors was very low or non-existent, with only 11% of butchers wearing gloves. There was a gendered dimension, evidenced by markedly different participation in value chains and lower adoption rates and knowledge levels among female actors. Finally, cultural and religious practices were shown to play an important role in exposure and transmission of diseases, influencing perceptions and attitudes to risks and adoption of biosecurity measures.

  12. Uncivil actors and violence systems in the Latin American urban domain

    Directory of Open Access Journals (Sweden)

    Dirk Kruijt

    2014-06-01

    Full Text Available The character and quality of Latin America’s democracy is in dispute. Uncertainties about its nature and future prevail in the development debate. In the early 2000s the UNDP (2004 coined the terms “low-intensity citizenship” and “low-intensity democracy” to describe the post-dictatorship democracy in the region. When in the 1980s the military establishment withdrew from the political arena and democracy was restored, a severe economic crisis affected the region, producing long lasting effects in terms of mass poverty, informality and social exclusion. In the urban domain, and especially in territories where the representatives of law and order are relatively absent, “uncivil” nonstate actors surfaced, including local drug lords and their small territorial armies; youth gangs; organised crime and the so-called “dark forces”, joined by former belligerent actors of the Andean and Central American civil wars. In this article, I will analyse and typify this erosion of formal social order and the emergence of parallel and informal structures and hierarchies throughout Latin America.

  13. Identification and priority setting for health technology assessment in The Netherlands : Actors and activities

    NARCIS (Netherlands)

    Oortwijn, W.; Banta, D.; Vondeling, H.; Bouter, L.

    1999-01-01

    This article describes the actual situation at the beginning of 1999 with regard to identification and priority setting for health technology assessment (HTA) on a national level in the Netherlands. For this purpose the literature on HTA published in 1980-1998, mainly national, was thoroughly

  14. [Lato sensu post-graduation in psychiatric nursing and mental health: history, institutional context, and actors].

    Science.gov (United States)

    Olschowsky, Agnes; da Silva, Graciette Borges

    2003-01-01

    The theme of this study is "latu sensu" post-graduation teaching in nursing psychiatry and mental health in EE/UFRGS and EERP/USP nursing schools. In this study we characterize this courses and the profile of its professors. Through the analysis of the teaching plans, programs and documents of the specialization courses, as well as through the analysis of semi-structured interviews, we obtained data regarding the history and structure of these courses, which were pioneers and motivators of the specialized education in this field. The characterization of the courses will be done through the presentation of its timetable, number of disciplines, professional titles, and development of the professors involved, in order to show how psychiatry nursing and mental health teaching has been constituted.

  15. A matter of relationships: Actor-networks of colonial rule in the Gezira irrigation system, Sudan

    Directory of Open Access Journals (Sweden)

    Maurits Ertsen

    2016-06-01

    Full Text Available In the first half of the 20th century, colonial rulers, a British firm and Sudanese farmers changed the Gezira Plain in Sudan into a large-scale irrigated cotton scheme. Gezira continues to be in use up to date. Its story shows how the abstract concept 'development' is shaped through the agency of humans and non-humans alike in government offices and muddy fields. Gezira provides a well-suited starting point for moving into the networks of development without any pre-suggested division in terms of levels, contexts or relations. Hierarchies, arenas and institutions do exist. Such power relations are associations between humans and non-humans: relatively stable relations are typically produced when non-human agency is involved, for example through books, roads, and money. The Gezira case shows the potential of actor-network theory in building and understanding of conceptual and empirical links between water, infrastructure and political rule.

  16. Poland health system review.

    Science.gov (United States)

    Sagan, Anna; Panteli, Dimitra; Borkowski, W; Dmowski, M; Domanski, F; Czyzewski, M; Gorynski, Pawel; Karpacka, Dorota; Kiersztyn, E; Kowalska, Iwona; Ksiezak, Malgorzata; Kuszewski, K; Lesniewska, A; Lipska, I; Maciag, R; Madowicz, Jaroslaw; Madra, Anna; Marek, M; Mokrzycka, A; Poznanski, Darius; Sobczak, Alicja; Sowada, Christoph; Swiderek, Maria; Terka, A; Trzeciak, Patrycja; Wiktorzak, Katarzyna; Wlodarczyk, Cezary; Wojtyniak, B; Wrzesniewska-Wal, Iwona; Zelwianska, Dobrawa; Busse, Reinhard

    2011-01-01

    , particularly in areas such as pharmaceuticals, are highly regressive. The health status of the Polish population has improved substantially, with average life expectancy at birth reaching 80.2 years for women and 71.6 years for men in 2009. However, there is still a vast gap in life expectancy between Poland and the western European Union (EU) countries and between life expectancy overall and the expected number of years without illness or disability. Given its modest financial, human and material health care resources and the corresponding outcomes, the overall financial efficiency of the Polish system is satisfactory. Both allocative and technical efficiency leave room for improvement. Several measures, such as prioritizing primary care and adopting new payment mechanisms such as diagnosis-related groups (DRGs), have been introduced in recent years but need to be expanded to other areas and intensified. Additionally, numerous initiatives to enhance quality control and build the required expertise and evidence base for the system are also in place. These could improve general satisfaction with the system, which is not particularly high. Limited resources, a general aversion to cost-sharing stemming from a long experience with broad public coverage and shortages in health workforce need to be addressed before better outcomes can be achieved by the system. Increased cooperation between various bodies within the health and social care sectors would also contribute in this direction. The HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services, and the role of the main actors in health systems; they describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. World

  17. Adaptive Actor-Critic Design-Based Integral Sliding-Mode Control for Partially Unknown Nonlinear Systems With Input Disturbances.

    Science.gov (United States)

    Fan, Quan-Yong; Yang, Guang-Hong

    2016-01-01

    This paper is concerned with the problem of integral sliding-mode control for a class of nonlinear systems with input disturbances and unknown nonlinear terms through the adaptive actor-critic (AC) control method. The main objective is to design a sliding-mode control methodology based on the adaptive dynamic programming (ADP) method, so that the closed-loop system with time-varying disturbances is stable and the nearly optimal performance of the sliding-mode dynamics can be guaranteed. In the first step, a neural network (NN)-based observer and a disturbance observer are designed to approximate the unknown nonlinear terms and estimate the input disturbances, respectively. Based on the NN approximations and disturbance estimations, the discontinuous part of the sliding-mode control is constructed to eliminate the effect of the disturbances and attain the expected equivalent sliding-mode dynamics. Then, the ADP method with AC structure is presented to learn the optimal control for the sliding-mode dynamics online. Reconstructed tuning laws are developed to guarantee the stability of the sliding-mode dynamics and the convergence of the weights of critic and actor NNs. Finally, the simulation results are presented to illustrate the effectiveness of the proposed method.

  18. Exploring the Obstacles to Implementing Economic Mechanisms to Stimulate Antibiotic Research and Development: A Multi-Actor and System-Level Analysis.

    Science.gov (United States)

    Baraldi, Enrico; Ciabuschi, Francesco; Leach, Ross; Morel, Chantal M; Waluszewski, Alexandra

    2016-05-01

    This Article examines the potential stakeholder-related obstacles hindering the implementation of mechanisms to re-ignite the development of novel antibiotics. Proposed economic models and incentives to drive such development include: Public Funding of Research and Development ("R&D"), Tax Incentives, Milestone Prizes, End Payments, Intellectual Property ("IP") and Exclusivity Extensions, Pricing and Reimbursement Incentives, Product Development Partnerships ("PDPs"), and the Options Market for Antibiotics model. Drawing on personal experience and understanding of the antibiotic field, as well as stakeholder consultation and numerous expert meetings within the DRIVE-AB project and Uppsala Health Summit 2015, the Authors identify obstacles attributable to the following actors: Universities and Research Institutes, Small and Medium-sized Enterprises ("SMEs"), Large Pharmaceutical Companies, Marketing Approval Regulators, Payors, Healthcare Providers, National Healthcare Authorities, Patients, and Supranational Institutions. The analysis also proposes a characterization and ranking of the difficulty associated with implementing the reviewed mechanisms. Public Funding of R&D, Pricing and Reimbursement Incentives, and PDPs are mechanisms expected to meet highly systemic barriers (i.e., obstacles across the entire antibiotic value chain), imposing greater implementation challenges in that they require convincing and involving several motivationally diverse actors in order to have much effect.

  19. Structuring an integrated care system: interpreted through the enacted diversity of the actors involved – the case of a French healthcare network

    Directory of Open Access Journals (Sweden)

    Corinne Grenier

    2011-02-01

    Full Text Available Research question: We are looking at the process of structuring an integrated care system as an innovative process that swings back and forth between the diversity of the actors involved, local aspirations and national and regional regulations. We believe that innovation is enriched by the variety of the actors involved, but may also be blocked or disrupted by that diversity. Our research aims to add to other research, which, when questioning these integrated systems, analyses how the actors involved deal with diversity without really questioning it. Case study: The empirical basis of the paper is provided by case study analysis. The studied integrated care system is a French healthcare network that brings together healthcare professionals and various organisations in order to improve the way in which interventions are coordinated and formalised, in order to promote better detection and diagnosis procedures and the implementation of a care protocol. We consider this case as instrumental in developing theoretical proposals for structuring an integrated care system in light of the diversity of the actors involved. Results and discussion: We are proposing a model for structuring an integrated care system in light of the enacted diversity of the actors involved. This model is based on three factors: the diversity enacted by the leaders, three stances for considering the contribution made by diversity in the structuring process and the specific leading role played by those in charge of the structuring process.  Through this process, they determined how the actors involved in the project were differentiated, and on what basis those actors were involved. By mobilizing enacted diversity, the leaders are seeking to channel the emergence of a network in light of their own representation of that network. This model adds to published research on the structuring of integrated care systems.

  20. Structuring an integrated care system: interpreted through the enacted diversity of the actors involved – the case of a French healthcare network

    Directory of Open Access Journals (Sweden)

    Corinne Grenier

    2011-02-01

    Full Text Available Research question: We are looking at the process of structuring an integrated care system as an innovative process that swings back and forth between the diversity of the actors involved, local aspirations and national and regional regulations. We believe that innovation is enriched by the variety of the actors involved, but may also be blocked or disrupted by that diversity. Our research aims to add to other research, which, when questioning these integrated systems, analyses how the actors involved deal with diversity without really questioning it.Case study: The empirical basis of the paper is provided by case study analysis. The studied integrated care system is a French healthcare network that brings together healthcare professionals and various organisations in order to improve the way in which interventions are coordinated and formalised, in order to promote better detection and diagnosis procedures and the implementation of a care protocol. We consider this case as instrumental in developing theoretical proposals for structuring an integrated care system in light of the diversity of the actors involved.Results and discussion: We are proposing a model for structuring an integrated care system in light of the enacted diversity of the actors involved. This model is based on three factors: the diversity enacted by the leaders, three stances for considering the contribution made by diversity in the structuring process and the specific leading role played by those in charge of the structuring process.  Through this process, they determined how the actors involved in the project were differentiated, and on what basis those actors were involved. By mobilizing enacted diversity, the leaders are seeking to channel the emergence of a network in light of their own representation of that network. This model adds to published research on the structuring of integrated care systems.

  1. Proceedings (slides) of the ANCCLI-IRSN seminar: 'environment - health: what monitoring in territories by the different actors'

    International Nuclear Information System (INIS)

    2012-01-01

    Relations between the operation of nuclear facilities and the health of populations are recurrent topics. For this reason, the national association of information committees and local commissions (ANCCLI), and the radiation protection and nuclear safety institute (IRSN) have jointly organized this seminar devoted to the monitoring of environment and public health. Its aim was to share the experience of the different actors in order to help the local commissions of information (CLI) in carrying out their own actions on these topics. The first day, the Golfech, Gravelines, Cadarache and Saint-Laurent-Des-Eaux CLIs presented their local environmental monitoring actions and their impact studies for facilities effluents. IRSN presented its methodology for the elaboration of its annual radiological status of the French environment. A round table permitted the different intervening parties to exchange about their monitoring goals. The second day, the Tricastin and Gravelines CLI, as well as the health care supervision institute InVS), presented different studies and attempts of answers to the health-impact questions coming from the surrounding communities. The contributions and limitations of public health studies were discussed through a presentation of the joint ANCCLI/IRSN/InVS methodological guidebook 'public health in the vicinity of nuclear facilities: how to approach the questions asked'. This document gathers the slides of the available presentations: 1 - Environmental monitoring by the Tarn-et-Garonne departmental laboratory in partnership with the Golfech's CLI (A. Calafat); 2 - Environmental monitoring by the Tarn-et-Garonne veterinary laboratory (V. Rossetto); 3 - Independent environmental monitoring by the Tarn-et-Garonne and occasional expertises around the Gravelines site (F. Cazier); 4 - Study of the impact on Durance river of the liquid radiological effluents of CEA-Cadarache site (C. Fourcaud); 5 - Study of the impact on Loire river of the chemical

  2. World Health Organization and the search for accountability: a critical analysis of the new framework of engagement with non-state actors

    Directory of Open Access Journals (Sweden)

    Danielle Hanna Rached

    Full Text Available The article probes the origins and content of the Framework of Engagement with Non-State Actors (FENSA of the World Health Organization (WHO, approved on May 28, 2016, at the 69th World Health Assembly, which established different rules of collaboration to four categories of actors: nongovernmental organizations (NGOs, private sector entities, philanthropic foundations, and academic institutions. Applying the findings of International Legal Theory and based on extensive documentary research, we sought to determine whether FENSA is an appropriate accountability mechanism according to four functions of accountability: constitutional, democratic, epistemic, and populist. The article concludes that there is a risk of the prevalence of the populist function at the expense of the accountability potential that could result from the better use of the other three accountability functions.

  3. World Health Organization and the search for accountability: a critical analysis of the new framework of engagement with non-state actors.

    Science.gov (United States)

    Rached, Danielle Hanna; Ventura, Deisy de Freitas Lima

    2017-07-03

    The article probes the origins and content of the Framework of Engagement with Non-State Actors (FENSA) of the World Health Organization (WHO), approved on May 28, 2016, at the 69th World Health Assembly, which established different rules of collaboration to four categories of actors: nongovernmental organizations (NGOs), private sector entities, philanthropic foundations, and academic institutions. Applying the findings of International Legal Theory and based on extensive documentary research, we sought to determine whether FENSA is an appropriate accountability mechanism according to four functions of accountability: constitutional, democratic, epistemic, and populist. The article concludes that there is a risk of the prevalence of the populist function at the expense of the accountability potential that could result from the better use of the other three accountability functions.

  4. Requirements and Solutions for Personalized Health Systems.

    Science.gov (United States)

    Blobel, Bernd; Ruotsalainen, Pekka; Lopez, Diego M; Oemig, Frank

    2017-01-01

    Organizational, methodological and technological paradigm changes enable a precise, personalized, predictive, preventive and participative approach to health and social services supported by multiple actors from different domains at diverse level of knowledge and skills. Interoperability has to advance beyond Information and Communication Technologies (ICT) concerns, including the real world business domains and their processes, but also the individual context of all actors involved. The paper introduces and compares personalized health definitions, summarizes requirements and principles for pHealth systems, and considers intelligent interoperability. It addresses knowledge representation and harmonization, decision intelligence, and usability as crucial issues in pHealth. On this basis, a system-theoretical, ontology-based, policy-driven reference architecture model for open and intelligent pHealth ecosystems and its transformation into an appropriate ICT design and implementation is proposed.

  5. Getting ADAS on the Road : Actors' Interactions in Advanced Driver Assistance Systems Deployment

    NARCIS (Netherlands)

    Walta, L.

    2011-01-01

    Currently, many car drivers spend many hours in congested traffic. If their cars would have been equipped with an electronic system that automatically follows the car in front of them, congestion might have been prevented. Such a system is an example of Advanced Driver Assistance Systems (ADAS).

  6. Energy distribution system operator in interaction with social actors : Three cases

    NARCIS (Netherlands)

    Steenhuisen, B.M.; Veeneman, W.W.; Van Doorn, L.; Van Breen, H.

    2012-01-01

    A publicly owned Dutch energy distribution system operator (DSO) interacts during local infrastructure projects with its direct stakeholders to maximize utility in the public interest. These projects are about replacing, relocating, removing or reconstructing parts of the gas and electricity

  7. A Model of Trust for Developing Trustworthy Systems From Untrustworthy Actors

    National Research Council Canada - National Science Library

    Ray, Indrajit; Ray, Indrakshi

    2007-01-01

    The objective of this effort is to develop a new model of trust that allowed one to reason about trust relationships in information systems with special emphasis on trust as it related to integrity and availability...

  8. Off-Policy Actor-Critic Structure for Optimal Control of Unknown Systems With Disturbances.

    Science.gov (United States)

    Song, Ruizhuo; Lewis, Frank L; Wei, Qinglai; Zhang, Huaguang

    2016-05-01

    An optimal control method is developed for unknown continuous-time systems with unknown disturbances in this paper. The integral reinforcement learning (IRL) algorithm is presented to obtain the iterative control. Off-policy learning is used to allow the dynamics to be completely unknown. Neural networks are used to construct critic and action networks. It is shown that if there are unknown disturbances, off-policy IRL may not converge or may be biased. For reducing the influence of unknown disturbances, a disturbances compensation controller is added. It is proven that the weight errors are uniformly ultimately bounded based on Lyapunov techniques. Convergence of the Hamiltonian function is also proven. The simulation study demonstrates the effectiveness of the proposed optimal control method for unknown systems with disturbances.

  9. Tomorrow's Energy Prices: An Analysis of System, Actors and Shaping Factors. Crude price drop and its consequences

    International Nuclear Information System (INIS)

    Chevalier, Jean-Marie; Chauvin, Dominique

    2017-01-01

    If one sector in recent decades has been a byword for how difficult it is to anticipate future developments at the global level, it has been the energy sector. We have seen fears over the dangers of a hydrocarbon shortage, the announcement of 'peak oil' and a boom in shale gas and oil. Forecasts based on major trends within the field have been revised as non-conventional sources with a substantial impact on price levels have emerged. Added to this is the need to confront climate change and hence to revamp our modes of energy production to give an enhanced role to renewables. In such a context, as Jean-Marie Chevalier stresses here, it is quite tricky to say how energy prices will develop or how energy production systems will change. This is why, in addition to the overview of possible developments in the prices of oil, natural gas and coal which this article provides, it particularly stresses the many elements of uncertainty that still prevail. Chevalier demonstrates the multiplicity of factors - and actor - involved in the way energy systems and prices develop and highlights the key elements that will play a role in enhancing or curbing those developments in the medium-to-long term. (author)

  10. The interplay of institutions, actors and technologies in socio-technical systems - An analysis of transformations in the Australian urban water sector

    NARCIS (Netherlands)

    Fuenfschilling, Lea; Truffer, Bernhard

    2016-01-01

    Literature on socio-technical transitions has primarily emphasized the co-determination of institutions and technologies. In this paper, we want to focus on how actors play a mediating role between these two pillars of a socio-technical system. By introducing the theoretical concept of institutional

  11. Greece: Health system review.

    Science.gov (United States)

    Economou, Charalambos

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The health status of the Greek population has strongly improved over the last few decades and seems to compare relatively favourably with other OECD and European Union (EU) countries. The health system is a mixture of public integrated, public contract and public reimbursement models, comprising elements from both the public and private sectors and incorporating principles of different organizational patterns. Access to services is based on citizenship as well as on occupational status.The system is financed by the state budget, social insurance contributions and private payments.The largest share of health expenditure constitutes private expenditure, mainly in the form of out of pocket payments which is also the element contributing most to the overall increase in health expenditure. The delivery of health care services is based on both public and private providers. The presence of private providers is more obvious in primary care,especially in diagnostic technologies, private physicians' practices and pharmaceuticals. Despite success in improving the health of the population, the Greek health care system faces serious structural problems concerning the organization, financing and delivery of services. It suffers from the absence of cost-containment measures and defined criteria for funding, resulting in sickness funds experiencing economic constraints and budget deficits. The high percentage of private expenditure goes against the principle of fair

  12. Performance of community health workers : situating their intermediary position within complex adaptive health systems

    NARCIS (Netherlands)

    Kok, Maryse C; Broerse, Jacqueline E W; Theobald, Sally; Ormel, Hermen; Dieleman, Marjolein; Taegtmeyer, Miriam

    2017-01-01

    Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors.This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income

  13. HEALTH SYSTEMS

    International Development Research Centre (IDRC) Digital Library (Canada)

    many levels, and underscores the fact that health ... The health of mothers and their children depends on the status of women. INSIGHT ... tions find fertile ground when poverty ... Dr Gita Sen, Professor of Public Policy at the Indian Institute.

  14. Determinants of Actor Rationality

    DEFF Research Database (Denmark)

    Ellegaard, Chris

    Industrial companies must exercise influence on their suppliers (or supplier actors). Actor rationality is a central theme connected to this management task. In this article, relevant literature is studied with the purpose of shedding light on determinants of actor rationality. Two buyer-supplier...... relations are investigated in a multiple case study, leading to the proposal of various additional factors that determine and shape actor rationality. Moreover a conceptual model of rationality determinants in the buyer-supplier relation is proposed, a model that may help supply managers analyse...

  15. Moral actor, selfish agent.

    Science.gov (United States)

    Frimer, Jeremy A; Schaefer, Nicola K; Oakes, Harrison

    2014-05-01

    People are motivated to behave selfishly while appearing moral. This tension gives rise to 2 divergently motivated selves. The actor-the watched self-tends to be moral; the agent-the self as executor-tends to be selfish. Three studies present direct evidence of the actor's and agent's distinct motives. To recruit the self-as-actor, we asked people to rate the importance of various goals. To recruit the self-as-agent, we asked people to describe their goals verbally. In Study 1, actors claimed their goals were equally about helping the self and others (viz., moral); agents claimed their goals were primarily about helping the self (viz., selfish). This disparity was evident in both individualist and collectivist cultures, attesting to the universality of the selfish agent. Study 2 compared actors' and agents' motives to those of people role-playing highly prosocial or selfish exemplars. In content (Study 2a) and in the impressions they made on an outside observer (Study 2b), actors' motives were similar to those of the prosocial role-players, whereas agents' motives were similar to those of the selfish role-players. Study 3 accounted for the difference between the actor and agent: Participants claimed that their agent's motives were the more realistic and that their actor's motives were the more idealistic. The selfish agent/moral actor duality may account for why implicit and explicit measures of the same construct diverge, and why feeling watched brings out the better angels of human nature.

  16. Actor-Network Procedures

    NARCIS (Netherlands)

    Pavlovic, Dusko; Meadows, Catherine; Ramanujam, R.; Ramaswamy, Srini

    2012-01-01

    In this paper we propose actor-networks as a formal model of computation in heterogenous networks of computers, humans and their devices, where these new procedures run; and we introduce Procedure Derivation Logic (PDL) as a framework for reasoning about security in actor-networks, as an extension

  17. Contributions of Global Health Diplomacy to Health Systems in Sub ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    New research will help boost Africa's bargaining power in global health diplomacy, ... need to assert their public health interests in global health diplomacy from an ... Brazil, and India; and 3) the involvement of African actors in getting universal ...

  18. [The health system of Brazil].

    Science.gov (United States)

    Montekio, Víctor Becerril; Medina, Guadalupe; Aquino, Rosana

    2011-01-01

    This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.

  19. Actor/Character Dualism

    DEFF Research Database (Denmark)

    Riis, Johannes

    2012-01-01

    Our perception of agency may be inherently fallible, and this may explain not only our general awareness of actors when engaged in fictional characters but also the specific case of paradoxical characters...

  20. Health System Measurement Project

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Health System Measurement Project tracks government data on critical U.S. health system indicators. The website presents national trend data as well as detailed...

  1. Change-actors in the U.S. electric energy system: The role of environmental groups in utility adoption and diffusion of wind power

    International Nuclear Information System (INIS)

    Doblinger, Claudia; Soppe, Birthe

    2013-01-01

    We study the contribution of environmental groups to new technology adoption and diffusion by dominant incumbents. Building on institutional and social movement theory, we develop a theoretical framework that sheds light on environmental groups as change-actors. We theorize that by approaching embedded key constituents with various strategic actions, environmental groups affect taken-for-granted beliefs, build legitimacy for renewable energy technologies, and convince skeptical constituents to support the new technology. We verify our theoretical framework with a case study of wind power development in Colorado. We find that environmentalists educate constituents on the benefits of the new technology, engage in activities leading to regulatory and legislative decisions for wind, while also providing direct assistance to the utility. As a result, utilities are both pressured and encouraged to adopt and diffuse wind power on a large-scale. This research directs attention to the role of environmental groups as change-actors and the legitimating effects of their actions. It highlights their part in creating a more favorable institutional environment for new technologies while directly influencing the incumbent's technology choice. This paper contributes to an understanding of bottom-up, actor-initiated changes in energy systems taking into account both the systemic technological infrastructure and the institutional context. - Highlights: • We study environmentalists′ impact on utility-scale renewable technology diffusion. • Incumbent-dominated systems hinder the diffusion of new technologies. • Environmental groups′ strategic actions increase legitimacy for new technologies. • Environmental groups′ legitimating actions affect incumbent′s technology choice. • Environmental groups create a favorable institutional context for new technologies

  2. Actors at work

    NARCIS (Netherlands)

    Nobakht, Behrooz

    2016-01-01

    The core contributions of this thesis target the intersection of object orientation, actor model, and concurrency. We choose Java as the main target programming language and as one of the mainstream object-oriented languages. We formalize a subset of Java and its concurrency API to facilitate formal

  3. Crisis del Sistema Jurìdico Mexicano: entre la Reforma Penal y los Actores Sociales Contestatarios (Crisis of the Mexican Legal System: Between Penal Reform and Social Actors Protesters

    Directory of Open Access Journals (Sweden)

    Alicia Hernández De Gante

    2016-09-01

    Full Text Available Global economic conditions exert pressure on states, particularly for those who are linked to free trade agreements. Mexico, with the risk of being left out of these processes, has made a series of important reforms in its legislation to attract capital and to ensure cheap labor force. The legal system, from 2007, has been particularly reformed, not only to ensure the safety and enforcement of justice, by protecting human rights in their constitutional essence but also to generate expectations for capital investment. These and other reforms, as well as new institutions, have been very far from solving some serious national problems, such as social impoverishment, organized crime and insecurity. Under the law of the strongest, social movements are criminalized and the new players organized in community police and self-defense groups call into question the monopoly of the use of state violence disputing control of areas overwhelmed with violence. At this point, the objective pursued, based on a careful analysis, is to demonstrate the evident crisis and failure of the Mexican legal system, and the need to reform it given the globalization processes. Las condiciones globales económicas ejercen presión sobre los Estados, particularmente, en aquellos que están vinculados a los tratados de libre comercio. México, ante el riesgo de quedar al margen de estos procesos, ha realizado una importante serie de reformas en su legislación para atraer capitales y asegurar mano de obra barata. El sistema jurídico, a partir de 2007, ha sido particularmente reformado, no sólo para garantizar la seguridad e impartición de justicia, protegiendo los derechos humanos en su esencia constitucional, sino también para generar expectativas de seguridad para la inversión de capitales. Estas y otras reformas, así como sus nuevas instituciones, han estado muy lejos de solucionar parte de los graves problemas nacionales, como la delincuencia organizada y la

  4. Performance of community health workers: situating their intermediary position within complex adaptive health systems.

    Science.gov (United States)

    Kok, Maryse C; Broerse, Jacqueline E W; Theobald, Sally; Ormel, Hermen; Dieleman, Marjolein; Taegtmeyer, Miriam

    2017-09-02

    Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors.This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income countries. It examines their unique intermediary position between the communities they serve and actors in the health sector, and the complexity of the health systems in which they operate. The assessment combines evidence from the international literature on CHW programmes with research outcomes from the 5-year REACHOUT consortium, undertaking implementation research to improve CHW performance in six contexts (two in Asia and four in Africa). A conceptual framework on CHW performance, which explicitly conceptualizes the interface role of CHWs, is presented. Various categories of factors influencing CHW performance are distinguished in the framework: the context, the health system and intervention hardware and the health system and intervention software. Hardware elements of CHW interventions comprise the supervision systems, training, accountability and communication structures, incentives, supplies and logistics. Software elements relate to the ideas, interests, relationships, power, values and norms of the health system actors. They influence CHWs' feelings of connectedness, familiarity, self-fulfilment and serving the same goals and CHWs' perceptions of support received, respect, competence, honesty, fairness and recognition.The framework shines a spotlight on the need for programmes to pay more attention to ideas, interests, relationships, power, values and norms of CHWs, communities, health professionals and other actors in the health system, if CHW performance is to improve.

  5. Mapping Health Needs to Support Health System Management in Poland

    Science.gov (United States)

    Holecki, Tomasz; Romaniuk, Piotr; Woźniak-Holecka, Joanna; Szromek, Adam R.; Syrkiewicz-Świtała, Magdalena

    2018-01-01

    In Poland, following the example of other EU countries, the first maps of health needs prepared by the Ministry of Health were presented in 2016. The maps constitute a foundation for rational decision-making in the management of health care resources, being potentially useful for all actors in health system. This refers in particular to the institutions responsible for distribution of funds and contracting health service, but also for decision-makers, who determine the scope of funds to be utilized in the health system, or the structure of benefits provided to patients. Service providers are also addressees of the maps, to give them a basis for planning future activities. The article presents a structured assessment of the current state of affairs, based on recent experience and sets out likely directions for the development of health needs in mapping in Poland in the future. We discuss the criticism addressed toward maps by representatives of various groups acting in health care. It includes the lack of recognition of some of the key health needs, or wrong emphases, where much more attention is paid to the recognition of current resources in the health system, instead of making prognoses regarding the future developments of health needs. Nonetheless, we find that this instrument is potentially of high usability, in case of elimination of the existing weaknesses. PMID:29662876

  6. Intelligent policy making? Key actors' perspectives on the development and implementation of an early years' initiative in Scotland's public health arena.

    Science.gov (United States)

    Deas, L; Mattu, L; Gnich, W

    2013-11-01

    Increased political enthusiasm for evidence-based policy and action has re-ignited interest in the use of evidence within political and practitioner networks. Theories of evidence-based policy making and practice are being re-considered in an attempt to better understand the processes through which knowledge translation occurs. Understanding how policy develops, and practice results, has the potential to facilitate effective evidence use. Further knowledge of the factors which shape healthcare delivery and their influence in different contexts is needed. This paper explores the processes involved in the development of a complex intervention in Scotland's National Health Service (NHS). It uses a national oral health programme for children (Childsmile) as a case study, drawing upon key actors' perceptions of the influence of different drivers (research evidence, practitioner knowledge and values, policy, and political and local context) to programme development. Framework analysis is used to analyse stakeholder accounts from in-depth interviews. Documentary review is also undertaken. Findings suggest that Childsmile can be described as an 'evidence-informed' intervention, blending available research evidence with knowledge from practitioner experience and continual learning through evaluation, to plan delivery. The importance of context was underscored, in terms of the need to align with prevailing political ideology and in the facilitative strength of networks within the relatively small public health community in Scotland. Respondents' perceptions support several existing theoretical models of translation, however no single theory offered a comprehensive framework covering all aspects of the complex processes reported. Childsmile's use of best available evidence and on-going contribution to knowledge suggest that the programme is an example of intelligent policy making with international relevance. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Interrogating resilience in health systems development.

    Science.gov (United States)

    van de Pas, Remco; Ashour, Majdi; Kapilashrami, Anuj; Fustukian, Suzanne

    2017-11-01

    The Fourth Global Symposium on Health Systems Research was themed around 'Resilient and responsive health systems for a changing world.' This commentary is the outcome of a panel discussion at the symposium in which the resilience discourse and its use in health systems development was critically interrogated. The 2014-15 Ebola outbreak in West-Africa added momentum for the wider adoption of resilient health systems as a crucial element to prepare for and effectively respond to crisis. The growing salience of resilience in development and health systems debates can be attributed in part to development actors and philanthropies such as the Rockefeller Foundation. Three concerns regarding the application of resilience to health systems development are discussed: (1) the resilience narrative overrules certain democratic procedures and priority setting in public health agendas by 'claiming' an exceptional policy space; (2) resilience compels accepting and maintaining the status quo and excludes alternative imaginations of just and equitable health systems including the socio-political struggles required to attain those; and (3) an empirical case study from Gaza makes the case that resilience and vulnerability are symbiotic with each other rather than providing a solution for developing a strong health system. In conclusion, if the normative aim of health policies is to build sustainable, universally accessible, health systems then resilience is not the answer. The current threats that health systems face demand us to imagine beyond and explore possibilities for global solidarity and justice in health. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Henry Ford Health Systems

    Science.gov (United States)

    Henry Ford Health Systems evolved from a hospital into a system delivering care to 2.5 million patients and includes the Cancer Epidemiology, Prevention and Control Program, which focuses on epidemiologic and public health aspects of cancer.

  9. Fractal actors and infrastructures

    DEFF Research Database (Denmark)

    Bøge, Ask Risom

    2011-01-01

    -network-theory (ANT) into surveillance studies (Ball 2002, Adey 2004, Gad & Lauritsen 2009). In this paper, I further explore the potential of this connection by experimenting with Marilyn Strathern’s concept of the fractal (1991), which has been discussed in newer ANT literature (Law 2002; Law 2004; Jensen 2007). I...... under surveillance. Based on fieldwork conducted in 2008 and 2011 in relation to my Master’s thesis and PhD respectively, I illustrate fractal concepts by describing the acts, actors and infrastructure that make up the ‘DNA surveillance’ conducted by the Danish police....

  10. ACToR - Aggregated Computational Toxicology Resource

    International Nuclear Information System (INIS)

    Judson, Richard; Richard, Ann; Dix, David; Houck, Keith; Elloumi, Fathi; Martin, Matthew; Cathey, Tommy; Transue, Thomas R.; Spencer, Richard; Wolf, Maritja

    2008-01-01

    ACToR (Aggregated Computational Toxicology Resource) is a database and set of software applications that bring into one central location many types and sources of data on environmental chemicals. Currently, the ACToR chemical database contains information on chemical structure, in vitro bioassays and in vivo toxicology assays derived from more than 150 sources including the U.S. Environmental Protection Agency (EPA), Centers for Disease Control (CDC), U.S. Food and Drug Administration (FDA), National Institutes of Health (NIH), state agencies, corresponding government agencies in Canada, Europe and Japan, universities, the World Health Organization (WHO) and non-governmental organizations (NGOs). At the EPA National Center for Computational Toxicology, ACToR helps manage large data sets being used in a high-throughput environmental chemical screening and prioritization program called ToxCast TM

  11. Budget-makers and health care systems.

    Science.gov (United States)

    White, Joseph

    2013-10-01

    Health programs are shaped by the decisions made in budget processes, so how budget-makers view health programs is an important part of making health policy. Budgeting in any country involves its own policy community, with key players including budgeting professionals and political authorities. This article reviews the typical pressures on and attitudes of these actors when they address health policy choices. The worldview of budget professionals includes attitudes that are congenial to particular policy perspectives, such as the desire to select packages of programs that maximize population health. The pressures on political authorities, however, are very different: most importantly, public demand for health care services is stronger than for virtually any other government activity. The norms and procedures of budgeting also tend to discourage adoption of some of the more enthusiastically promoted health policy reforms. Therefore talk about rationalizing systems is not matched by action; and action is better explained by the need to minimize blame. The budget-maker's perspective provides insight about key controversies in healthcare policy such as decentralization, competition, health service systems as opposed to health insurance systems, and dedicated vs. general revenue finance. It also explains the frequency of various "gaming" behaviors. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Ukraine: health system review.

    Science.gov (United States)

    Lekhan, Valery; Rudiy, Volodymyr; Shevchenko, Maryna; Nitzan Kaluski, Dorit; Richardson, Erica

    2015-03-01

    This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system. World Health Organization 2015 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  13. Institutional analysis of health system governance.

    Science.gov (United States)

    Abimbola, Seye; Negin, Joel; Martiniuk, Alexandra L; Jan, Stephen

    2017-11-01

    It is important that researchers who study health system governance have a set of collective understandings of the meanings of governance, which can then inform the methods used in research. We present an institutional framing and definition of health system governance; that is, governance refers to making, changing, monitoring and enforcing the rules that govern the demand and supply of health services. This pervasive, relational view of governance is to be preferred to approaches that focus primarily on structures of governments and health care organizations, because health system governance involves communities and service users, and because governments in many low- and middle-income countries tend to under-govern. Therefore, the study of health system governance requires institutional analysis; an approach that focuses not only on structures, but also on the rules (both formal and informal) governing demand and supply relations. Using this 'structure-relations' lens, and based on our field experience, we discuss how this focus could be applied to the three approaches to framing and studying health system governance that we identified in the literature. In order of decreasing focus on structures ('hardware') and increasing focus on relations ('software'), they are: (1) the government-centred approach, which focuses on the role of governments, above or to the exclusion of non-government health system actors; (2) the building-block approach, which focuses on the internal workings of health care organizations, and treats governance as one of the several building blocks of organizations; and (3) the institutional approach, which focuses on how the rules governing social and economic interactions are made, changed, monitored and enforced. Notably, either or both qualitative and quantitative methods may be used by researchers in efforts to incorporate the analysis of how rules determine relations among health system actors into these three approaches to health system

  14. Governance of Health Systems Comment on “A Network Based Theory of Health Systems and Cycles of Well-Being”

    OpenAIRE

    Blanchet, Karl

    2013-01-01

    Health systems research aims to understand the governance of health systems (i.e. how health systems function and perform and how their actors interact with each other). This can be achieved by applying innovative methodologies and concepts that are going to capture the complexity and dynamics of health systems when they are affected by shocks. The capacity of health systems to adapt to shocks (i.e. the resilience of health systems) is a new area of investigation. Social network analysis is a...

  15. Slovenia: Health System Review.

    Science.gov (United States)

    Albreht, Tit; Pribakovic Brinovec, Radivoje; Josar, Dusan; Poldrugovac, Mircha; Kostnapfel, Tatja; Zaletel, Metka; Panteli, Dimitra; Maresso, Anna

    2016-06-01

    This analysis of the Slovene health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the population has improved over the last few decades. While life expectancy for both men and women is similar to EU averages, morbidity and mortality data show persistent disparities between regions, and mortality from external causes is particularly high. Satisfaction with health care delivery is high, but recently waiting times for some outpatient specialist services have increased. Greater focus on preventive measures is also needed as well as better care coordination, particularly for those with chronic conditions. Despite having relatively high levels of co-payments for many services covered by the universal compulsory health insurance system, these expenses are counterbalanced by voluntary health insurance, which covers 95% of the population liable for co-payments. However, Slovenia is somewhat unique among social health insurance countries in that it relies almost exclusively on payroll contributions to fund its compulsory health insurance system. This makes health sector revenues very susceptible to economic and labour market fluctuations. A future challenge will be to diversify the resource base for health system funding and thus bolster sustainability in the longer term, while preserving service delivery and quality of care. Given changing demographics and morbidity patterns, further challenges include restructuring the funding and provision of long-term care and enhancing health system efficiency through reform of purchasing and provider-payment systems. World Health Organization 2016 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  16. Rewiring food systems to enhance human health and biosphere stewardship

    Science.gov (United States)

    Gordon, Line J.; Bignet, Victoria; Crona, Beatrice; Henriksson, Patrik J. G.; Van Holt, Tracy; Jonell, Malin; Lindahl, Therese; Troell, Max; Barthel, Stephan; Deutsch, Lisa; Folke, Carl; Jamila Haider, L.; Rockström, Johan; Queiroz, Cibele

    2017-10-01

    Food lies at the heart of both health and sustainability challenges. We use a social-ecological framework to illustrate how major changes to the volume, nutrition and safety of food systems between 1961 and today impact health and sustainability. These changes have almost halved undernutrition while doubling the proportion who are overweight. They have also resulted in reduced resilience of the biosphere, pushing four out of six analysed planetary boundaries across the safe operating space of the biosphere. Our analysis further illustrates that consumers and producers have become more distant from one another, with substantial power consolidated within a small group of key actors. Solutions include a shift from a volume-focused production system to focus on quality, nutrition, resource use efficiency, and reduced antimicrobial use. To achieve this, we need to rewire food systems in ways that enhance transparency between producers and consumers, mobilize key actors to become biosphere stewards, and re-connect people to the biosphere.

  17. Actors and Practices

    DEFF Research Database (Denmark)

    Balslev, Lars

    Actors and practices – An institutional study on management accounting change in Air Greenland My former CEO was one of the first executives in Greenland to formally implement an extensive commercial strategy to identify the contradictory forces of social obligations and commercial strivings...... societal obligation. He noted that: “…there is some inherent conflict in having the type of ownership we have, one in which the commercial owner demands higher profits or they will sell their shares, and the other two government owners, where one wishes to have the lowest possible fares and better...... infrastructure and the other one just wants less trouble. Well! This is the ongoing inherent conflict of the owner composition we just have to deal with.” He emphasized that SAS, the more “commercial oriented” owner and private shareholder, wanted higher profits and gains, whereas the Government of Greenland...

  18. France: Health System Review.

    Science.gov (United States)

    Chevreul, Karine; Berg Brigham, Karen; Durand-Zaleski, Isabelle; Hernandez-Quevedo, Cristina

    2015-01-01

    This analysis of the French health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The French population has a good level of health, with the second highest life expectancy in the world for women. It has a high level of choice of providers, and a high level of satisfaction with the health system. However, unhealthy habits such as smoking and harmful alcohol consumption remain significant causes of avoidable mortality. Combined with the significant burden of chronic diseases, this has underscored the need for prevention and integration of services, although these have not historically been strengths of the French system. Although the French health care system is a social insurance system, it has historically had a stronger role for the state than other Bismarckian social insurance systems. Public financing of health care expenditure is among the highest in Europe and out-of-pocket spending among the lowest. Public insurance is compulsory and covers the resident population; it is financed by employee and employer contributions as well as increasingly through taxation. Complementary insurance plays a significant role in ensuring equity in access. Provision is mixed; providers of outpatient care are largely private, and hospital beds are predominantly public or private non-profit-making. Despite health outcomes being among the best in the European Union, social and geographical health inequities remain. Inequality in the distribution of health care professionals is a considerable barrier to equity. The rising cost of health care and the increasing demand for long-term care are also of concern. Reforms are ongoing to address these issues, while striving for equity in financial access; a long-term care reform including public coverage of long-term care is still pending. World Health Organization 2015 (acting as the host organization for, and secretariat of, the

  19. Malta: Health system review.

    Science.gov (United States)

    Azzopardi Muscat, Natasha; Calleja, Neville; Calleja, Antoinette; Cylus, Jonathan

    2014-01-01

    This analysis of the Maltese health system reviews the developments in its organization and governance, health financing, health-care provision, health reforms and health system performance. The health system in Malta consists of a public sector, which is free at the point of service and provides a comprehensive basket of health services for all its citizens, and a private sector, which accounts for a third of total health expenditure and provides the majority of primary care. Maltese citizens enjoy one of the highest life expectancies in Europe. Nevertheless, non-communicable diseases pose a major concern with obesity being increasingly prevalent among both adults and children. The health system faces important challenges including a steadily ageing population, which impacts the sustainability of public finances. Other supply constraints stem from financial and infrastructural limitations. Nonetheless, there exists a strong political commitment to ensure the provision of a healthcare system that is accessible, of high quality, safe and also sustainable. This calls for strategic investments to underpin a revision of existing processes whilst shifting the focus of care away from hospital into the community. World Health Organization 2014 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  20. Austria: health system review.

    Science.gov (United States)

    Hofmarcher, Maria M; Quentin, Wilm

    2013-01-01

    This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibilities and frequently results in inadequate coordination. For this reason, efforts have been made for several years to achieve more joint planning, governance and financing of the health-care system at the federal and regional level. As in any health system, a number of challenges remain. The costs of the health-care system are well above the EU15 average, both in absolute terms and as a percentage of GDP. There are important structural imbalances in healthcare provision, with an oversized hospital sector and insufficient resources available for ambulatory care and preventive medicine. This is coupled with stark regional differences in utilization, both in curative services (hospital beds and specialist physicians) and preventative services such as preventive health check-ups, outpatient rehabilitation, psychosocial and psychotherapeutic care and nursing. There are clear social inequalities in the use of medical services, such as preventive health check-ups, immunization or dentistry

  1. Management of radioactive waste in Belgium: ONDRAF/NIRAS and Belgoprocess as major actors of the waste acceptance system

    International Nuclear Information System (INIS)

    Zaelen, Gunter van; Verheyen, Annick

    2007-01-01

    The management of radioactive waste in Belgium is undertaken by the national agency for radioactive waste and enriched fissile materials, ONDRAF/NIRAS, and its industrial partner Belgoprocess. ONDRAF/NIRAS has set up a management system designed to guarantee that the general public and the environment are protected against the potential hazards arising from radioactive waste. Belgoprocess is a private company, founded in 1984 and located in Dessel, Belgium. It is a subsidiary of ONDRAF/NIRAS and its activities focus on the safe processing and storage of radioactive waste. The management system of ONDRAF/NIRAS includes two aspects: a) an integrated system and b) an acceptance system. The integrated system covers all aspects of management ranging from the origin of waste to its transport, processing, interim storage and long-term management. The safety of radioactive waste management not only depends on the quality of the design and construction of the processing, temporary storage or disposal infrastructure, but also on the quality of the waste accepted by ONDRAF/NIRAS. In order to be manage d safely, both in the short and the long term, the waste transferred to ONDRAF/NIRAS must meet certain specific requirements. To that end, ONDRAF/NIRAS has developed an acceptance system. (authors)

  2. Switzerland: Health System Review.

    Science.gov (United States)

    De Pietro, Carlo; Camenzind, Paul; Sturny, Isabelle; Crivelli, Luca; Edwards-Garavoglia, Suzanne; Spranger, Anne; Wittenbecher, Friedrich; Quentin, Wilm

    2015-01-01

    This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to

  3. Estonia: health system review.

    Science.gov (United States)

    Lai, Taavi; Habicht, Triin; Kahur, Kristiina; Reinap, Marge; Kiivet, Raul; van Ginneken, Ewout

    2013-01-01

    This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  4. Knowledge engineering as a support for building an actor profile ontology for integrating Home-Care systems.

    Science.gov (United States)

    Gibert, Karina; Valls, Aida; Riaño, David

    2008-01-01

    One of the tasks towards the definition of a knowledge model for home care is the definition of the different roles of the users involved in the system. The roles determine the actions and services that can or must be performed by each type of user. In this paper the experience of building an ontology to represent the home-care users and their associated information is presented, in a proposal for a standard model of a Home-Care support system to the European Community.

  5. The influence of actor capacities on EIA system performance in low and middle income countries -Cases from Georgia and Ghana

    NARCIS (Netherlands)

    Kolhoff, A.J.; Runhaar, H.A.C.; Gugushvili, Tamar; Sonderegger, Gabi; Leest, Van der Bart; Driessen, P.P.J.

    2016-01-01

    In this paper, we aim to better understand the factors that contribute to the substantive performance of EIA systems in low and middle income countries. Substantive performance is defined as the extent to which the EIA process contributes to the EIA objectives for the long term, namely

  6. The influence of actor capacities on EIA system performance in low and middle income countries -Cases from Georgia and Ghana

    NARCIS (Netherlands)

    Kolhoff, Arend J.; Runhaar, Hens A C; Gugushvili, Tamar; Sonderegger, Gabi; Van der Leest, Bart; Driessen, Peter

    2016-01-01

    In this paper, we aim to better understand the factors that contribute to the substantive performance of EIA systems in low and middle income countries. Substantive performance is defined as the extent to which the EIA process contributes to the EIA objectives for the long term, namely environmental

  7. Bulgaria health system review.

    Science.gov (United States)

    Dimova, Antoniya; Rohova, Maria; Moutafova, Emanuela; Atanasova, Elka; Koeva, Stefka; Panteli, Dimitra; van Ginneken, Ewout

    2012-01-01

    In the last 20 years, demographic development in Bulgaria has been characterized by population decline, a low crude birth rate, a low fertility rate, a high mortality rate and an ageing population. A stabilizing political situation since the early 2000s and an economic upsurge since the mid-2000s were important factors in the slight increase of the birth and fertility rates and the slight decrease in standardized death rates. In general, Bulgaria lags behind European Union (EU) averages in most mortality and morbidity indicators. Life expectancy at birth reached 73.3 years in 2008 with the main three causes of death being diseases of the circulatory system, malignant neoplasms and diseases of the respiratory system. One of the most important risk factors overall is smoking, and the average standardized death rate for smoking-related causes in 2008 was twice as high as the EU15 average. The Bulgarian health system is characterized by limited statism. The Ministry of Health is responsible for national health policy and the overall organization and functioning of the health system and coordinates with all ministries with relevance to public health. The key players in the insurance system are the insured individuals, the health care providers and the third party payers, comprising the National Health Insurance Fund, the single payer in the social health insurance (SHI) system, and voluntary health insurance companies (VHICs). Health financing consists of a publicprivate mix. Health care is financed from compulsory health insurance contributions, taxes, outofpocket (OOP) payments, voluntary health insurance (VHI) premiums, corporate payments, donations, and external funding. Total health expenditure (THE) as a share of gross domestic product (GDP) increased from 5.3% in 1995 to 7.3% in 2008. At the latter date it consisted of 36.5% OOP payments, 34.8% SHI, 13.6% Ministry of Health expenditure, 9.4% municipality expenditure and 0.3% VHI. Informal payments in the health

  8. A haptic sensor-actor-system based on ultrasound elastography and electrorheological fluids for virtual reality applications in medicine.

    Science.gov (United States)

    Khaled, W; Ermert, H; Bruhns, O; Boese, H; Baumann, M; Monkman, G J; Egersdoerfer, S; Meier, A; Klein, D; Freimuth, H

    2003-01-01

    Mechanical properties of biological tissue represent important diagnostic information and are of histological relevance (hard lesions, "nodes" in organs: tumors; calcifications in vessels: arteriosclerosis). The problem is, that such information is usually obtained by digital palpation only, which is limited with respect to sensitivity. It requires intuitive assessment and does not allow quantitative documentation. A suitable sensor is required for quantitative detection of mechanical tissue properties. On the other hand, there is also some need for a realistic mechanical display of those tissue properties. Suitable actuator arrays with high spatial resolution and real-time capabilities are required operating in a haptic sensor actuator system with different applications. The sensor system uses real time ultrasonic elastography whereas the tactile actuator is based on electrorheological fluids. Due to their small size the actuator array elements have to be manufactured by micro-mechanical production methods. In order to supply the actuator elements with individual high voltages a sophisticated switching and control concept have been designed. This haptic system has the potential of inducing real time substantial forces, using a compact lightweight mechanism which can be applied to numerous areas including intraoperative navigation, telemedicine, teaching, space and telecommunication.

  9. Circumpolar Inuit health systems.

    Science.gov (United States)

    Ellsworth, Leanna; O'Keeffe, Annmaree

    2013-01-01

    The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic - Canada, Greenland, USA (Alaska) and Russia (Chukotka). In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska) and Russia (Chukotka) and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Literature review. It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems' effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of comparison in terms of methodology and timing of the available data

  10. Landscape of the EU-US Research Infrastructures and actors: Moving towards international interoperability of earth system data

    Science.gov (United States)

    Asmi, Ari; Powers, Lindsay

    2015-04-01

    Research Infrastructures (RIs) are major long-term investments supporting innovative, bottom-up research activities. In the environmental research, they range from high atmosphere radars, to field observation networks and coordinated laboratory facilities. The Earth system is highly interactive and each part of the system interconnected across the spatial and disciplinary borders. However, due practical and historical reasons, the RIs are built from disciplinary points-of-view and separately in different parts of the world, with differing standards, policies, methods and research cultures. This heterogeneity provides necessary diversity to study the complex Earth system, but makes cross-disciplinary and/or global interoperability a challenge. Global actions towards better interoperability are surfacing, especially with EU and US. For example, recent mandates within the US government prioritize open data for federal agencies and federally funded science, and encourage collaboration among agencies to reduce duplication of efforts and increase efficient use of resources. There are several existing initiatives working toward these goals (e.g., COOPEUS, EarthCube, RDA, ICSU-WDS, DataOne, ESIP, USGEO, GEO). However, there is no cohesive framework to coordinate efforts among these, and other, entities. COOPEUS and EarthCube have now begun to map the landscape of interoperability efforts across earth science domains. The COOPEUS mapping effort describes the EU and US landscape of environmental research infrastructures to accomplish the following: identify gaps in services (data provision) necessary to address societal priorities; provide guidance for development of future research infrastructures; and identify opportunities for Research Infrastructures (RIs) to collaborate on issues of common interest. EarthCube mapping effort identifies opportunities to engage a broader community by identifying scientific domain organizations and entities. We present the current situation

  11. Circumpolar Inuit health systems

    Directory of Open Access Journals (Sweden)

    Leanna Ellsworth

    2013-08-01

    Full Text Available Background . The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic – Canada, Greenland, USA (Alaska and Russia (Chukotka. In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. Objective . To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska and Russia (Chukotka and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Study design . Literature review. Results . It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems’ effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of

  12. Roles of Governments in Multi-Actor Sustainable Supply Chain. Governance Systems and the effectiveness of their interventions. An exploratory study

    International Nuclear Information System (INIS)

    Vermeulen, W.; Uitenboogaart, Y.; Pesqueira, L.D.I.; Metselaar, J.; Kok, M.

    2010-11-01

    During the last decade, a growing number of market-based certification systems has been introduced for sustainable products consumed in the Netherlands and the EU but sourced through international supply chains. These systems, which cover agro-food products as well as non-food products, consist of requirements for products from developing countries with regard to environmental and social-ethical issues. These systems aim to improve production processes at the front end of the supply chain. These so called 'sustainable supply chain systems' have been initiated and are managed mainly by the market and civil society, without directly involving the government. This raises questions about the effectiveness, transparency, and legitimacy of such forms of self-regulation and about the most appropriate role for national government in relation to these emerging systems. This exploratory study analyses some of the earliest multi-actor sustainable supply chain governance systems in order to answer the key research questions: Which strategies and instruments do governments - national and supranational - apply in advancing sustainable production and consumption in global supply chains; and What is known about the effectiveness of these strategies and instruments? The study focuses on two supply chains with the longest history of addressing imports from developing countries (tropical timber and coffee). These two supply chains are compared with two supply chains that are gaining increasing attention: cocoa and tea. This study shows that the two most 'mature' global sustainable supply chains are market led in issuing voluntary certification and that buying certified products is starting to become mainstream and increasingly effective. The sustainable supply chains for tea and cacoa are more recent developments but may develop faster because of the lessons learnt in sustainable supply chains developed earlier.

  13. Roles of Governments in Multi-Actor Sustainable Supply Chain. Governance Systems and the effectiveness of their interventions. An exploratory study

    Energy Technology Data Exchange (ETDEWEB)

    Vermeulen, W.; Uitenboogaart, Y.; Pesqueira, L.D.I.; Metselaar, J. [Copernicus Institute for Sustainable Development and Innovation, Utrecht University, Utrecht (Netherlands); Kok, M. [Netherlands Environmental Assessment Agency PBL, Den Haag (Netherlands)

    2010-11-15

    During the last decade, a growing number of market-based certification systems has been introduced for sustainable products consumed in the Netherlands and the EU but sourced through international supply chains. These systems, which cover agro-food products as well as non-food products, consist of requirements for products from developing countries with regard to environmental and social-ethical issues. These systems aim to improve production processes at the front end of the supply chain. These so called 'sustainable supply chain systems' have been initiated and are managed mainly by the market and civil society, without directly involving the government. This raises questions about the effectiveness, transparency, and legitimacy of such forms of self-regulation and about the most appropriate role for national government in relation to these emerging systems. This exploratory study analyses some of the earliest multi-actor sustainable supply chain governance systems in order to answer the key research questions: Which strategies and instruments do governments - national and supranational - apply in advancing sustainable production and consumption in global supply chains; and What is known about the effectiveness of these strategies and instruments? The study focuses on two supply chains with the longest history of addressing imports from developing countries (tropical timber and coffee). These two supply chains are compared with two supply chains that are gaining increasing attention: cocoa and tea. This study shows that the two most 'mature' global sustainable supply chains are market led in issuing voluntary certification and that buying certified products is starting to become mainstream and increasingly effective. The sustainable supply chains for tea and cacoa are more recent developments but may develop faster because of the lessons learnt in sustainable supply chains developed earlier.

  14. Iranian Sanctions: An Actor-Centric Analysis

    Science.gov (United States)

    2012-03-01

    cultivated to counterbalance other actors in the system who opposed Khamenei’s ascension, based on his weak religious credentials.42 These security...trumped up religious infraction.256 The bonyads are the Iranian economy’s dominating revenue generating entity outside the oil sector,257 mushrooming in

  15. Medical tourism's impact for health systems: A study from three Asian countries

    OpenAIRE

    Ala`a Nimer AbuKhalifeh; Erwin Martinez Faller

    2015-01-01

    Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism’s growth for health systems, illustration ...

  16. Global Surgery 2030: a roadmap for high income country actors

    Science.gov (United States)

    Greenberg, Sarah L M; Abdullah, Fizan; Amado, Vanda; Anderson, Geoffrey A; Cossa, Matchecane; Costas-Chavarri, Ainhoa; Davies, Justine; Debas, Haile T; Dyer, George S M; Erdene, Sarnai; Farmer, Paul E; Gaumnitz, Amber; Hagander, Lars; Haider, Adil; Leather, Andrew J M; Lin, Yihan; Marten, Robert; Marvin, Jeffrey T; McClain, Craig D; Meara, John G; Meheš, Mira; Mock, Charles; Mukhopadhyay, Swagoto; Orgoi, Sergelen; Prestero, Timothy; Price, Raymond R; Raykar, Nakul P; Riesel, Johanna N; Riviello, Robert; Rudy, Stephen M; Saluja, Saurabh; Sullivan, Richard; Tarpley, John L; Taylor, Robert H; Telemaque, Louis-Franck; Toma, Gabriel; Varghese, Asha; Walker, Melanie; Yamey, Gavin; Shrime, Mark G

    2016-01-01

    The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future. PMID:28588908

  17. Health Information Systems

    International Development Research Centre (IDRC) Digital Library (Canada)

    the technology and expertise to process and share ... services. GEHS supports efforts that reach beyond healthcare institutions to capture evidence ... Health information systems are a foundation for quality care, and can increase accountability ...

  18. International Political Actorness of the European Union: Evaluation Criteria

    Directory of Open Access Journals (Sweden)

    GNATYUK N.N.

    2014-06-01

    Full Text Available The European Union is a completely new international entity which is hard to evaluate using traditional criteria of political actorness. Its active international presence stimulates the modeling of international actor features beyond the scope of “state-international organization” scheme. The concept of international actorness serves as a starting point for the development of appropriate analytical model. Unlike the traditional state-centered approaches which define an international actor through its affiliation witch the international system, this concept operates at the internal level of international entity and at the international structure level. Furthermore, both of these levels are treated as ontologically neutral and mutually constitutive. This basic theoretical scheme is used for elaboration of evaluation criteria of political actorness. The proposed system of criteria is based on drawing, synthesizing and developing the main writings on “new international actors” since the times of classic work by Carol A. Cosgrove and Kenneth J. Twitchett. The key elements of actorness assessed in this article include defining of capacity to act on the global scene as well as the acceptance by other actors and by international system as a whole. At the internal level, the EU’s actor capacity is measured by assessing its core elements ranging from core aspects, such as autonomy, authority, actor capability, coherence and cohesion to identity aspects. On the external level, the decisive criteria are recognition and acceptance by others which reflect expectations and perceptions of the EU. The proposed approach of evaluating the international actorness enables us to consider the political activity of the EU on the basis of coordinated system of interaction between the variables of international and domestic levels of the analysis. Furthermore, this contributes to the development of cumulative, coherent, and comprehensive theory of international

  19. Identifying and Mapping Linkages between Actors in the Climate ...

    African Journals Online (AJOL)

    Promoting innovations in climate change requires innovation partnerships and linkages and also creating an enabling environment for actors. The paper reviewed available information on the identification and mapping of linkages between actors in the climate change innovation system. The findings showed different ...

  20. System health monitoring

    International Nuclear Information System (INIS)

    Reneke, J.A.; Fryer, M.O.

    1995-01-01

    Well designed large systems include many instrument taking data. These data are used in a variety of ways. They are used to control the system and its components, to monitor system and component health, and often for historical or financial purposes. This paper discusses a new method of using data from low level instrumentation to monitor system and component health. The method uses the covariance of instrument outputs to calculate a measure of system change. The method involves no complicated modeling since it is not a parameter estimation algorithm. The method is iterative and can be implemented on a computer in real time. Examples are presented for a metal lathe and a high efficiency particulate air (HEPA) filter. It is shown that the proposed method is quite sensitive to system changes such as wear out and failure. The method is useful for low level system diagnostics and fault detection

  1. Health system challenges of NCDs in Tunisia.

    Science.gov (United States)

    Ben Romdhane, Habiba; Tlili, Faten; Skhiri, Afef; Zaman, Shahaduz; Phillimore, Peter

    2015-01-01

    The objective of this study was to present a qualitative 'situation analysis' of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs). Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson's framework (1994) for policy analysis was used: content, actors, context, and process. Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void. This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.

  2. Contributions of Global Health Diplomacy to Health Systems in Sub ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    African policymakers and other relevant actors will be exposed to the arguments, methods, and challenges of global health diplomacy so they can engage more ... L'Association internationale de ressources en eau (IWRA), en étroite collaboration avec le CRDI, organise un webinaire intitulé "Changements climatiques et ...

  3. Aggregated Computational Toxicology Resource (ACTOR)

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Aggregated Computational Toxicology Resource (ACTOR) is a database on environmental chemicals that is searchable by chemical name and other identifiers, and by...

  4. An Erlang Implementation of Multiparty Session Actors

    Directory of Open Access Journals (Sweden)

    Simon Fowler

    2016-08-01

    Full Text Available By requiring co-ordination to take place using explicit message passing instead of relying on shared memory, actor-based programming languages have been shown to be effective tools for building reliable and fault-tolerant distributed systems. Although naturally communication-centric, communication patterns in actor-based applications remain informally specified, meaning that errors in communication are detected late, if at all. Multiparty session types are a formalism to describe, at a global level, the interactions between multiple communicating entities. This article describes the implementation of a prototype framework for monitoring Erlang/OTP gen_server applications against multiparty session types, showing how previous work on multiparty session actors can be adapted to a purely actor-based language, and how monitor violations and termination of session participants can be reported in line with the Erlang mantra of "let it fail". Finally, the framework is used to implement two case studies: an adaptation of a freely-available DNS server, and a chat server.

  5. What is a conservation actor?

    Directory of Open Access Journals (Sweden)

    Paul Jepson

    2011-01-01

    Full Text Available As a crisis-oriented discipline, conservation biology needs actions to understand the state of nature and thwart declines in biodiversity. Actors-traditionally individuals, institutions, and collectives-have been central to delivering such goals in practice. However, the definition of actors within the discipline has been narrow and their role in influencing conservation outcomes inadequately conceptualised. In this paper, we examine the question ′What is a conservation actor?′ Who or what creates the capacity to influence conservation values and actions? Drawing from theoretical developments in Actor-Network Theory and collective governance, we argue that the concept of an actor in conservation biology should be broadened to include non-humans, such as species and devices, because they have the agency and ability to influence project goals and outcomes. We illustrate this through four examples: the Asian elephant, International Union for Conservation of Nature red lists, the High Conservation Value approach, and an Integrated Conservation and Development Project. We argue that a broader conceptualisation of actors in conservation biology will produce new forms of understanding that could open up new areas of conservation research, enhance practice and draw attention to spheres of conservation activity that might require stronger oversight and governance.

  6. Efficient Actor Recovery Paradigm for Wireless Sensor and Actor Networks.

    Science.gov (United States)

    Mahjoub, Reem K; Elleithy, Khaled

    2017-04-14

    The actor nodes are the spine of wireless sensor and actor networks (WSANs) that collaborate to perform a specific task in an unverified and uneven environment. Thus, there is a possibility of high failure rate in such unfriendly scenarios due to several factors such as power consumption of devices, electronic circuit failure, software errors in nodes or physical impairment of the actor nodes and inter-actor connectivity problem. Therefore, it is extremely important to discover the failure of a cut-vertex actor and network-disjoint in order to improve the Quality-of-Service (QoS). In this paper, we propose an Efficient Actor Recovery (EAR) paradigm to guarantee the contention-free traffic-forwarding capacity. The EAR paradigm consists of a Node Monitoring and Critical Node Detection (NMCND) algorithm that monitors the activities of the nodes to determine the critical node. In addition, it replaces the critical node with backup node prior to complete node-failure which helps balancing the network performance. The packets are handled using Network Integration and Message Forwarding (NIMF) algorithm that determines the source of forwarding the packets; either from actor or sensor. This decision-making capability of the algorithm controls the packet forwarding rate to maintain the network for a longer time. Furthermore, for handling the proper routing strategy, Priority-Based Routing for Node Failure Avoidance (PRNFA) algorithm is deployed to decide the priority of the packets to be forwarded based on the significance of information available in the packet. To validate the effectiveness of the proposed EAR paradigm, the proposed algorithms were tested using OMNET++ simulation.

  7. Canada: Health system review.

    Science.gov (United States)

    Marchildon, Gregory

    2013-01-01

    Canada is a high-income country with a population of 33 million people. Its economic performance has been solid despite the recession that began in 2008. Life expectancy in Canada continues to rise and is high compared with most OECD countries; however, infant and maternal mortality rates tend to be worse than in countries such as Australia, France and Sweden. About 70% of total health expenditure comes from the general tax revenues of the federal, provincial and territorial governments. Most public revenues for health are used to provide universal medicare (medically necessary hospital and physician services that are free at the point of service for residents) and to subsidise the costs of outpatient prescription drugs and long-term care. Health care costs continue to grow at a faster rate than the economy and government revenue, largely driven by spending on prescription drugs. In the last five years, however, growth rates in pharmaceutical spending have been matched by hospital spending and overtaken by physician spending, mainly due to increased provider remuneration. The governance, organization and delivery of health services is highly decentralized, with the provinces and territories responsible for administering medicare and planning health services. In the last ten years there have been no major pan-Canadian health reform initiatives but individual provinces and territories have focused on reorganizing or fine tuning their regional health systems and improving the quality, timeliness and patient experience of primary, acute and chronic care. The medicare system has been effective in providing Canadians with financial protection against hospital and physician costs. However, the narrow scope of services covered under medicare has produced important gaps in coverage and equitable access may be a challenge in these areas. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and

  8. Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts.

    Science.gov (United States)

    Zhang, Xiulan; Bloom, Gerald; Xu, Xiaoxin; Chen, Lin; Liang, Xiaoyun; Wolcott, Sara J

    2014-08-26

    This paper explores the evolution of schemes for rural finance in China as a case study of the long and complex process of health system development. It argues that the evolution of these schemes has been the outcome of the response of a large number of agents to a rapidly changing context and of efforts by the government to influence this adaptation process and achieve public health goals. The study draws on several sources of data including a review of official policy documents and academic papers and in-depth interviews with key policy actors at national level and at a sample of localities. The study identifies three major transition points associated with changes in broad development strategy and demonstrates how the adaptation of large numbers of actors to these contextual changes had a major impact on the performance of the health system. Further, it documents how the Ministry of Health viewed its role as both an advocate for the interests of health facilities and health workers and as the agency responsible for ensuring that government health system objectives were met. It is argued that a major reason for the resilience of the health system and its ability to adapt to rapid economic and institutional change was the ability of the Ministry to provide overall strategy leadership. Additionally, it postulates that a number of interest groups have emerged, which now also seek to influence the pathway of health system development. This history illustrates the complex and political nature of the management of health system development and reform. The paper concludes that governments will need to increase their capacity to analyze the health sector as a complex system and to manage change processes.

  9. Agente Comunitário de Saúde: um novo ator no cenário da saúde do Brasil Community Health Agent: a new actor in the Brazilian health scenario

    Directory of Open Access Journals (Sweden)

    Andréa Sabino Filgueiras

    2011-01-01

    Full Text Available O Programa de Agentes Comunitários de Saúde (PACS foi introduzido no Brasil em 1991 como uma tática para o desenvolvimento de atividades relacionadas à prevenção de doenças e educação em saúde. Em 1994, o Ministério da Saúde propôs o Programa de Saúde da Família (PSF como estratégia de reestruturação da atenção à saúde. Essas propostas introduzem, no cenário da saúde, um novo ator, o Agente Comunitário de Saúde (ACS, desempenhando importante papel na atenção básica, ao agir como um elo entre famílias, usuários e serviço de saúde. O estudo toma como objeto o trabalho desenvolvido pelos ACS em uma unidade do PSF do município de Volta Redonda-RJ. Tem como objetivo discutir os aspectos facilitadores e limitantes das atividades designadas aos ACS. Trata-se de uma pesquisa do tipo descritiva, com abordagem qualitativa. A análise de dados se deu por categorias analíticas, que emergiram a partir dos dados encontrados nas entrevistas. Após a apreciação dos dados, pôde-se constatar que os ACS do PSF de Volta Redonda ainda não recebem formação destinada à execução de suas atividades e que consideram a experiência prática como o principal motor para o desempenho delas. O trabalho em equipe é reconhecido como espaço de circulação de saberes científicos e o saber popular como mediador entre a equipe e a população. Os ACS têm como eixo de trabalho a visita domiciliar, focada principalmente na doença.The Community Health Agents Program (PACS was created in 1991 as a strategy to implement the SUS, developing activities related to prevention and health education. In 1994, the Health Ministry proposed the Family Health Program (PSF as a strategy for restructuring the dominant care model. With the emergence of these two programs, there is the emergence of a new actor in the health scenario, the Community Health Agent (ACS. This actor plays an important role in basic care, acting as a link between families

  10. Croatia: health system review.

    Science.gov (United States)

    Džakula, Aleksandar; Sagan, Anna; Pavić, Nika; Lonćčarek, Karmen; Sekelj-Kauzlarić, Katarina

    2014-01-01

    Croatia is a small central European country on the Balkan peninsula, with a population of approximately 4.3 million and a gross domestic product (GDP) of 62% of the European Union (EU) average (expressed in purchasing power parity; PPP) in 2012. On 1 July 2013, Croatia became the 28th Member State of the EU. Life expectancy at birth has been increasing steadily in Croatia (with a small decline in the years following the 1991 to 1995 War of Independence) but is still lower than the EU average. Prevalence of overweight and obesity in the population has increased during recent years and trends in physical inactivity are alarming. The Croatian Health Insurance Fund (CHIF), established in 1993, is the sole insurer in the mandatory health insurance (MHI) system that provides universal health coverage to the whole population. The ownership of secondary health care facilities is distributed between the State and the counties. The financial position of public hospitals is weak and recent reforms were aimed at improving this. The introduction of concessions in 2009 (public private partnerships whereby county governments organize tenders for the provision of specific primary health care services) allowed the counties to play a more active role in the organization, coordination and management of primary health care; most primary care practices have been privatized. The proportion of GDP spent on health by the Croatian government remains relatively low compared to western Europe, as does the per capita health expenditure. Although the share of public expenditure as a proportion of total health expenditure (THE) has been decreasing, at around 82% it is still relatively high, even by European standards. The main source of the CHIFs revenue is compulsory health insurance contributions, accounting for 76% of the total revenues of the CHIF, although only about a third of the population (active workers) is liable to pay full health care contributions. Although the breadth and scope

  11. Measuring name system health

    NARCIS (Netherlands)

    Casalicchio, Emiliano; Caselli, Marco; Coletta, Alessio; Di Blasi, Salvatore; Fovino, Igor Nai; Butts, Jonathan; Shenoi, Sujeet

    2012-01-01

    Modern critical infrastructure assets are exposed to security threats arising from their use of IP networks and the Domain Name System (DNS). This paper focuses on the health of DNS. Indeed, due to the increased reliance on the Internet, the degradation of DNS could have significant consequences for

  12. Health system reform.

    Science.gov (United States)

    Ortolon, Ken

    2009-06-01

    A vote on reforming the nation's health care system seems likely this summer as President Obama makes good on a campaign pledge. Although the Democratic leadership in Congress appears ready to push through reform legislation before the next election, TMA and AMA leaders say very little is known about what that "reform" likely will look like.

  13. Designing and Conducting Health Systems Research Projects ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    ... and field testing (Part 1) and with data analysis and report writing (Part 2). ... New website will help record vital life events to improve access to services for all ... How are public health actors working with the food and drinks industry to ...

  14. The influence of actor capacities on EIA system performance in low and middle income countries —Cases from Georgia and Ghana

    International Nuclear Information System (INIS)

    Kolhoff, Arend J.; Runhaar, Hens A.C.; Gugushvili, Tamar; Sonderegger, Gabi; Van der Leest, Bart; Driessen, Peter P.J.

    2016-01-01

    In this paper, we aim to better understand the factors that contribute to the substantive performance of EIA systems in low and middle income countries. Substantive performance is defined as the extent to which the EIA process contributes to the EIA objectives for the long term, namely environmental protection or, even more ambitious, sustainable development. We have therefore developed a conceptual model in which we focus on the key actors in the EIA system, the proponent and the EIA authority and their level of ownership as a key capacity to measure their performance, and we distinguish procedural performance and some contextual factors. This conceptual model is then verified and refined for the EIA phase and the EIA follow-up phase (permitting, monitoring and enforcement) by means of 12 case studies from Ghana (four cases) and Georgia (eight cases), both lower–middle income countries. We observe that in most cases the level of substantive performance increases during the EIA phase but drops during the EIA follow-up phase, and as a result only five out of 12 operational cases are in compliance with permit conditions or national environmental standards. We conclude, firstly that ownership of the proponent is the most important factor explaining the level of substantive performance; the higher the proponent's level of ownership the higher the level of substantive performance. The influence of the EIA authority on substantive performance is limited. Secondly, the influence of procedural performance on substantive performance seems less important than expected in the EIA phase but more important during the EIA follow-up phase. In order to improve substantive performance we learned two lessons. Firstly, increasing the proponent's level of ownership seems obvious, but direct change is probably difficult. However, where international finance institutes are involved they can increase ownership. Despite the limited influence of the EIA authority, a proactive strategy of

  15. The influence of actor capacities on EIA system performance in low and middle income countries —Cases from Georgia and Ghana

    Energy Technology Data Exchange (ETDEWEB)

    Kolhoff, Arend J., E-mail: akolhoff@eia.nl [Netherlands Commission for Environmental Assessment, P.O. Box 2345, 3500 GH Utrecht (Netherlands); Runhaar, Hens A.C., E-mail: H.A.C.Runhaar@uu.nl [Environmental Studies and Policy, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht (Netherlands); Forest and Nature Conservation Policy Group, Wageningen University and Research Centre, Wageningen (Netherlands); Gugushvili, Tamar, E-mail: gugushvili.tamuna@gmail.com [Netherlands Commission for Environmental Assessment, P.O. Box 2345, 3500 GH Utrecht (Netherlands); Sonderegger, Gabi, E-mail: gabi.sonderegger@gmail.com [Netherlands Commission for Environmental Assessment, P.O. Box 2345, 3500 GH Utrecht (Netherlands); Van der Leest, Bart, E-mail: bartvanderleest@hotmail.com [Netherlands Commission for Environmental Assessment, P.O. Box 2345, 3500 GH Utrecht (Netherlands); Driessen, Peter P.J., E-mail: p.driessen@uu.nl [Innovation and Environmental Sciences, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht (Netherlands)

    2016-02-15

    In this paper, we aim to better understand the factors that contribute to the substantive performance of EIA systems in low and middle income countries. Substantive performance is defined as the extent to which the EIA process contributes to the EIA objectives for the long term, namely environmental protection or, even more ambitious, sustainable development. We have therefore developed a conceptual model in which we focus on the key actors in the EIA system, the proponent and the EIA authority and their level of ownership as a key capacity to measure their performance, and we distinguish procedural performance and some contextual factors. This conceptual model is then verified and refined for the EIA phase and the EIA follow-up phase (permitting, monitoring and enforcement) by means of 12 case studies from Ghana (four cases) and Georgia (eight cases), both lower–middle income countries. We observe that in most cases the level of substantive performance increases during the EIA phase but drops during the EIA follow-up phase, and as a result only five out of 12 operational cases are in compliance with permit conditions or national environmental standards. We conclude, firstly that ownership of the proponent is the most important factor explaining the level of substantive performance; the higher the proponent's level of ownership the higher the level of substantive performance. The influence of the EIA authority on substantive performance is limited. Secondly, the influence of procedural performance on substantive performance seems less important than expected in the EIA phase but more important during the EIA follow-up phase. In order to improve substantive performance we learned two lessons. Firstly, increasing the proponent's level of ownership seems obvious, but direct change is probably difficult. However, where international finance institutes are involved they can increase ownership. Despite the limited influence of the EIA authority, a proactive

  16. A Multi-Actor Dynamic Integrated Assessment Model (MADIAM)

    OpenAIRE

    Weber, Michael

    2004-01-01

    The interactions between climate and the socio-economic system are investigated with a Multi-Actor Dynamic Integrated Assessment Model (MADIAM) obtained by coupling a nonlinear impulse response model of the climate sub-system (NICCS) to a multi-actor dynamic economic model (MADEM). The main goal is to initiate a model development that is able to treat the dynamics of the coupled climate socio-economic system, including endogenous technological change, in a non-equilibrium situation, thereby o...

  17. PROLOGUE : Health Information System

    OpenAIRE

    Tomar, Shivanjali

    2013-01-01

    Prologue is a health information system developed for underserved communities in Bihar, India. It is aimed at helping people living in poverty and with low literacy to take the right steps to manage their and their family’s health. Bihar suffers from one of the worst healthcare records in the country. This is as much due to the lack of access to the right information as it is due to the economic condition of the region. The inaccessibility of information is aggravated by the complex social se...

  18. Veneto Region, Italy. Health system review.

    Science.gov (United States)

    Toniolo, Franco; Mantoan, Domenico; Maresso, Anna

    2012-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. This HiT is one of the first to be written on a subnational level of government and focuses on the Veneto Region of northern Italy. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Veneto Region is one of Italy's richest regions and the health of its resident population compares favourably with other regions in Italy. Life expectancy for both men and women, now at 79.1 and 85.2 years, respectively, is slightly higher than the national average, while mortality rates are comparable to national ones. The major causes of death are tumours and cardiovascular diseases. Under Italy's National Health Service, the organization and provision of health care is a regional responsibility and regions must provide a nationally defined (with regional input) basic health benefit package to all of their citizens; extra services may be provided if budgets allow. Health care is mainly financed by earmarked central and regional taxes, with regions receiving their allocated share of resources from the National Health Fund. Historically, health budget deficits have been a major problem in most Italian regions, but since the early 2000s the introduction of efficiency measures and tighter procedures on financial management have contributed to a significant decrease in the Veneto Regions health budget deficit.The health system is governed by the Veneto Region government (Giunta) via the Departments of Health and Social Services, which receive technical support from a single General Management Secretariat. Health care is

  19. You're a What? Voice Actor

    Science.gov (United States)

    Liming, Drew

    2009-01-01

    This article talks about voice actors and features Tony Oliver, a professional voice actor. Voice actors help to bring one's favorite cartoon and video game characters to life. They also do voice-overs for radio and television commercials and movie trailers. These actors use the sound of their voice to sell a character's emotions--or an advertised…

  20. Multicultural Monologues for Young Actors. The Young Actors Series.

    Science.gov (United States)

    Slaight, Craig, Ed.; Sharrar, Jack, Ed.

    This book presents 62 monologue selections from diverse cultures for young actors to perform. The book's selections offer "quality literature by significant writers." Some of the writers represented in the book are George C. Wolfe, Miguel Pinero, Lorraine Hansberry, Amiri Baraka (LeRoi Jones), John M. Synge, Yukio Mishima, Reynolds…

  1. United Kingdom (England): Health system review.

    Science.gov (United States)

    Boyle, Seán

    2011-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Various indicators show that the health of the population has improved over the last few decades. However, inequalities in health across socioeconomic groups have been increasing since the 1970s. The main diseases affecting the population are circulatory diseases, cancer, diseases of the respiratory system and diseases of the digestive system. Risk factors such as the steadily rising levels of alcohol consumption, the sharp increases in adult and child obesity and prevailing smoking levels are among the most pressing public health concerns, particularly as they reflect the growing health inequalities among different socioeconomic groups. Health services in England are largely free at the point of use. The NHS provides preventive medicine, primary care and hospital services to all those ordinarily resident. Over 12% of the population is covered by voluntary health insurance schemes, known in the United Kingdom as private medical insurance (PMI), which mainly provides access to acute elective care in the private sector. Responsibility for publicly funded health care rests with the Secretary of State for Health, supported by the Department of Health. The Department operates at a regional level through 10 strategic health authorities (SHAs), which are responsible for ensuring the quality and performance of local health services within their geographic area. Responsibility for commissioning health services at the local level lies with 151 primary care

  2. An Actor and His Suitcase

    OpenAIRE

    Williams, Maurice

    2013-01-01

    The idea of the actor as journeyman is as old as the profession itself. The travel troupes of yesteryear laid the groundwork for the theatres of Shakespeare and the regional theatre circuit here in America. So if there is one thing an actor must have: it's a good suitcase. Or two. One for the rags and trinkets he, or she, holds dear; and another for all the skills he, or she, brings to every project.When I left the east coast for San Diego I brought with me those two suitcases. Luckily for me...

  3. Health Information Systems.

    Science.gov (United States)

    Sirintrapun, S Joseph; Artz, David R

    2015-06-01

    This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Importance of Actors and Agency in Sustainability Transitions: A Systematic Exploration of the Literature

    Directory of Open Access Journals (Sweden)

    Lisa-Britt Fischer

    2016-05-01

    Full Text Available This article explores the role of actors and agency in the literature on sustainability transitions. We reviewed 386 journal articles on transition management and sustainability transitions listed in Scopus from 1995 to 2014. We investigate the thesis that actors have been neglected in this literature in favor of more abstract system concepts. Results show that this thesis cannot be confirmed on a general level. Rather, we find a variety of different approaches, depending on the systemic level, for clustering actors and agency as niche, regime, and landscape actors; the societal realm; different levels of governance; and intermediaries. We also differentiate between supporting and opposing actors. We find that actor roles in transitions are erratic, since their roles can change over the course of time, and that actors can belong to different categories. We conclude by providing recommendations for a comprehensive typology of actors in sustainability transitions.

  5. Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia

    OpenAIRE

    Pocock, Nicola S; Phua, Kai Hong

    2011-01-01

    Abstract Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, draw...

  6. Games as Actors - Interaction, Play, Design, and Actor Network Theory

    DEFF Research Database (Denmark)

    Jessen, Jari Due; Jessen, Carsten

    2014-01-01

    When interacting with computer games, users are forced to follow the rules of the game in return for the excitement, joy, fun, or other pursued experiences. In this paper, we investigate how games a chieve these experiences in the perspective of Actor Network Theory (ANT). Based on a qualitative......, and by doing so they create in humans what in modern play theory is known as a “state of play”...

  7. Guide Actor-Critic for Continuous Control

    OpenAIRE

    Tangkaratt, Voot; Abdolmaleki, Abbas; Sugiyama, Masashi

    2017-01-01

    Actor-critic methods solve reinforcement learning problems by updating a parameterized policy known as an actor in a direction that increases an estimate of the expected return known as a critic. However, existing actor-critic methods only use values or gradients of the critic to update the policy parameter. In this paper, we propose a novel actor-critic method called the guide actor-critic (GAC). GAC firstly learns a guide actor that locally maximizes the critic and then it updates the polic...

  8. Les institutions et les acteurs en santé au travail au Québec et en France : regard croisé Occupational health institutions and actors in Québec and in France: new comparative perspective Las instituciones y los actores en salud laboral en Quebec y en Francia : una mirada cruzada

    Directory of Open Access Journals (Sweden)

    Nathalie Ferré

    2010-02-01

    Full Text Available Au Québec comme en France, l’environnement institutionnel dans le domaine de la santé et de la sécurité au travail présente une grande densité. La loi québécoise du 21 décembre 1979, orchestrant l’ensemble du dispositif, a placé en son cœur la Commission de la santé et de la sécurité du travail. Elle cumule toutes les fonctions constitutionnelles en matière de prévention et de réparation. Elle est assistée par un corps d’inspection et s’appuie sur le réseau public de santé. En France, le paysage est plus éclaté. Il n’existe pas d’organisme équivalent. L’inspection du travail intervient pour s’assurer du respect des normes. Les organismes de sécurité sociale, qui prennent en charge les lésions professionnelles, incitent les employeurs à faire de la prévention. Les médecins du travail sont des travailleurs subordonnés, liés aux entreprises dans lesquelles ils interviennent. Dans les établissements, plusieurs acteurs héritent de missions diverses. L’étendue de la responsabilité de l’employeur est plus importante en France.In Québec, as in France, the institutional environment in the occupational health and safety field is extremely important. The Québec law of December 21, 1979, orchestrating its entire organization, placed the Commission de la santé et de la sécurité du travail (workers’ compensation board at its centre. It encompasses all the constitutional prevention and repair functions. It is assisted by an inspection body and is supported by the public health network. In France, the landscape is more dispersed. There is no equivalent organization. Work inspection comes into play to ensure compliance with standards. Social security organizations, which take charge of occupational injuries, encourage employers to do prevention. Occupational health physicians are subordinate workers, linked to the companies in which they work. In establishments, several actors inherit various missions

  9. Balancing influence between actors in healthcare decision making.

    Science.gov (United States)

    Kaplan, Robert M; Babad, Yair M

    2011-04-19

    Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision

  10. Health system capacity: maternal health policy implementation in the state of Gujarat, India

    Directory of Open Access Journals (Sweden)

    Linda Sanneving

    2013-03-01

    Full Text Available Introduction: The Government of Gujarat has for the past couple of decades continuously initiated several interventions to improve access to care for pregnant and delivering women within the state. Data from the last District Family Heath survey in Gujarat in 2007–2008 show that 56.4% of women had institutional deliveries and 71.5% had at least one antenatal check-up, indicating that challenges remain in increasing use of and access to maternal health care services. Objective: To explore the perceptions of high-level stakeholders on the process of implementing maternal health interventions in Gujarat. Method: Using the policy triangle framework developed by Walt and Gilson, the process of implementation was approached using in-depth interviews and qualitative content analysis. Result: Based on the analysis, three themes were developed: lack of continuity; the complexity of coordination; and lack of confidence and underutilization of the monitoring system. The findings suggest that decisions made and actions advocated and taken are more dependent on individual actors than on sustainable structures. The findings also indicate that the context in which interventions are implemented is challenged in terms of weak coordination and monitoring systems that are not used to evaluate and develop interventions on maternal health. Conclusions: The implementation of interventions on maternal health is dependent on the capacity of the health system to implement evidence-based policies. The capacity of the health system in Gujarat to facilitate implementation of maternal health interventions needs to be improved, both in terms of the role of actors and in terms of structures and processes.

  11. Actors with Multi-Headed Message Receive Patterns

    DEFF Research Database (Denmark)

    Sulzmann, Martin; Lam, Edmund Soon Lee; Van Weert, Peter

    2008-01-01

    style actors with receive clauses containing multi-headed message patterns. Patterns may be non-linear and constrained by guards. We provide a number of examples to show the usefulness of the extension. We also explore the design space for multi-headed message matching semantics, for example first-match......The actor model provides high-level concurrency abstractions to coordinate simultaneous computations by message passing. Languages implementing the actor model such as Erlang commonly only support single-headed pattern matching over received messages. We propose and design an extension of Erlang...... and rule priority-match semantics. The various semantics are inspired by the multi-set constraint matching semantics found in Constraint Handling Rules. This provides us with a formal model to study actors with multi-headed message receive patterns. The system can be implemented efficiently and we have...

  12. Health worker posting and transfer at primary level in Tamil Nadu: Governance of a complex health system function

    Directory of Open Access Journals (Sweden)

    Surekha Garimella

    2016-01-01

    Full Text Available Background: Posting and transfer (PT of health personnel - placing the right health workers in the right place at the right time - is a core function of any large-scale health service. In the context of government health services, this may be seen as a simple process of bureaucratic governance and implementation of the rule of law. However the literature from India and comparable low and middle-income country health systems suggests that in reality PT is a contested domain, driven by varied expressions of private and public interest throughout the chain of implementation. Objective: To investigate policymaking for PT in the government health sector and implementation of policies as experienced by different health system actors and stakeholders at primary health care level. Methodology: We undertook an empirical case study of a PT reform policy at primary health care level in Tamil Nadu State, to understand how different groups of health systems actors experience PT. In-depth qualitative methods were undertaken to study processes of implementation of PT policies enacted through ′counselling′ of health workers (individualized consultations to determine postings and transfers. Results: PT emerges as a complex phenomenon, shaped partially by the laws of the state and partially as a parallel system of norms and incentives requiring consideration and coordination of the interests of different groups. Micro-practices of governance represent homegrown coping mechanisms of health administrators that reconcile public and private interests and sustain basic health system functions. Beyond a functional perspective of PT, it also reflects justice and fairness as it plays out in the health system. It signifies how well a system treats its employees, and by inference, is an index of the overall health of the system. Conclusions: For a complex governance function such as PT, the roles of private actors and private interests are not easily separable from the

  13. The Netherlands: health system review

    NARCIS (Netherlands)

    Schäfer, W.; Kroneman, M.; Boerma, W.; van den Berg, M.; Westert, G.; Devillé, W.; van Ginneken, E.

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of health systems and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of

  14. TRICARE, Military Health System

    Science.gov (United States)

    ... Claim Get Proof of TRICARE Coverage View My Military Health Record Less TRICARE Enrollment Freeze Starting Dec. ... Disaster Information Download a Form Go Paperless My Military Health Records Multimedia Center Plan Information Kits Recoupment ...

  15. Actor bonds after relationship dissolution

    DEFF Research Database (Denmark)

    Skaates, Maria Anne

    2000-01-01

    Most of the presented papers at the 1st NoRD Workshop can be classified as belonging to the business marketing approach to relationship dissolution. Two papers were conceptual, and the remaining six were empirical studies. The first conceptual study by Skaates (2000) focuses on the nature...... of the actor bonds that remain after a business relationship has ended. The study suggests that an interdisciplinary approach would provide a richer understanding of the phenomenon; this could be achieved by using e.g. Bourdieu's sociological concepts in dissolution research....

  16. [The health system of Ecuador].

    Science.gov (United States)

    Lucio, Ruth; Villacrés, Nilhda; Henríquez, Rodrigo

    2011-01-01

    This paper describes the health conditions in Ecuador and, in more detail, the characteristics of the Ecuadorian health system, including its structure and coverage, its financial sources, the physical, material and human resources available, and the stewardship activities developed by the Ministry of Public Health. It also describes the structure and content of its health information system, and the participation of citizens in the operation and evaluation of the health system. The paper ends with a discussion of the most recent policy innovations implemented in the Ecuadorian system, including the incorporation of a chapter on health into the new Constitution which recognizes the protection of health as a human right, and the construction of the Comprehensive Public Health Network.

  17. Studying integrated health care systems with a structurationist approach

    Science.gov (United States)

    Demers, Louis; Arseneault, Stéphane; Couturier, Yves

    2010-01-01

    Introduction To implement an integrated health care system is not an easy task and to ensure its sustainability is yet more difficult. Aim Discuss how a structurationist approach can shed light on the stakes of these processes and guide the managers of such endeavours. Theory and method Structuration theory [1] has been used by numerous authors to cast new light on complex organizational phenomena. One of the central tenets of this theory is that social systems, such as integrated health care systems, are recurrent social practices across time-space and are characterized by structural properties which simultaneously constrain and enable the constitutive social actors who reproduce and transform the system through their practices. We will illustrate our theoretical standpoint with empirical material gathered during the study of an integrated health care system for the frail elderly in Quebec, Canada. This system has been implemented in 1997 and is still working well in 2010. Results and conclusion To implement an integrated health care system that is both effective and sustainable, its managers must shrewdly allow for the existing system and progressively introduce changes in the way managers and practitioners at work in the system view their role and act on a daily basis.

  18. [Public health and mental health: methodological tools to evaluate the Brazilian Network of Referral Centers for Psycho-Social Care (CAPS) in the Brazilian Unified Health System].

    Science.gov (United States)

    Onocko-Campos, Rosana Teresa; Furtado, Juarez Pereira

    2006-05-01

    This article presents a preliminary discussion of potential methodological tools for qualitative research on the Network of Referral Centers for Psycho-Social Care (CAPS) in the Brazilian Unified Health System (SUS). The relevance of mental health within the field of public health is examined. The study focuses on the high prevalence of mental disorders and the disproportionate lack of studies on the interface between mental health and public health. The establishment of an interdisciplinary field between public health and mental health is proposed to meet common needs by achieving similar perspectives in knowledge and practice. A particular group of tools is proposed, emphasizing the importance of reclaiming and guaranteeing the roles of various social actors to shape the assessment process, the need for collecting and standardizing academic studies on the topic, and the importance of promoting a new research field focusing on public health policies to support policymakers, managers, and health teams in reshaping their practices.

  19. Research, evidence and policymaking: the perspectives of policy actors on improving uptake of evidence in health policy development and implementation in Uganda

    Directory of Open Access Journals (Sweden)

    Orem Juliet

    2012-02-01

    Full Text Available Abstract Background Use of evidence in health policymaking plays an important role, especially in resource-constrained settings where informed decisions on resource allocation are paramount. Several knowledge translation (KT models have been developed, but few have been applied to health policymaking in low income countries. If KT models are expected to explain evidence uptake and implementation, or lack of it, they must be contextualized and take into account the specificity of low income countries for example, the strong influence of donors. The main objective of this research is to elaborate a Middle Range Theory (MRT of KT in Uganda that can also serve as a reference for other low- and middle income countries. Methods This two-step study employed qualitative approaches to examine the principal barriers and facilitating factors to KT. Step 1 involved a literature review and identification of common themes. The results informed the development of the initial MRT, which details the facilitating factors and barriers to KT at the different stages of research and policy development. In Step 2, these were further refined through key informant interviews with policymakers and researchers in Uganda. Deductive content and thematic analysis was carried out to assess the degree of convergence with the elements of the initial MRT and to identify other emerging issues. Results Review of the literature revealed that the most common emerging facilitating factors could be grouped under institutional strengthening for KT, research characteristics, dissemination, partnerships and political context. The analysis of interviews, however, showed that policymakers and researchers ranked institutional strengthening for KT, research characteristics and partnerships as the most important. New factors emphasized by respondents were the use of mainstreamed structures within MoH to coordinate and disseminate research, the separation of roles between researchers and

  20. Elaborating on systems thinking in health promotion practice.

    Science.gov (United States)

    Naaldenberg, Jenneken; Vaandrager, Lenneke; Koelen, Maria; Wagemakers, Anne-Marie; Saan, Hans; de Hoog, Kees

    2009-03-01

    Health and well-being are the result of a series of complex processes in which an individual interacts with other people and the environment. A systematic approach ensures incorporation of individual, ecological, social and political factors. However, interactions between these factors can be overlooked within a systematical approach. A systemic approach can provide additional information by incorporating interactions and communication. The opportunities of a systems thinking perspective for health promotion were investigated for this paper. Although others have also made attempts to explore systems thinking in the field of health promotion, the implications of systems thinking in practice need attention. Other fields such as agricultural extension studies, organizational studies and development studies provide useful experiences with the use of a systems thinking perspective in practice. Building on experiences from these fields, we give a theoretical background in which processes of social learning and innovation play an important role. From this background, we derive an overview of important concepts for the practical application of a systems thinking perspective. These concepts are the structure of the system, meanings attached to actions, and power relations between actors. To make these concepts more explicit and reduce the theoretical character of systems thinking, we use an illustration to elaborate on these concepts in practice. For this purpose, we describe a health promotion partnership in The Netherlands using the concepts structure, meaning and power relations. We show how a systems perspective increases insight in the functioning of a partnership and how this can facilitate processes of social learning and innovation. This article concludes by identifying future opportunities and challenges in adopting systems thinking for health promotion practice. A systems perspective towards health promotion can help projects reaching a more integral and

  1. Self-Recovering Sensor-Actor Networks

    Directory of Open Access Journals (Sweden)

    Maryam Kamali

    2010-07-01

    Full Text Available Wireless sensor-actor networks are a recent development of wireless networks where both ordinary sensor nodes and more sophisticated and powerful nodes, called actors, are present. In this paper we formalize a recently introduced algorithm that recovers failed actor communication links via the existing sensor infrastructure. We prove via refinement that the recovery is terminating in a finite number of steps and is distributed, thus self-performed by the actors. Most importantly, we prove that the recovery can be done at different levels, via different types of links, such as direct actor links or indirect links between the actors, in the latter case reusing the wireless infrastructure of sensors. This leads to identifying coordination classes, e.g., for delegating the most security sensitive coordination to the direct actor-actor coordination links, the least real-time constrained coordination to indirect links, and the safety critical coordination to both direct actor links and indirect sensor paths between actors. Our formalization is done using the theorem prover in the RODIN platform.

  2. Challenges and opportunities for policy decisions to address health equity in developing health systems: case study of the policy processes in the Indian state of Orissa

    Directory of Open Access Journals (Sweden)

    Gopalan Saji S

    2011-11-01

    Full Text Available Abstract Introduction Achieving health equity is a pertinent need of the developing health systems. Though policy process is crucial for planning and attaining health equity, the existing evidences on policy processes are scanty in this regard. This article explores the magnitude, determinants, challenges and prospects of 'health equity approach' in various health policy processes in the Indian State of Orissa - a setting comparable with many other developing health systems. Methods A case-study involving 'Walt-Gilson Policy Triangle' employed key-informant interviews and documentary reviews. Key informants (n = 34 were selected from the departments of Health and Family Welfare, Rural Development, and Women and Child Welfare, and civil societies. The documentary reviews involved various published and unpublished reports, policy pronouncements and articles on health equity in Orissa and similar settings. Results The 'health policy agenda' of Orissa was centered on 'health equity' envisaging affordable and equitable healthcare to all, integrated with public health interventions. However, the subsequent stages of policy process such as 'development, implementation and evaluation' experienced leakage in the equity approach. The impediment for a comprehensive approach towards health equity was the nexus among the national and state health priorities; role, agenda and capacity of actors involved; and existing constraints of the healthcare delivery system. Conclusion The health equity approach of policy processes was incomprehensive, often inadequately coordinated, and largely ignored the right blend of socio-medical determinants. A multi-sectoral, unified and integrated approach is required with technical, financial and managerial resources from different actors for a comprehensive 'health equity approach'. If carefully geared, the ongoing health sector reforms centered on sector-wide approaches, decentralization, communitization and involvement of

  3. Fixing Health Systems

    International Development Research Centre (IDRC) Digital Library (Canada)

    In Africa, health care has been in a state of crisis for several decades. ..... Instead, think about them as representations of real people — people with families that ...... blood screening; patient care, counseling, and social support; palliative care.

  4. Power system health analysis

    International Nuclear Information System (INIS)

    Billinton, Roy; Fotuhi-Firuzabad, Mahmud; Aboreshaid, Saleh

    1997-01-01

    This paper presents a technique which combines both probabilistic indices and deterministic criteria to reflect the well-being of a power system. This technique permits power system planners, engineers and operators to maximize the probability of healthy operation as well as minimizing the probability of risky operation. The concept of system well-being is illustrated in this paper by application to the areas of operating reserve assessment and composite power system security evaluation

  5. Practicing governance towards equity in health systems: LMIC perspectives and experience.

    Science.gov (United States)

    Gilson, Lucy; Lehmann, Uta; Schneider, Helen

    2017-09-15

    The unifying theme of the papers in this series is a concern for understanding the everyday practice of governance in low- and middle-income country (LMIC) health systems. Rather than seeing governance as a normative health system goal addressed through the architecture and design of accountability and regulatory frameworks, these papers provide insights into the real-world decision-making of health policy and system actors. Their multiple, routine decisions translate policy intentions into practice - and are filtered through relationships, underpinned by values and norms, influenced by organizational structures and resources, and embedded in historical and socio-political contexts. These decisions are also political acts - in that they influence who accesses benefits and whose voices are heard in decision-making, reinforcing or challenging existing institutional exclusion and power inequalities. In other words, the everyday practice of governance has direct impacts on health system equity.The papers in the series address governance through diverse health policy and system issues, consider actors located at multiple levels of the system and draw on multi-disciplinary perspectives. They present detailed examination of experiences in a range of African and Indian settings, led by authors who live and work in these settings. The overall purpose of the papers in this series is thus to provide an empirical and embedded research perspective on governance and equity in health systems.

  6. Spanning maternal, newborn and child health (MNCH) and health systems research boundaries: conducive and limiting health systems factors to improving MNCH outcomes in West Africa.

    Science.gov (United States)

    Agyepong, Irene Akua; Kwamie, Aku; Frimpong, Edith; Defor, Selina; Ibrahim, Abdallah; Aryeetey, Genevieve C; Lokossou, Virgil; Sombie, Issiaka

    2017-07-12

    interventions is needed. This requires multi-level, multi-sectoral and multi-stakeholder engagement approaches that span current geographical, language, research and practice community boundaries in West Africa, and effectively link the efforts of actors interested in health systems strengthening with those of actors interested in MNCH outcome improvement.

  7. Hawaii's public mental health system.

    Science.gov (United States)

    VanderVoort, Debra J

    2005-03-01

    The following article addresses the nature of and problems with the public mental health system in Hawaii. It includes a brief history of Hawaii's public mental health system, a description and analysis of this system, economic factors affecting mental health, as well as a needs assessment of the elderly, individuals with severe mental illness, children and adolescents, and ethnically diverse individuals. In addition to having the potential to increase suicide rates and unnecessarily prolong personal suffering, problems in the public mental health system such as inadequate services contribute to an increase in social problems including, but not limited to, an increase in crime rates (e.g., domestic violence, child abuse), divorce rates, school failure, and behavioral problems in children. The population in need of mental health services in Hawaii is under served, with this inadequacy of services due to economic limitations and a variety of other factors.

  8. Integrated Systems Health Management for Intelligent Systems

    Science.gov (United States)

    Figueroa, Fernando; Melcher, Kevin

    2011-01-01

    The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.

  9. Action adaptation during natural unfolding social scenes influences action recognition and inferences made about actor beliefs.

    Science.gov (United States)

    Keefe, Bruce D; Wincenciak, Joanna; Jellema, Tjeerd; Ward, James W; Barraclough, Nick E

    2016-07-01

    When observing another individual's actions, we can both recognize their actions and infer their beliefs concerning the physical and social environment. The extent to which visual adaptation influences action recognition and conceptually later stages of processing involved in deriving the belief state of the actor remains unknown. To explore this we used virtual reality (life-size photorealistic actors presented in stereoscopic three dimensions) to see how visual adaptation influences the perception of individuals in naturally unfolding social scenes at increasingly higher levels of action understanding. We presented scenes in which one actor picked up boxes (of varying number and weight), after which a second actor picked up a single box. Adaptation to the first actor's behavior systematically changed perception of the second actor. Aftereffects increased with the duration of the first actor's behavior, declined exponentially over time, and were independent of view direction. Inferences about the second actor's expectation of box weight were also distorted by adaptation to the first actor. Distortions in action recognition and actor expectations did not, however, extend across different actions, indicating that adaptation is not acting at an action-independent abstract level but rather at an action-dependent level. We conclude that although adaptation influences more complex inferences about belief states of individuals, this is likely to be a result of adaptation at an earlier action recognition stage rather than adaptation operating at a higher, more abstract level in mentalizing or simulation systems.

  10. Metodología para el empoderamiento en salud sexual de actores sociales vinculados a niños/as preescolares Methodology for empowerment in sexual health of social participants linked to preschool boys/girls

    Directory of Open Access Journals (Sweden)

    Guillermo Díaz Llanes

    2010-12-01

    Full Text Available INTRODUCCIÓN: la promoción de comportamientos sexuales salutógenos es uno de los principales retos de la salud pública contemporánea, por la gran complejidad que estos exhiben y su potencial beneficio al cuadro de salud de todos los países. Uno de los referentes teóricos que sustentan las intervenciones en esta dimensión de la salud, es el empoderamiento, sin embargo, todavía se carece de metodologías capaces de guiar las intervenciones al nivel comunitario. OBJETIVO: el presente estudio se propuso la construcción y validación de una metodología dirigida a empoderar en salud sexual a actores sociales de la comunidad, vinculados a la educación de niños preescolares. MÉTODOS: el estudio se vertebró en un diseño de investigación-acción participativa. RESULTADOS: se consiguió una metodología ajustada al empoderamiento con 3 etapas y subetapas diferenciadas, y a su vez, conectadas entre sí, con suficiente flexibilidad para ser adaptada a diversos entornos. Cada etapa contiene salidas esperadas a partir de procedimientos y técnicas lógicamente ordenadas, que parten de la acción, reflexionan críticamente sobre ella y la transforman.INTRODUCTION: the promotion of health sexual behaviors is one of the major challenges of current public health due to its great complexity and its potential benefit to health situation at world level. One of the concerning theoretical features supporting the interventions in this health dimension is the empowerment, however, still there is a lack of methodologies able to guide the interventions at community level. OBJECTIVE: the objective of present paper was to create and to validate the methodology directed to empower in sexual health to social participants of community, linked with the education of preschool children. METHODS: the study included a participation-research design. RESULTS: it was possible to obtain a methodology fitted to empowerment including three differentiated stages and

  11. Improving Access to Essential Medicines: How Health Concerns can be Prioritised in the Global Governance System.

    Science.gov (United States)

    Sridhar, Devi

    2008-07-01

    This paper discusses the politics of access to essential medicines and identifies 'space' in the current system where health concerns can be strengthened relative to trade. This issue is addressed from a global governance perspective focusing on the main actors who can have the greatest impact. These include developing country coalitions and citizens in developed countries though participation in civil society organisations. These actors have combined forces to tackle this issue successfully, resulting in the 2001 Doha Declaration on Public Health. The collaboration has been so powerful due to the assistance of the media as well as the decision to compromise with pharmaceutical companies and their host countries. To improve access to essential medicines, six C's are needed: coalitions, civil society, citizenship, compromise, communication and collaboration.

  12. Burst Diplomacy The Diplomacies of Foreign Policy: Actors and Methods

    Directory of Open Access Journals (Sweden)

    Guillaume Devin

    2010-12-01

    Full Text Available Approaches to diplomacy tend to be restrictive because of an exclusively interstate insight. Indeed, historically, the state monopoly over diplomacy has always been challenged by private actors. Today, it is defied both from the inside because of growing public fragmentation (every ministry tends to lead its own foreign policy; subnational authorities develop their diplomatic relations and from the outside (the business sector and civil society play a growing role on the international scene. This proliferation of actors has transformed diplomatic methods. Beyond the binary division between “old diplomacy” – bilateral, secret and resident – and “new diplomacy” – multilateral, public and itinerant – this article shows that diplomacy has to adapt to number and complexity. Therefore a more global conception need now be considered. Diplomacy today is a system of multiple actors using diverse methods in order to coordinate positions of common interest in a competitive and sometimes hostile environment.

  13. Mobile health systems and emergence

    NARCIS (Netherlands)

    Jones, Valerie M.; Graziosi, Barbara

    2015-01-01

    Changes in the age distribution of the population and increased prevalence of chronic illnesses, together with a shortage of health professionals and other resources, will increasingly challenge the ability of national healthcare systems to meet rising demand for services. Large-scale use of eHealth

  14. Czechoslovakia's changing health care system.

    Science.gov (United States)

    Raffel, M W; Raffel, N K

    1992-01-01

    Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services.

  15. Breast Health Belief Systems Study

    National Research Council Canada - National Science Library

    Williams, Mary

    1999-01-01

    .... The hypothesis underlying this research is that a breast health promotion approach that is based in specific belief systems among three disparate African American rural populations of low socioeconomic status (SES...

  16. Balancing influence between actors in healthcare decision making

    Directory of Open Access Journals (Sweden)

    Babad Yair M

    2011-04-01

    Full Text Available Abstract Background Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. Discussion A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc. motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. Summary A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include

  17. [Corruption and health care system].

    Science.gov (United States)

    Marasović Šušnjara, Ivana

    2014-06-01

    Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.

  18. Health Systems Strengthening

    DEFF Research Database (Denmark)

    Hanlin, Rebecca; Andersen, Margrethe Holm

    The Global Network for the Economics of Learning, Innovation, and Competence Building Systems (Globelics) is an open and diverse community of scholars working on innovation and competence building in the context of economic development. The major purpose of the network is to contribute to buildin...

  19. Actors of the hydrogen sector in France

    International Nuclear Information System (INIS)

    2010-01-01

    This document proposes brief presentations (web site address, activities) of actors operating in the hydrogen sector in France. These actors are public actors who can be incentive or financing actors (ADEME, ANR) or research institutions (CNRS, CEA, university and engineering schools, IFP, INERIS, INRETS), private actors like industrial groups (Air Liquide, AREVA, GDF Suez, Total, PSA Peugeot Citroen, Renault, Saint-Gobain, SNECMA, ST Microelectronics, 3M, Veolia Environnement) or small companies (Alca Torda Applications, Axane, CETH2, Helion, MaHytec, N-GHY, PaxiTech, Sertronic, ULLIT). It also presents the HyPAC platform created by the AFH2 and ADEME), the AFH2 (the French Association for Hydrogen), and regional initiatives

  20. The Management of Political Actors in Institutions

    Directory of Open Access Journals (Sweden)

    Peter Odion Omoijiade

    2016-10-01

    Full Text Available The argument that the minimization of the dysfunctional consequences of organizational politics is no longer dependent on self-equilibrating mechanism remains valid. This inquiry is therefore framed with a view to establishing suitable strategies for managing political actors. There is a nexus between the diagnosis typology of political actors and the qualitative classes of political actors and their management strategies. In the management of mixed blessing, supportive, non-supportive and marginal political actors; collaborative, involvement, defensive and information strategies respectively were found suitable. This research is based on existing theoretical knowledge on organizational politics and stakeholders management. Data was collected from the literature by means of critical analysis and dialectic reflection on the emerging themes. The study will enhance capability in contexts where the scientific management of political actors is yet to be exemplified.

  1. Intelligent Integrated System Health Management

    Science.gov (United States)

    Figueroa, Fernando

    2012-01-01

    Intelligent Integrated System Health Management (ISHM) is the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system (Management: storage, distribution, sharing, maintenance, processing, reasoning, and presentation). Presentation discusses: (1) ISHM Capability Development. (1a) ISHM Knowledge Model. (1b) Standards for ISHM Implementation. (1c) ISHM Domain Models (ISHM-DM's). (1d) Intelligent Sensors and Components. (2) ISHM in Systems Design, Engineering, and Integration. (3) Intelligent Control for ISHM-Enabled Systems

  2. What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework

    Science.gov (United States)

    Mirzoev, Tolib; Kane, Sumit

    2017-01-01

    Responsiveness is a key objective of national health systems. Responsive health systems anticipate and adapt to existing and future health needs, thus contributing to better health outcomes. Of all the health systems objectives, responsiveness is the least studied, which perhaps reflects lack of comprehensive frameworks that go beyond the normative characteristics of responsive services. This paper contributes to a growing, yet limited, knowledge on this topic. Herewith, we review the current frameworks for understanding health systems responsiveness and drawing on these, as well as key frameworks from the wider public services literature, propose a comprehensive conceptual framework for health systems responsiveness. This paper should be of interest to different stakeholders who are engaged in analysing and improving health systems responsiveness. Our review shows that existing knowledge on health systems responsiveness can be extended along the three areas. First, responsiveness entails an actual experience of people’s interaction with their health system, which confirms or disconfirms their initial expectations of the system. Second, the experience of interaction is shaped by both the people and the health systems sides of this interaction. Third, different influences shape people’s interaction with their health system, ultimately affecting their resultant experiences. Therefore, recognition of both people and health systems sides of interaction and their key determinants would enhance the conceptualisations of responsiveness. Our proposed framework builds on, and advances, the core frameworks in the health systems literature. It positions the experience of interaction between people and health system as the centrepiece and recognises the determinants of responsiveness experience both from the health systems (eg, actors, processes) and the people (eg, initial expectations) sides. While we hope to trigger further thinking on the conceptualisation of health

  3. What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework.

    Science.gov (United States)

    Mirzoev, Tolib; Kane, Sumit

    2017-01-01

    Responsiveness is a key objective of national health systems. Responsive health systems anticipate and adapt to existing and future health needs, thus contributing to better health outcomes. Of all the health systems objectives, responsiveness is the least studied, which perhaps reflects lack of comprehensive frameworks that go beyond the normative characteristics of responsive services. This paper contributes to a growing, yet limited, knowledge on this topic. Herewith, we review the current frameworks for understanding health systems responsiveness and drawing on these, as well as key frameworks from the wider public services literature, propose a comprehensive conceptual framework for health systems responsiveness. This paper should be of interest to different stakeholders who are engaged in analysing and improving health systems responsiveness. Our review shows that existing knowledge on health systems responsiveness can be extended along the three areas. First, responsiveness entails an actual experience of people's interaction with their health system, which confirms or disconfirms their initial expectations of the system. Second, the experience of interaction is shaped by both the people and the health systems sides of this interaction. Third, different influences shape people's interaction with their health system, ultimately affecting their resultant experiences. Therefore, recognition of both people and health systems sides of interaction and their key determinants would enhance the conceptualisations of responsiveness. Our proposed framework builds on, and advances, the core frameworks in the health systems literature. It positions the experience of interaction between people and health system as the centrepiece and recognises the determinants of responsiveness experience both from the health systems (eg, actors, processes) and the people (eg, initial expectations) sides. While we hope to trigger further thinking on the conceptualisation of health system

  4. Building institutions for an effective health system: lessons from China's experience with rural health reform.

    Science.gov (United States)

    Bloom, Gerald

    2011-04-01

    This paper is concerned with the management of health system changes aimed at substantially increasing the access to safe and effective health services. It argues that an effective health sector relies on trust-based relationships between users, providers and funders of health services, and that one of the major challenges governments face is to construct institutional arrangements within which these relationships can be embedded. It presents the case of China, which is implementing an ambitious health reform, drawing on a series of visits to rural counties by the author over a 10-year period. It illustrates how the development of reform strategies has been a response both to the challenges arising from the transition to a market economy and the result of actions by different actors, which have led to the gradual creation of increasingly complex institutions. The overall direction of change has been strongly influenced by the efforts made by the political leadership to manage a transition to a modern economy which provides at least some basic benefits to all. The paper concludes that the key lessons for other countries from China's experience with health system reform are less about the detailed design of specific interventions than about its approach to the management of institution-building in a context of complexity and rapid change. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Application of the actor model to large scale NDE data analysis

    Science.gov (United States)

    Coughlin, Chris

    2018-03-01

    The Actor model of concurrent computation discretizes a problem into a series of independent units or actors that interact only through the exchange of messages. Without direct coupling between individual components, an Actor-based system is inherently concurrent and fault-tolerant. These traits lend themselves to so-called "Big Data" applications in which the volume of data to analyze requires a distributed multi-system design. For a practical demonstration of the Actor computational model, a system was developed to assist with the automated analysis of Nondestructive Evaluation (NDE) datasets using the open source Myriad Data Reduction Framework. A machine learning model trained to detect damage in two-dimensional slices of C-Scan data was deployed in a streaming data processing pipeline. To demonstrate the flexibility of the Actor model, the pipeline was deployed on a local system and re-deployed as a distributed system without recompiling, reconfiguring, or restarting the running application.

  6. [The health system of Guatemala].

    Science.gov (United States)

    Becerril-Montekio, Víctor; López-Dávila, Luis

    2011-01-01

    This paper describes the health conditions in Guatemala and, in more detail, the characteristics of the Guatemalan health system, including its structure en coverage, its financial sources, the stewardship functions developed by the Ministry of Health, as well as the generation of health information and the development of research activities. It also discusses the recent efforts to extend coverage of essential health services, mostly to poor rural areas.The most recent innovations also discussed in this paper include the Program for the Expansion of Coverage of Essential Services, the Program to Expand Access to Essential Drugs and the agreements between the Ministry of Health and several non-governmental organizations to provide essential services in rural settings.

  7. Strengthening Governance in Health Systems for Reproductive ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Home · What we do ... As a result, Pakistan's health system has suffered and health service delivery has worsened. ... This four-year project aims to strengthen health systems governance for reproductive health and rights in Pakistan.

  8. Involving new actors to achieve ART scaling-up: difficulties in an HIV/AIDS counselling and testing centre in Cameroon.

    Science.gov (United States)

    Yakam, J C Y Tantchou; Gruénais, M-E

    2009-03-01

    The high HIV/AIDS-related mortality among young adults is devastating countries in sub-Saharan Africa. The implementing capacity of the health systems is the main limiting factor of antiretroviral treatment (ART) scaling-up;(1) this capacity depends mainly on the health workforce. Tackling the issue of human resources for health is thus of paramount importance to achieve universal access to ART and for the survival of health systems in time of AIDS. To support such a process, the World Health Organization stresses the importance of task shifting(2) from medical doctors to nurses and from nurses to community health workers. Such task shifting is not easy to achieve but undoubtedly needed. This paper raises issues about the involvement of new actors(3) without precise redefinitions of roles and task-shifting procedures. We take the example of a 'Centre de Prévention et de Dépistage Volontaire du VIH/sida'(4) in one major town of the Far-North province of Cameroon (Central Africa). The study was qualitative. Observations were carried out in the service and in-depth interviews conducted with health workers and actors of Cameroon's National AIDS Control Committee. These interviews were recorded and transcribed. The material was analysed using keywords. KEY RESULT: The involvement of new actors in a context of human resources for health shortage and health system crisis creates confusion and role conflicts, which lead to frustration. It favours the appearance of chinks within which these new actors slip and 'find their way' in the system; it finally raises problems related to their legitimacy and position within the existing hierarchy. KEY POLICY MESSAGE: It is necessary, when involving new staff members (particularly when they do not belong to internationally recognized health professionals such as nurses, doctors and pharmacists), to redefine roles and build precise task-shifting procedures so that everyone may still have a place in the whole system and feel useful.

  9. Mobile health information system: a mobile app. to aid health ...

    African Journals Online (AJOL)

    Mobile health information system: a mobile app. to aid health workers relate health information. ... Global Journal of Mathematical Sciences ... phones in delivering vital health information and effective fieldwork reporting is of significance.

  10. [Health system sustainability from a network perspective: a proposal to optimize healthy habits and social support].

    Science.gov (United States)

    Marqués Sánchez, Pilar; Fernández Peña, Rosario; Cabrera León, Andrés; Muñoz Doyague, María F; Llopis Cañameras, Jaime; Arias Ramos, Natalia

    2013-01-01

    The search of new health management formulas focused to give wide services is one of the priorities of our present health policies. Those formulas examine the optimization of the links between the main actors involved in public health, ie, users, professionals, local socio-political and corporate agents. This paper is aimed to introduce the Social Network Analysis as a method for analyzing, measuring and interpreting those connections. The knowledge of people's relationships (what is called social networks) in the field of public health is becoming increasingly important at an international level. In fact, countries such as UK, Netherlands, Italy, Australia and U.S. are looking formulas to apply this knowledge to their health departments. With this work we show the utility of the ARS on topics related to sustainability of the health system, particularly those related with health habits and social support, topics included in the 2020 health strategies that underline the importance of the collaborative aspects in networks.

  11. Introduction on health recommender systems.

    Science.gov (United States)

    Sanchez-Bocanegra, C L; Sanchez-Laguna, F; Sevillano, J L

    2015-01-01

    People are looking for appropriate health information which they are concerned about. The Internet is a great resource of this kind of information, but we have to be careful if we don't want to get harmful info. Health recommender systems are becoming a new wave for apt health information as systems suggest the best data according to the patients' needs.The main goals of health recommender systems are to retrieve trusted health information from the Internet, to analyse which is suitable for the user profile and select the best that can be recommended, to adapt their selection methods according to the knowledge domain and to learn from the best recommendations.A brief definition of recommender systems will be given and an explanation of how are they incorporated in the health sector. A description of the main elementary recommender methods as well as their most important problems will also be made. And, to finish, the state of the art will be described.

  12. [Change management: An analysis of actors; perceptions about technical assistance in the Democratic Republic of Congo].

    Science.gov (United States)

    Ribesse, Nathalie; Iyeti, Alain; Macq, Jean

    2015-01-01

    Technical assistance (TA) is a common component of health system strengthening interventions. This type of intervention is too often designed and evaluated according to a logic that fails to take into account social complexity. Actors' perceptions are one element of this complexity. This article presents a study conducted in the Democratic Republic of Congo designed to identify perceptions concerning two types of technical support providers for health system strengthening: long-term technical assistants (agents of development agencies) and provincial technical advisors (agents of the Ministry of Health). Interviews were conducted with an innovative tool inspired by the principles of systems thinking. Interviewees were actors involved in a TA intervention in the province of Bandundu. Their expectations regarding TA providers were identified in terms of personal characteristics (knowledge, know-how and interpersonal skills), roles, and styles of interaction for capacity building ("interventionist/ prescriptive axes"). Interviewees emphasized the importance of mutual learning and the quality of interactions, which depends on TA provider's interpersonal skills and mutual willingness. Perceptions of TA provider's characteristics tend to be similar, but several differences were observed concerning the expectations about the roles of TAs, and the style that should be adopted for capacity building. Ignoring these differences in expectations may be a threat to the effectiveness of TA.

  13. Review of models and actors in energy mix optimization – can leader visions and decisions align with optimum model strategies for our future energy systems?

    NARCIS (Netherlands)

    Weijermars, R.; Taylor, P.; Bahn, O.; Das, S.R.; Wei, Y.M.

    2011-01-01

    Organizational behavior and stakeholder processes continually influence energy strategy choices and decisions. Although theoretical optimizations can provide guidance for energy mix decisions from a pure physical systems engineering point of view, these solutions might not be optimal from a

  14. Portable Health Algorithms Test System

    Science.gov (United States)

    Melcher, Kevin J.; Wong, Edmond; Fulton, Christopher E.; Sowers, Thomas S.; Maul, William A.

    2010-01-01

    A document discusses the Portable Health Algorithms Test (PHALT) System, which has been designed as a means for evolving the maturity and credibility of algorithms developed to assess the health of aerospace systems. Comprising an integrated hardware-software environment, the PHALT system allows systems health management algorithms to be developed in a graphical programming environment, to be tested and refined using system simulation or test data playback, and to be evaluated in a real-time hardware-in-the-loop mode with a live test article. The integrated hardware and software development environment provides a seamless transition from algorithm development to real-time implementation. The portability of the hardware makes it quick and easy to transport between test facilities. This hard ware/software architecture is flexible enough to support a variety of diagnostic applications and test hardware, and the GUI-based rapid prototyping capability is sufficient to support development execution, and testing of custom diagnostic algorithms. The PHALT operating system supports execution of diagnostic algorithms under real-time constraints. PHALT can perform real-time capture and playback of test rig data with the ability to augment/ modify the data stream (e.g. inject simulated faults). It performs algorithm testing using a variety of data input sources, including real-time data acquisition, test data playback, and system simulations, and also provides system feedback to evaluate closed-loop diagnostic response and mitigation control.

  15. [Public health stewardship and governance regarding the Colombian healthcare system, 2012-2013].

    Science.gov (United States)

    Roth-Deubel, André N; Molina-Marín, Gloria

    2013-01-01

    Analysing decision-making concerning public health issues regarding the Colombian healthcare system from a market economy-based approach. This study involved applying Glaser and Strauss's grounded theory in six Colombian cities during 2012: Bogotá, Barranquilla, Bucaramanga, Leticia, Medellin and Pasto. 120 individual interviews were conducted with professionals involved in decision-making, running public healthcare programmes and making policy within public and private institutions. Fourteen focus groups were held with community organisation leaders. The findings suggested national and municipal health authorities' weak stewardship and ineffective governance regarding public healthcare policy and programmes, related to a lack of staff trained in public health management issues. In turn, this was related to political parties' interference and private insurers' particular interests and the structural fragmentation of functions and actors within the health system, thereby limiting public health development. A new axiology is necessary for achieving effective governance (I.e. cooperation between Colombian Healthcare Social Security System actors) to overcome current incompetence and financial self-interest predominating within the Colombian healthcare system.

  16. Understanding Regional Actors: A Case Study

    National Research Council Canada - National Science Library

    Harden, James

    2002-01-01

    .... It is possible the estimation process could improve if greater attention was given to the interests, challenges, and opportunities of the regional actors involved, rather than concentrating on U.S. interests...

  17. The Chinese Health Care System

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter; Yu, Yi

    In the present paper we describe the structure of the Chinese health care system and sketch its future development. We analyse issues of provider incentives and the actual burden sharing between government, enterprises and people. We further aim to identify a number of current problems and link...

  18. Impact of global health governance on country health systems: the case of HIV initiatives in Nigeria.

    Science.gov (United States)

    Chima, Charles Chikodili; Homedes, Nuria

    2015-06-01

    Three global health initiatives (GHIs) - the US President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank Multi-Country HIV/AIDS Program - finance most HIV services in Nigeria. Critics assert that GHIs burden fragile health systems in resource-poor countries and that health system limitations in these countries constrain the achievement of the objectives of GHIs. This study analyzed interactions between HIV GHIs and the Nigerian Health System and explored how the impact of the GHIs could be optimized. A country case study was conducted using qualitative methods, including: semi-structured interviews, direct observation, and archival review. Semi-structured interviews were held with key informants selected to reach a broad range of stakeholders including policymakers, program managers, service providers, representatives of donor agencies and their implementing partners; the WHO country office in Nigeria; independent consultants; and civil society organizations involved in HIV work. The fieldwork was conducted between June and August 2013. HIV GHIs have had a mixed impact on the health system. They have enhanced availability of and access to HIV services, improved quality of services, and strengthened health information systems and the role of non-state actors in health care. On the negative end, HIV donor funding has increased dependency on foreign aid, widened disparities in access to HIV services, done little to address the sustainability of the services, crowded out non-HIV health services, and led to the development of a parallel supply management system. They have also not invested significantly in the production of new health workers and have not addressed maldistribution problems, but have rather contributed to internal brain drain by luring health workers from the public sector to non-governmental organizations and have increased workload for existing health workers. There is poor policy direction

  19. Strengthening Health Systems Research Capacity in Mozambique ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Mozambique's health sector is dealing with system-wide challenges. ... the Ministry's work on national health accounts, resource allocation, and national health ... a combined INS-FIOCRUS program, and the master's in public health and field ...

  20. African Health Systems Initiative (AHSI) | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The African Health Systems Initiative (AHSI) is a 10-year Canadian International ... for strengthening African-led health systems and human resources for health. ... IDRC congratulates first cohort of Women in Climate Change Science Fellows.

  1. ACTOR`S EXPRESSIVENESS: PHYSICAL ACTION AS A LANGUAGE OF ARCHETYPES

    Directory of Open Access Journals (Sweden)

    CATEREVA IRINA

    2016-06-01

    Full Text Available Physical activity is the main element of the nonverbal expressiveness of the actor. Th e nonpsychological theatre of Europe in the second half of the 20th century was looking for the actor`s possibility of physical action for revealing the archetypal image of the character. Expressing the meanings similar among themselves in diff erent Nations, they connect the actors and spectators at the level of feelings, of the subconscious. Destroying the barriers in people’s minds which divides them into Europeans and Asians, or French and Germans, they are understandable to any audience regardless of their cultural or linguistic affiliation.

  2. Private sector in public health care systems

    OpenAIRE

    Matějusová, Lenka

    2008-01-01

    This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market o...

  3. APPROACHES TO GLOBAL SECURITY. ACTORS, MANIFESTATIONS AND TENDENCIES

    Directory of Open Access Journals (Sweden)

    Gheorghe MINCULETE

    2013-01-01

    Full Text Available Nowadays, the world seems to be in a transition from the current system founded on the liberal social, economic and political model to a more diverse and heterogeneous model in which the determinant role is played by a number of state and non-state actors. The step from the Western system of cultural, political and predominant economic values to a more diverse and heterogeneous system makes the actors involved defend not only their visions, but also promote their own interests. The differences between visions gain relevance and clarity because the countries supporting them obtain increased power, and that is more than obvious. All this leads to a symmetric allocation of different means, which generates uncertainties and diminishes unilateral actions This transition process impacts global security especially through the asymmetric, unconventional and hybrid risks and threats manifesting worldwide.

  4. Planning, Anticipatory Systems, and Kinds of Actors

    Science.gov (United States)

    Jorna, René; van Wezel, Wout

    2002-09-01

    Anticipation and planning have much in common. Anticipation means being ahead of things. Planning means not only anticipating on things to come, but also trying to determine a course of action to reach a goal. Planning is investigated in many domains, for example, in economy, biology, and in the cognitive sciences. Each of these domains uses its own research methodologies, languages, ontologies, and models. Although there are many differences between the various approaches and models, there must of course also be similarities, since they all deal with establishing a future course of actions to reach a goal. We will compare several planning approaches on a number of aspects, e.g., the kind of entity that makes the plan (natural or artificial), whether the plan is executed by the planner or by another entity, representational issues, and the domain that the plan is executed in. Our article focuses on analytical dimensions in the extended field of planning. We do not discuss empirical results.

  5. Actors and externally legitimated social systems

    NARCIS (Netherlands)

    Kooistra, J.

    1992-01-01

    This paper is about a holy cow. It is the holy cow of rationality, meaning, as such, the retardation of our knowing. The paper goes into the elements "competence", "performer" and kinds of legitimisation that play a role here. The objective of the paper is to depict the situation in science

  6. Planning, anticipatory systems, and kinds of actors

    NARCIS (Netherlands)

    Jorna, R; van Wezel, W; Dubois, DM

    2002-01-01

    Anticipation and planning have much in common. Anticipation means being ahead of things. Planning means not only anticipating on things to come, but also trying to determine a course of action to reach a goal. Planning is investigated in many domains, for example, in economy, biology, and in the

  7. Health systems reforms in Singapore: A qualitative study of key stakeholders.

    Science.gov (United States)

    Ong, Suan Ee; Tyagi, Shilpa; Lim, Jane Mingjie; Chia, Kee Seng; Legido-Quigley, Helena

    2018-02-19

    In response to a growing chronic disease burden and ageing population, Singapore implemented Regional Health Systems (RHS) in 2008. In January 2017, the MOH announced that the six RHS clusters would be reorganised into three in 2018. This qualitative study sought to identify the health system challenges, opportunities, and ways forward for the implementation of the RHS. We conducted semi-structured interviews with 35 key informants from RHS clusters, government, academia, and private and voluntary sectors. Integration, innovation, and people-centeredness were identified as the key principles of the RHS. The RHS was described as an opportunity to holistically care for a person across the care continuum, address social determinants of health, develop new models of care, and work with social and community partners. Challenges to RHS implementation included difficulties aligning the goals, values, and priorities of multiple actors, the need for better integration across clusters, differing care capabilities and capacities across partners, healthcare financing structures that may not reflect RHS goals, scalability and evaluation of pilot programmes, and disease-centricity, provider-centricity, and medicalisation in health and healthcare. Suggested ways forward included building relationships between actors to facilitate integration; exploring innovative new models of care; clear long-term/scale-up plans for successful pilots; healthcare financing reforms to meet changing patient and population needs; and developing evaluation systems reflective of RHS principles and priorities. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening.

    Science.gov (United States)

    Barasa, Edwine W; Cloete, Keith; Gilson, Lucy

    2017-11-01

    Recent health system shocks such as the Ebola disease outbreak have focused global health attention on the notion of resilient health systems. In this commentary, we reflect on the current framing of the concept of resilience in health systems discourse and propose a reframing. Specifically, we propose that: (1) in addition to sudden shocks, health systems face the ongoing strain of multiple factors. Health systems need the capacity to continue to deliver services of good quality and respond effectively to wider health challenges. We call this capacity everyday resilience; (2) health system resilience entails more than bouncing back from shock. In complex adaptive systems (CAS), resilience emerges from a combination of absorptive, adaptive and transformative strategies; (3) nurturing the resilience of health systems requires understanding health systems as comprising not only hardware elements (such as finances and infrastructure), but also software elements (such as leadership capacity, power relations, values and appropriate organizational culture). We also reflect on current criticisms of the concept of resilient health systems, such as that it assumes that systems are apolitical, ignoring actor agency, promoting inaction, and requiring that we accept and embrace vulnerability, rather than strive for stronger and more responsive systems. We observe that these criticisms are warranted to the extent that they refer to notions of resilience that are mismatched with the reality of health systems as CAS. We argue that the observed weaknesses of resilience thinking can be addressed by reframing and applying a resilience lens that is better suited to the attributes of health systems as CAS. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Energy Systems and Population Health

    Energy Technology Data Exchange (ETDEWEB)

    Ezzati, Majid; Bailis, Rob; Kammen, Daniel M.; Holloway, Tracey; Price, Lynn; Cifuentes, Luis A.; Barnes, Brendon; Chaurey, Akanksha; Dhanapala, Kiran N.

    2004-04-12

    It is well-documented that energy and energy systems have a central role in social and economic development and human welfare at all scales, from household and community to regional and national (41). Among its various welfare effects, energy is closely linked with people s health. Some of the effects of energy on health and welfare are direct. With abundant energy, more food or more frequent meals can be prepared; food can be refrigerated, increasing the types of food items that are consumed and reducing food contamination; water pumps can provide more water and eliminate the need for water storage leading to contamination or increased exposure to disease vectors such as mosquitoes or snails; water can be disinfected by boiling or using other technologies such as radiation. Other effects of energy on public health are mediated through more proximal determinants of health and disease. Abundant energy can lead to increased irrigation, agricultural productivity, and access to food and nutrition; access to energy can also increase small-scale income generation such as processing of agricultural commodities (e.g., producing refined oil from oil seeds, roasting coffee, drying and preserving fruits and meats) and production of crafts; ability to control lighting and heating allows education or economic activities to be shielded from daily or seasonal environmental constraints such as light, temperature, rainfall, or wind; time and other economic resources spent on collecting and/or transporting fuels can be used for other household needs if access to energy is facilitated; energy availability for transportation increases access to health and education facilities and allow increased economic activity by facilitating the transportation of goods and services to and from markets; energy for telecommunication technology (radio, television, telephone, or internet) provides increased access to information useful for health, education, or economic purposes; provision of energy

  10. Non-state actors in control of territory as 'actors of protection' in international refugee law

    NARCIS (Netherlands)

    Karavias, M.

    2015-01-01

    This article examines the concept of non-state ‘actors of protection’ in international refugee law. This concept breaks with traditional State-centric readings of international law, as it connotes that a non-state actor may offer ‘protection’ against persecution, comparable to that normally offered

  11. Sistema de salud de Cuba The health system of Cuba

    Directory of Open Access Journals (Sweden)

    Emma Domínguez-Alonso

    2011-01-01

    Full Text Available En este trabajo se describen las condiciones de salud de Cuba y el sistema cubano de salud, incluyendo su estructura y cobertura, sus fuentes de financiamiento, su gasto en salud, los recursos físicos, materiales y humanos de los que dispone, y las actividades de rectoría e investigación que desarrolla. También se discute la importancia de sus instituciones de investigación y se describe el papel de los usuarios de los servicios en la operación y evaluación del sistema, así como las actividades que en este sentido desarrollan la Federación de Mujeres Cubanas y los Comités de Defensa de la Revolución. La parte final de este trabajo se dedica a discutir las innovaciones más recientes dentro de las que destacan las redes de cardiología, la Misión Milagro y la Batalla de Ideas.This paper describes the health conditions in Cuba and the general characteristics of the Cuban health system, including its structure and coverage, its financial sources, its health expenditure, its physical, material and human resources, and its stewardship functions. It also discusses the increasing importance of its research institutions and the role played by its users in the operation and evaluation of the system. Salient among the social actors involved in the health sector are the Cuban Women Federation and the Committees for the Defense of the Revolution. The paper concludes with the discussion of the most recent innovations implemented in the Cuban health system, including the cardiology networks, the Miracle Mission (Misión Milagro and the Battle of Ideas (Batalla de Ideas.

  12. Postdecisional counterfactual thinking by actors and readers.

    Science.gov (United States)

    Girotto, Vittorio; Ferrante, Donatella; Pighin, Stefania; Gonzalez, Michel

    2007-06-01

    How do individuals think counterfactually about the outcomes of their decisions? Most previous studies have investigated how readers think about fictional stories, rather than how actors think about events they have actually experienced. We assumed that differences in individuals' roles (actor vs. reader) can make different information available, which in turn can affect counterfactual thinking. Hence, we predicted an effect of role on postdecisional counterfactual thinking. Reporting the results of eight studies, we show that readers undo the negative outcome of a story by undoing the protagonist's choice to tackle a given problem, rather than the protagonist's unsuccessful attempt to solve it. But actors who make the same choice and experience the same negative outcome as the protagonist undo this outcome by altering features of the problem. We also show that this effect does not depend on motivational factors. These results contradict current accounts of counterfactual thinking and demonstrate the necessity of investigating the counterfactual thoughts of individuals in varied roles.

  13. Counterterrorism in the Russian Arctic: legal framework and central actors

    Directory of Open Access Journals (Sweden)

    Ingvill M. Elgsaas

    2017-12-01

    Full Text Available Russia’s strategic interests in the Arctic coupled with a complex and diffuse terrorist threat has produced a niche topic: Arctic counterterrorism. Arctic counterterrorism is a new and underdeveloped topic that has received only limited attention. This article contributes a discussion of the legal framework and the main actors involved in countering terrorism in the Russian Arctic. The author finds that the legal framework for counterterrorism is extensive yet centered in core documents. Similarly, counterterrorism involves many and varied actors united in a relatively simple and streamlined national system for counterterrorism. Current legal regulation and organisation provide a solid base that may support efficient management of counterterrorism, also in the Arctic. A notable strength is the concentration of coordination responsibilities in the hands of one central actor, the FSB. Another important characteristic is that the system is symmetrical and follows Russia’s federal organisation with coordinating bodies for all regions including those in the Arctic. Counterterrorism legislation is kept up to date and the trend is towards tougher punishments and a wide understanding of terrorist offenses. A potential weak spot is the unclear role of the newly formed National Guard. The uncertainty surrounding the role of the National Guard in the fight against terrorism may challenge the FSB and weaken coordination of the system for counterterrorism in the future.

  14. [Social actors and phenomenologic modelling].

    Science.gov (United States)

    Laflamme, Simon

    2012-05-01

    The phenomenological approach has a quasi-monopoly in the individual and subjectivity analyses in social sciences. However, the conceptual apparatus associated with this approach is very restrictive. The human being has to be understood as rational, conscious, intentional, interested, and autonomous. Because of this, a large dimension of human activity cannot be taken into consideration: all that does not fit into the analytical categories (nonrational, nonconscious, etc.). Moreover, this approach cannot really move toward a relational analysis unless it is between individuals predefined by its conceptual apparatus. This lack of complexity makes difficult the establishment of links between phenomenology and systemic analysis in which relation (and its derivatives such as recursiveness, dialectic, correlation) plays an essential role. This article intends to propose a way for systemic analysis to apprehend the individual with respect to his complexity.

  15. Lone Actors: Challenges and Opportunities for Countering Violent Extremism

    NARCIS (Netherlands)

    Spaaij, R.; Richman, A.; Sharan, Y.

    2015-01-01

    This paper explores some of the key challenges and opportunities concerning the prevention and control of lone actor terrorism. It is argued that lone actors do not operate in a social vacuum and that the interaction points between lone actors and their social environments can render lone actors

  16. The Unified Health System (SUS as a large technological system: territory, technique and politic

    Directory of Open Access Journals (Sweden)

    Luis Henrique Leandro Ribeiro

    2018-03-01

    Full Text Available The Uni ed Health System (SUS constitutes a large technological system wi- thin the Brazilian territory since it aggregates a broad and diverse materiality in organizing and managing its ows. Additionally, it has two other attributes that make it unique: high sensibility to speci cities of different places; and technical and political centralization and decentralization of its actions. The macro dimen- sion is the SUS, leading it to be understood not simply as a health system, through its: multidimensionality – elements of other life instances (social, economic, cul- tural and political; broad and unequal spectrum of actors (state and non-state who move it and the meanings of its actions; and the trans-scaleness of its con- cretion in places (local, national and international nexuses. As an infrastructure of everyday life, it is a hegemonic large technological system that acts upon objec- tive (technosphere and subjective (psychosphere conditions of existence, a con- ception that has important implications for health policy and territory integration.

  17. New Actors and Alliances in Development

    DEFF Research Database (Denmark)

    Richey, Lisa Ann; Ponte, Stefano

    2014-01-01

    ‘New actors and alliances in development’ brings together an interdisciplinary group of scholars exploring how development financing and interventions are being shaped by a wider and more complex platform of actors than usually considered in the existing literature. The contributors also trace...... a changing set of key relations and alliances in development – those between business and consumers; ngos and celebrities; philanthropic organisations and the state; diaspora groups and transnational advocacy networks; ruling elites and productive capitalists; and ‘new donors’ and developing country...

  18. Exploring the nature of governance at the level of implementation for health system strengthening: the DIALHS experience.

    Science.gov (United States)

    Scott, Vera; Schaay, Nikki; Olckers, Patti; Nqana, Nomsa; Lehmann, Uta; Gilson, Lucy

    2014-09-01

    Health system governance has been recognized as a critical element of the health system strengthening agenda. To date, health governance research often focuses at national or global levels, adopting a macro-perspective that deals with governance structures, forms and principles. Little attention has been given to a micro-perspective which recognizes the role of health system actors in governance, or to considering the operational level of the health system. This article presents a South African case study of an intervention to address conflict in roles and responsibilities between multiple actors supporting service delivery at the local level, and explores the broader insights this experience generates about the nature of local health system governance. In an embedded case study, action learning and reflection theory were used to design and implement the intervention. Data in this article were drawn from minutes, observations and recorded reflections of the meetings and workshops that comprised the intervention. A theoretical governance framework was used both to understand the context of the intervention and to analyse the dimensions of governance relevant in the experience. The study shows how, through action learning and reflection, local managers in two organizations came to understand how the higher level misalignment of organizational structures and processes imposed governance constraints on them, and to see the impact this had on their organizational relationships. By re-framing the conflict as organizational, they were then able to create opportunities for staff to understand their context and participate in negotiating principles for communication and collaborative work. The result reduced conflict between staff in the two organizations, leading to improved implementation of programme support. Strengthening relationships among those working at local level by building collaborative norms and values is an important part of local health system governance for

  19. Moving from Servile Actors to. .

    DEFF Research Database (Denmark)

    Hansen, Søren Bolvig

    2005-01-01

    ? connection to business growth and seen the limits of cost reduction strategies for improving productivity and profit. This notion has altered manufacturing companies? requirements to designers as they now seek the capability to identify potential design directions. Designers, who have recognized these new......This paper deals with the changing role of the designer. Changes in society and within people?s consumption patterns have increased the demand for products, which are rich on utility, symbolic and systemic qualities - innovative products. Manufacturing companies have realised innovations...

  20. Semantics for Communicating Actors with Interdependent Real-Time Deadlines

    DEFF Research Database (Denmark)

    Knoll, Istvan; Ravn, Anders Peter; Skou, Arne

    2009-01-01

    on the results, these tools must use consistent semantics for the model. Yet, a monolithic semantic model is just as complex as the entity it describes. In order to circumvent this issue, we define a three level semantics giving independent definitions of the functionality of actors, the temporal properties...... of communications, and finally imposing deadlines on the timing of dependent actors. With this approach the semantics is used directly in developing a simulator supporting the nondeterminism of the abstract semantics such that e.g. potential race conditions can be detected. The layers are also planned to underpin...... independent specialized verification tools. The verification task for timed, hybrid systems can thus be divided into the continuous, discrete, and timing domains with automated translation to specialized tools, and this promises better scalability than simulation or model checking of one complex model....

  1. Health Care Information System (HCIS) Data File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A...

  2. People-centred science: strengthening the practice of health policy and systems research

    Science.gov (United States)

    2014-01-01

    Health policy and systems research (HPSR) is a transdisciplinary field of global importance, with its own emerging standards for creating, evaluating, and utilizing knowledge, and distinguished by a particular orientation towards influencing policy and wider action to strengthen health systems. In this commentary, we argue that the ability of the HPSR field to influence real world change hinges on its becoming more people-centred. We see people-centredness as recognizing the field of enquiry as one of social construction, requiring those conducting HPSR to locate their own position in the system, and conduct and publish research in a manner that foregrounds human agency attributes and values, and is acutely attentive to policy context. Change occurs at many layers of a health system, shaped by social, political, and economic forces, and brought about by different groups of people who make up the system, including service users and communities. The seeds of transformative practice in HPSR lie in amplifying the breadth and depth of dialogue across health system actors in the conduct of research – recognizing that these actors are all generators, sources, and users of knowledge about the system. While building such a dialogic practice, those conducting HPSR must strive to protect the autonomy and integrity of their ideas and actions, and also clearly explain their own positions and the value-basis of their work. We conclude with a set of questions that health policy and systems researchers may wish to consider in making their practice more people-centred, and hence more oriented toward real-world change. PMID:24739525

  3. Political actors playing games: Theory and experiments

    NARCIS (Netherlands)

    Kamm, A.

    2015-01-01

    Political actors exert enormous influence over our daily lives. Their influence on economic activities cannot be underestimated. Voters determine the distribution of political power, political candidates choose policy platforms that they intend to enact if elected, and legislators bargain to arrive

  4. Corporate actors in Western European television news

    NARCIS (Netherlands)

    Verhoeven, P.

    2009-01-01

    News about corporations can be understood as an interdependent relationship among the public relations function, organizational logic and the logic of the media. This research addresses the visibility and role of corporate actors in Western European public television news. A quantitative content

  5. Policy Actors: Doing Policy Work in Schools

    Science.gov (United States)

    Ball, Stephen J.; Maguire, Meg; Braun, Annette; Hoskins, Kate

    2011-01-01

    This paper considers the "policy work" of teacher actors in schools. It focuses on the "problem of meaning" and offers a typology of roles and positions through which teachers engage with policy and with which policies get "enacted". It argues that "policy work" is made up of a set of complex and…

  6. Health policy, health systems research and analysis capacity ...

    African Journals Online (AJOL)

    Introduction: Health Policy and Systems Research and Analysis (HPSR&A) is an applied science that deals with complexity as it tries to provide lessons, tools and methods to understand and improve health systems and health policy. It is defined by the kinds of questions asked rather than a particular methodology.

  7. Software for Intelligent System Health Management

    Science.gov (United States)

    Trevino, Luis C.

    2004-01-01

    This viewgraph presentation describes the characteristics and advantages of autonomy and artificial intelligence in systems health monitoring. The presentation lists technologies relevant to Intelligent System Health Management (ISHM), and some potential applications.

  8. The public health system in England

    National Research Council Canada - National Science Library

    Hunter, David J; Marks, Linda; Smith, Katherine E

    2010-01-01

    .... The Public Health System in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted over time...

  9. Pensar e intervenir el territorio a traves de la Teoria del Actor-Red

    Directory of Open Access Journals (Sweden)

    Juan E. Cabrera

    2011-03-01

    Full Text Available El propósito de este artículo es reflexionar sobre las coincidencias entre la forma de ver el territorio como red, algunas posturas teóricas sobre su concepto y la teoría del actor-red. Sobre lo anterior se centra en proponer una forma de entender las relaciones entre actores cuando se va a intervenir el territorio a través de políticas públicas como la planificación utilizando un modelo de gestión territorial a través de las orientaciones de la TAR.   

  10. The moral problem of worse actors

    Directory of Open Access Journals (Sweden)

    Scott Wisor

    2014-05-01

    Full Text Available Individuals and institutions sometimes have morally stringent reasons to not do a given action. For example, an oil company might have morally stringent reasons to refrain from providing revenue to a genocidal regime, or an engineer might have morally stringent reasons to refrain from providing her expertise in the development of weapons of mass destruction. But in some cases, if the agent does not do the action, another actor will do it with much worse consequences. For example, the oil company might know their assets will be bought by a company with worse environmental and labor practices. Or the engineer might know her position will be filled by a more ambitious and amoral engineer. I call this the moral problem of worse actors (MPWA. MPWA gives reason, at least some of the time, to consider otherwise morally impermissible actions permissible or even obligatory. On my account, doing the action in the circumstances of MPWA remains morally objectionable even if permissible or obligatory, and this brings additional moral responsibilities and obligations to the actor. Similarly, not doing the action in the circumstances of MPWA may also bring additional (but different moral responsibilities and obligations. Acknowledging MPWA creates considerable challenges, as many bad actors may appeal to it to justify morally objectionable action. In this paper, I develop a set of strategies for individuals and institutions to handle MPWA. This includes appeals to integrity and the proper attribution of expressive responsibility, regulatory responsibility, and compensatory responsibility. I also address a set of related concerns, including worries about incentivizing would-be bad actors, concerns about epistemic uncertainty, and the problem of mala in se exceptions.

  11. THE ANALYSIS OF ACTORS IN THE MAKING OF THE BUDGET REVENUE OF REGIONAL COST

    Directory of Open Access Journals (Sweden)

    Muhammad Saad

    2015-07-01

    Full Text Available This article is the result of research on the analysis of the policy making of the budget revenues and shopping area of Makassar city fiscal year 2009. One part of this research use approach to the actors and the relationships between actors in policy making. Within the framework of the system of policy making of Budget income and Expenditure area (Budgets Makassar city, this research is the description of the analysis of the local government and actors People’s Representative Council District Makassar city as policy makers in making Grant Makassar city

  12. Actor-critic-based ink drop spread as an intelligent controller

    OpenAIRE

    SAGHA, Hesam; AFRAKOTI, Iman Esmaili Paeen; BAGHERISHOURAKI, Saeed

    2014-01-01

    This paper introduces an innovative adaptive controller based on the actor-critic method. The proposed approach employs the ink drop spread (IDS) method as its main engine. The IDS method is a new trend in soft-computing approaches that is a universal fuzzy modeling technique and has been also used as a supervised controller. Its process is very similar to the processing system of the human brain. The proposed actor-critic method uses an IDS structure as an actor and a 2-dimensional...

  13. Rolling-out Lean in the Saskatchewan Health Care System: Politics Derailing Policy

    Directory of Open Access Journals (Sweden)

    Tom McIntosh

    2016-03-01

    Full Text Available Following on the work of Marchildon (2013 this paper examines the political challenges faced by the government of Saskatchewan in rolling out their Lean reforms to the entire provincial health system. The government’s Lean reforms were meant as a vehicle to empower patients and workers in the redesign of service delivery and the creation of a patient-centred system. Lean focuses on continuous improvement, priority setting, employee engagement and the elimination of waste. The reforms appear to have been derailed to a significant degree insofar as key actors inside the system, the media and the public have challenged the goals of the reform, the Lean methodology and process, as well as the cost of the consultants employed to oversee the process. The government’s implementation of the roll-out suffered both from the ability of key actors to withdraw their support and challenge the viability of the reforms in public as well as from a public relations perspective that put the government on the defensive about how people inside the system were being treated with the reforms. As the government moves forward it will have to adjust its implementation processes and strategy in order to overcome the now strong resistance within the health sector.

  14. The key role of supply chain actors in groundwater irrigation development in North Africa

    Science.gov (United States)

    Lejars, Caroline; Daoudi, Ali; Amichi, Hichem

    2017-09-01

    The role played by supply chain actors in the rapid development of groundwater-based irrigated agriculture is analyzed. Agricultural groundwater use has increased tremendously in the past 50 years, leading to the decline of water tables. Groundwater use has enabled intensification of existing farming systems and ensured economic growth. This "groundwater economy" has been growing rapidly due to the initiative of farmers and the involvement of a wide range of supply chain actors, including suppliers of equipment, inputs retailers, and distributors of irrigated agricultural products. In North Africa, the actors in irrigated production chains often operate at the margin of public policies and are usually described as "informal", "unstructured", and as participating in "groundwater anarchy". This paper underlines the crucial role of supply chain actors in the development of groundwater irrigation, a role largely ignored by public policies and rarely studied. The analysis is based on three case studies in Morocco, Tunisia and Algeria, and focuses on the horticultural sub-sector, in particular on onions and tomatoes, which are irrigated high value crops. The study demonstrates that although supply chain actors are catalyzers of the expansion of groundwater irrigation, they could also become actors in adaptation to the declining water tables. Through their informal activities, they help reduce market risks, facilitate credit and access to subsidies, and disseminate innovation. The interest associated with making these actors visible to agricultural institutions is discussed, along with methods of getting them involved in the management of the resource on which they depend.

  15. Health system strengthening in the context of CMAM

    International Nuclear Information System (INIS)

    Israel, Anne-Dominique; Gallagher, Maureen

    2014-01-01

    pertinently tackle those constrains/ barriers. AM specialists need to join efforts with health specialists to achieve the reduction of the barriers identified as “common”. In order to strengthen coverage, the approach to health systems strengthening has to be two-fold – to increase availability and access as part of the health system. Taking on a more horizontal approach with AM integrated to basic package of health services can support improved availability. In turn, to increase access for AM, there is a need to identify barriers that are specific to SAM/ MAM management within that package. These barriers could be what the “Acute malnutrition champions” could focus on while strengthening the capacity of health actors to mainstream acute malnutrition management in their activities. Efforts have to be coordinated with the health system in order to ensure that the various barriers are addressed nonetheless. (author)

  16. The population-development tangle. Aspects and actors.

    Science.gov (United States)

    Sen, G

    1993-01-01

    Since the 1974 Population Conference, the population field has become of interest to members of the fundamentalist right wing, feminists, and environmentalists. Therefore, it is necessary to understand the areas of agreement and disagreement among each set of actors as well as how they define the issues. Currently, development discourse is characterized by considerations of: 1) economic growth, 2) the provision of livelihoods, 3) the provision of basic needs, 4) ecological sustainability and renewability, and 5) political participation. The actors who define the terms of this discourse include: 1) corporate interests, which concentrate on economic growth; 2) international and national agencies, which place primary importance on economic growth and some importance on basic needs and ecological sustainability; 3) popular organizations and social movements, which concentrate on livelihoods, basic needs, and political participation; and 4) environmentalists, who focus on ecological sustainability, economic growth, and (occasionally) political participation. The field of population, on the other hand, is dominated by traditional populationists, whose primary focus is economic growth; developmentalists; the fundamentalist right, who are most concerned with family and control over reproduction; environmentalists; and the women's movement, which is most concerned with reproductive rights and reproductive health. When the perspective of poor women is considered, it can be seen that economic growth and ecological sustainability must support the securing of livelihoods, basic needs, political participation, and reproductive rights, and that reproductive health programs must be part of an overall health agenda.

  17. [Health services research for the public health service (PHS) and the public health system].

    Science.gov (United States)

    Hollederer, A; Wildner, M

    2015-03-01

    There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich". © Georg Thieme Verlag KG Stuttgart · New York.

  18. Strengthening of oral health systems

    DEFF Research Database (Denmark)

    Petersen, Poul Erik

    2014-01-01

    is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral...... diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work......Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care...

  19. The actors and privatization of sanitation services in Ciudad Juarez, Chihuahua

    Directory of Open Access Journals (Sweden)

    Gustavo Córdova Bojórquez

    2006-07-01

    Full Text Available This document offers an analysis about possibilities to implement a concession system in the recollection and disposal of non-hazardous trash collection service in Ciudad Juarez. The recognition of view points from different actors in the timeframe, applying a survey to home heads and interviews to opinion leaders, as actors key in city´s production, let us to identify a high politized item that keep off efficient and transparent public participation.

  20. Managing Actors, Resources, and Activities in Innovation Ecosystems – A Design Science Approach

    OpenAIRE

    Valkokari , Katri; Amitrano , Cristina ,; Bifulco , Francesco; Valjakka , Tiina

    2016-01-01

    Part 13: Design Science and Business Models - Design Science Research; International audience; Through a design science approach, the paper explores how actors in a network create and sustain competitive advantage independently and through participation in a system of actors (i.e., a collaborative network) who are not hierarchically managed but, rather, act toward their own goals within the innovation ecosystem. In accordance with design studies, the relevance of research and its quality are ...

  1. Adversarial Advantage Actor-Critic Model for Task-Completion Dialogue Policy Learning

    OpenAIRE

    Peng, Baolin; Li, Xiujun; Gao, Jianfeng; Liu, Jingjing; Chen, Yun-Nung; Wong, Kam-Fai

    2017-01-01

    This paper presents a new method --- adversarial advantage actor-critic (Adversarial A2C), which significantly improves the efficiency of dialogue policy learning in task-completion dialogue systems. Inspired by generative adversarial networks (GAN), we train a discriminator to differentiate responses/actions generated by dialogue agents from responses/actions by experts. Then, we incorporate the discriminator as another critic into the advantage actor-critic (A2C) framework, to encourage the...

  2. Technology strategy as macro-actor

    DEFF Research Database (Denmark)

    Tryggestad, Kjell

    2003-01-01

    -human entities to the explanatory repertoire of strategy research, another line of inquiry is pursued. The performative perspective thus proposed, is inspired by the classical work of Von Clausewitz and the recent anthropology of science, technology and organizational identities. In the proposed perspective...... case account for how the strategic technology and the strategic collective emerge and co-produce each other as a macro-actor, only to become transformed in unexpected ways - as common technology and reflective human subjects.In the concluding section, it is argued that the humanity of the reflective...... outcomes, as providers of explanations and observations. The expression `technological strategy as macro-actor' summarizes these findings and the associated implications for research and practice....

  3. African Initiated Churches’ potential as development actors

    Directory of Open Access Journals (Sweden)

    Philipp Öhlmann

    2016-11-01

    Full Text Available African Initiated Churches (AICs are not yet recognised as relevant actors of community development interventions. While it has been acknowledged that many of them provide coping mechanisms in adverse environments, support in social transformation and social capital, little information is available on their role as development actors. In this article, we evaluate the potential of AICs as partners of international development agencies for community development. We draw on interviews and focus group discussions with leaders of various AICs conducted in South Africa in February and March 2016. In particular, we examine the churches’ understanding of development, their view on the separation of spiritual and development activities and their priorities. Moreover, we outline the development activities which they are currently engaged in and analyse the structures they have in place to do so. Our findings indicate that AICs are increasingly active in community development and offer various entry points for possible cooperation.

  4. Integrated System Health Management Development Toolkit

    Science.gov (United States)

    Figueroa, Jorge; Smith, Harvey; Morris, Jon

    2009-01-01

    This software toolkit is designed to model complex systems for the implementation of embedded Integrated System Health Management (ISHM) capability, which focuses on determining the condition (health) of every element in a complex system (detect anomalies, diagnose causes, and predict future anomalies), and to provide data, information, and knowledge (DIaK) to control systems for safe and effective operation.

  5. [The 2010 earthquake in Chile: the response of the health system and international cooperation].

    Science.gov (United States)

    López Tagle, Elizabeth; Santana Nazarit, Paula

    2011-08-01

    Understand the health system and international cooperation response to the catastrophic situation left by the earthquake and tsunami of 27 February 2010 in Chile, and draft proposals for improving strategies to mitigate the devastating effects of natural disasters. Descriptive and qualitative study with a first phase involving the analysis of secondary information-such as news articles, official statements, and technical reports-and a second phase involving semistructured interviews of institutional actors in the public health sector responsible for disaster response and users of the health system who acted as leaders and/or managers of the response. The study was conducted between May and October 2010, and information-gathering focused on the Maule, Bío Bío, and Metropolitan regions. Procedures for recording, distributing, and controlling donations were lacking. The health services suffered significant damage, including the complete destruction of 10 hospitals. The presence of field hospitals and foreign medical teams were appreciated by the community. The family health model and the commitment of personnel helped to ensure the quality of the response. While public health management was generally good, problems dealing with mental health issues were encountered due to a lack of local plans and predisaster simulations. The poor were the most affected. Women became social leaders, organizing the community. Although the health response to the emergency was satisfactory, both the health system and the mobilization of international assistance suffered from weaknesses that exacerbated existing inequities, revealing the need for multisectoral participatory mitigation plans for better disaster preparedness.

  6. The health professions and the performance of future health systems in low-income countries: support or obstacle?

    Science.gov (United States)

    Dussault, Gilles

    2008-05-01

    This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. The suggestion is made that a "social contract", granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role.

  7. Managing Health Information System | Campbell | Nigerian ...

    African Journals Online (AJOL)

    The effective planning, management monitoring and evaluation of health services, health resources and indeed the health system requires a wealth of health information, with its simultaneous effective and efficient management. It is an instrument used to help policy-making, decision making and day to day actions in the ...

  8. Synergy between indigenous knowledge systems, modern health ...

    African Journals Online (AJOL)

    ... the people of this country should harness a synergy between indigenous health care systems, scientific research and modern health care methods. This article attempts to address the historical evolution of health care methods in South Africa, its effect on the community as well as challenges facing the health professions.

  9. Military Health System Transformation Implications on Health Information Technology Modernization.

    Science.gov (United States)

    Khan, Saad

    2018-03-01

    With the recent passage of the National Defense Authorization Act for Fiscal Year 2017, Congress has triggered groundbreaking Military Health System organizational restructuring with the Defense Health Agency assuming responsibility for managing all hospitals and clinics owned by the Army, Navy, and Air Force. This is a major shift toward a modern value-based managed care system, which will require much greater military-civilian health care delivery integration to be in place by October 2018. Just before the National Defense Authorization Act for Fiscal Year 2017 passage, the Department of Defense had already begun a seismic shift and awarded a contract for the new Military Health System-wide electronic health record system. In this perspective, we discuss the implications of the intersection of two large-scope and large-scale initiatives, health system transformation, and information technology modernization, being rolled out in the largest and most complex federal agency and potential risk mitigating steps. The Military Health System will require an expanded unified clinical leadership to spearhead short-term transformation; furthermore, developing, organizing, and growing a cadre of informatics expertise to expand the use and diffusion of novel solutions such as health information exchanges, data analytics, and others to transcend organizational barriers are still needed to achieve the long-term aim of health system reform as envisioned by the National Defense Authorization Act for Fiscal Year 2017.

  10. Integrating ICTs within health systems | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-06-10

    Jun 10, 2016 ... But for too long, ICT and health system researchers have worked in isolation ... be used to enable the governance and functioning of health systems in ... most African countries adopted direct payment for health services as the ...

  11. Occupational Health Record-keeping System (OHRS)

    Data.gov (United States)

    Department of Veterans Affairs — Occupational Health Record-keeping System (OHRS) is part of the Clinical Information Support System (CISS) portal framework and the initial CISS partner system. OHRS...

  12. [A Maternal Health Care System Based on Mobile Health Care].

    Science.gov (United States)

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

  13. Mobile health monitoring system for community health workers

    CSIR Research Space (South Africa)

    Sibiya, G

    2014-09-01

    Full Text Available of hypertension as it provides real time information and eliminates the need to visit a healthcare facility to take blood pressure readings. Our proposed mobile health monitoring system enables faster computerization of data that has been recorded... pressure, heart rate and glucose readings. These reading closely related to most common NCDs. D. Feedback to health worker and the subject of care Community health workers are often not professionally trained on health. As a result they are not expected...

  14. Actor/Actant-Network Theory as Emerging Methodology for ...

    African Journals Online (AJOL)

    4carolinebell@gmail.com

    2005-01-31

    Jan 31, 2005 ... to trace relationships, actors, actants and actor/actant-networks .... associated with a particular type of social theory (Latour, 1987; ..... the Department of Environmental Affairs and Tourism, Organised Business and Organised.

  15. Multipurpose Health Care Telemedicine System

    National Research Council Canada - National Science Library

    Kyriacou, E

    2001-01-01

    .... Ambulances, Rural Health Centers (RHC) or other remote health location, Ships navigating in wide seas and Airplanes in flight are common examples of possible emergency sites, while critical care telemetry, and telemedicine home follow-ups...

  16. Medical tourism’s impact for health systems: A study from three Asian countries

    Directory of Open Access Journals (Sweden)

    Ala`a Nimer AbuKhalifeh

    2015-12-01

    Full Text Available Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism’s growth for health systems, illustration on the cases of Thailand, Singapore and Malaysia, three provincial centres for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growing of the medical tourist industry.

  17. Food Safety Perceptions and Practices among Smallholder Pork Value Chain Actors in Hung Yen Province, Vietnam.

    Science.gov (United States)

    Dang-Xuan, Sinh; Nguyen-Viet, Hung; Meeyam, Tongkorn; Fries, Reinhard; Nguyen-Thanh, Huong; Pham-Duc, Phuc; Lam, Steven; Grace, Delia; Unger, Fred

    2016-09-01

    Pork safety is an important public health concern in Vietnam and is a shared responsibility among many actors along the pork value chain. We examined the knowledge, perceptions, and practices regarding food safety, disease, and health risk among selected pork value chain actors (slaughterhouse owners and workers, people living around slaughterhouses, pork sellers, consumers, and veterinary and public health staff) in three districts in Hung Yen Province, Vietnam. We randomly selected 52 pork value chain actors to be surveyed through questionnaires, observation checklists, key informant interviews, and focus group discussions. Most slaughterhouse workers acquired knowledge and experience of food safety through "learning by doing" rather than from training by a veterinary or public health professional. Both slaughterhouse worker and pork seller groups had some accurate perceptions about pig diseases and foodborne diseases; however, misperceptions of risk and, especially, of zoonoses were present. Furthermore, while workers and sellers often use cloths to dry the meat and clean equipment, they did not think this was a risk for meat contamination. Moreover, when sellers wear protective equipment, such as gloves, masks, or hats, consumers perceive that the sellers may have health issues they are trying to conceal and so consumers avoid buying from them. The perceived freshness of pork, along with trust in the seller and in the pork production process, were strong indicators of consumer preference. And yet, pork value chain actors tend to trust their own individual food safety practices more, rather than the practices of other actors along the chain. Veterinary and public health staff emphasized the gap between regulations and food safety practices. Education and training on food safety risks and proper handling are priorities, along with integrated and intensive efforts to improve food safety among pork value chain actors.

  18. Strengthening Health Systems Governance in Latin American ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    This project seeks to improve the governance of health systems by designing and ... of the data (locally elected officials, health authorities, civil society groups), the ... In partnership with UNESCO's Organization for Women in Science for the ...

  19. Governance for Equity in Health Systems

    International Development Research Centre (IDRC) Digital Library (Canada)

    GEHS

    allocation, and power distribution in health systems are addressed to improve health ... development of a knowledge base on innovative and rigorous research ..... The Public Sector Anti-retroviral Treatment in Free State – Phase II; and Impact ...

  20. Participatory Action Research in Health Systems: Empowering ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2014-12-02

    Dec 2, 2014 ... Home · Resources · Publications ... A new publication, Participatory Action Research in Health Systems: a methods ... organizations, most African countries adopted direct payment for health services as the primary means.

  1. Fourth Global Health Systems Research Symposium features ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2017-01-13

    Jan 13, 2017 ... Home · Resources · Publications ... These solutions touch on diverse aspects of health systems, ... Read more on how IDRC is helping increase equitable access to health services for the poor in Mali and Burkina Faso.

  2. An Actor's Approach to Management Conceptual framework and company practices

    DEFF Research Database (Denmark)

    of Contents Foreword: Actor-based managemet - long-term and sustainable management (Bo Prangsgaard) Chapter 1. Introduction (Morten Jakobsen, Inga-Lill Johansson & Hanne Nørreklit) Chapter 2. Actors and reality: a conceptual framework for creative governance (Lennart Nørreklit) Chapter 3. An actor...

  3. Co-evolution of social networks and continuous actor attributes

    NARCIS (Netherlands)

    Niezink, Nynke M.D.; Snijders, Tom A.B.

    2017-01-01

    Social networks and the attributes of the actors in these networks are not static; they may develop interdependently over time. The stochastic actor-oriented model allows for statistical inference on the mechanisms driving this co-evolution process. In earlier versions of this model, dynamic actor

  4. Development prospects of health and reform of the fiscal system in bosnia and herzegovina.

    Science.gov (United States)

    Salihbasic, Sehzada

    2011-01-01

    The functions of the health system, according to the key objectives and relationships within the sub-systems that are available to the policy makers and managers in the Health Care system in Bosnia and Herzegovina - B&H, have been elaborated in detail, with the analytical overview of relevant indicators, thus confirming the limitations of the health promotion in B&H. The ability to overcome the expressed problems is in the startup of process for structural adjustment of the health sector, reform of the health care system and its financing. The reform in health system implies fundamental changes that need to take place, in B&H, as a state in health policy and institutions in the health care system, in order to improve the functioning of health systems with the aim of ensuring better health of the population. Reform implies the existence of documents with clearly formulated health policy objectives, for which the state stands, and for which a consensus was reached on the national level with all key actors in the political structure: public promotion of the basic principles for carrying out the reform, its implementation within a reasonable time frame, the corresponding effects for providers and customer satisfaction, as well as improving health services' efficacy (i.e. micro and macro) and the quality of healthcare. In this article, we elaborated the criteria for the classification of health systems, whereby the scientifically-based and empirical analysis is conducted on the health system in B&H and elaborated the key levers of the system. Leveraged organizational arrangements relating to the economic and political environment, organization and management functions, in connection with the services of finance, funds, customers and service providers, from which it follows the framework of state legislation related to health policy and health institutions at the state level are responsible for finance, planning, the organization, payment, regulation and conduct. If we

  5. Systems Biology and Health Systems Complexity in;

    NARCIS (Netherlands)

    Donald Combs, C.; Barham, S.R.; Sloot, P.M.A.

    2016-01-01

    Systems biology addresses interactions in biological systems at different scales of biological organization, from the molecular to the cellular, organ, organism, societal, and ecosystem levels. This chapter expands on the concept of systems biology, explores its implications for individual patients

  6. Health, Health Care, and Systems Science: Emerging Paradigm.

    Science.gov (United States)

    Janecka, Ivo

    2017-02-15

    Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public's health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite of

  7. An Interconnection of Armed Conflict and Health Service system in Rolpa District of Nepal

    Directory of Open Access Journals (Sweden)

    Sachin Kumar Ghimire

    2009-08-01

    Full Text Available The health service system is the part of the political system. Likewise, political systems should be an integral part of the health system. Contrary to this, local political tussle, national level power conflicts, long-term civil war, and crises in the bureaucracy have led to the continuous ignorance of people’s health issues in Rolpa. War is always detrimental for people's health, health service system and social well-being of the population. The chronic condition of exclusion prevalent in large section of the society is the “favorable” fertile ground to capitalize the expectations toward inclusive and healthy condition in Rolpa. The process of capitalizing such historical exclusion in the name of “revolution” gives rise to new sects of political actors. However, rising expectations and aspirations toward “equitable society” have been resulting in severe frustrations because no significant changes have been done to address the general living conditions of people. The continuous rise and fall of expectations after all lead to infinitive journey of producing ill health that could be extremely detrimental to people's expectation, even to live a normal life as a human.

  8. A system of health accounts 2011

    National Research Council Canada - National Science Library

    2011-01-01

    .... As demands for information increase and more countries implement and institutionalize health accounts according to the system, the data produced are expected to be more comparable, more detailed...

  9. [The national health system in Peru].

    Science.gov (United States)

    Sánchez-Moreno, Francisco

    2014-01-01

    In 1975, a group of professionals in Peru who were experts on national health systems began a process that led the country to be the first in South America to initiate a modern organization of the health system. This pioneering development meant that the creation of the National Health Services System [in Peru] in 1978 occurred before the health system reforms in Chile (1980), Brazil (1990), Colombia (1993), and Ecuador (2008). This encouraging start has had permanent reformist fluctuations since then, with negative development because of the lack of a State policy. Current features of the Peruvian system are inefficient performance, discontinuity, and lack of assessment, which creates a major setback in comparison with other health systems in America. In the 21st century, significant technical efforts have been missed to modernize the system and its functions. The future is worrying and the role of new generations will be decisive.

  10. Understanding the complex relationships among actors involved in the implementation of public-private mix (PPM) for TB control in India, using social theory.

    Science.gov (United States)

    Salve, Solomon; Harris, Kristine; Sheikh, Kabir; Porter, John D H

    2018-06-07

    Public Private Partnerships (PPP) are increasingly utilized as a public health strategy for strengthening health systems and have become a core component for the delivery of TB control services in India, as promoted through national policy. However, partnerships are complex systems that rely on relationships between a myriad of different actors with divergent agendas and backgrounds. Relationship is a crucial element of governance, and relationship building an important aspect of partnerships. To understand PPPs a multi-disciplinary perspective that draws on insights from social theory is needed. This paper demonstrates how social theory can aid the understanding of the complex relationships of actors involved in implementation of Public-Private Mix (PPM)-TB policy in India. Ethnographic research was conducted within a district in a Southern state of India over a 14 month period, combining participant observations, informal interactions and in-depth interviews with a wide range of respondents across public, private and non-government organisation (NGO) sectors. Drawing on the theoretical insights from Bourdieu's "theory of practice" this study explores the relationships between the different actors. The study found that programme managers, frontline TB workers, NGOs, and private practitioners all had a crucial role to play in TB partnerships. They were widely regarded as valued contributors with distinct social skills and capabilities within their organizations and professions. However, their potential contributions towards programme implementation tended to be unrecognized both at the top and bottom of the policy implementation chain. These actors constantly struggled for recognition and used different mechanisms to position themselves alongside other actors within the programme that further complicated the relationships between different actors. This paper demonstrates that applying social theory can enable a better understanding of the complex relationship

  11. Neoliberalism and political actors in contemporary Argentina

    Directory of Open Access Journals (Sweden)

    Juan Manuel Reynares

    2017-11-01

    Full Text Available In this paper we set out a critical reading of the literature on political neoliberal actors in Argentina. We consider that the concentration of these studies in the national level has to do with a definition of neoliberalism as a set of economical and structural macro politics. We propose to define neoliberalism as a technology of government that intends to hegemonize an “enterprise form” in different social spheres, articulating a symbolical framework in a contingent and contentious way. This insight allows analyzing neoliberal identification processes as heterogeneous trajectories with diverse geographic and temporal scopes.

  12. Health system vision of iran in 2025.

    Science.gov (United States)

    Rostamigooran, N; Esmailzadeh, H; Rajabi, F; Majdzadeh, R; Larijani, B; Dastgerdi, M Vahid

    2013-01-01

    Vast changes in disease features and risk factors and influence of demographic, economical, and social trends on health system, makes formulating a long term evolutionary plan, unavoidable. In this regard, to determine health system vision in a long term horizon is a primary stage. After narrative and purposeful review of documentaries, major themes of vision statement were determined and its context was organized in a work group consist of selected managers and experts of health system. Final content of the statement was prepared after several sessions of group discussions and receiving ideas of policy makers and experts of health system. Vision statement in evolutionary plan of health system is considered to be :"a progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region(1) and with the regarding to health in all policies, accountability and innovation". An explanatory context was compiled either to create a complete image of the vision. Social values and leaders' strategic goals, and also main orientations are generally mentioned in vision statement. In this statement prosperity and justice are considered as major values and ideals in society of Iran; development and excellence in the region as leaders' strategic goals; and also considering efficiency and equality, health in all policies, and accountability and innovation as main orientations of health system.

  13. Embedded Sensor Systems for Health - A Step Towards Personalized Health.

    Science.gov (United States)

    Lindén, Maria; Björkman, Mats

    2018-01-01

    The demography is changing towards older people, and the challenge to provide an appropriate care is well known. Sensor systems, combined with IT solutions are recognized as one of the major tools to handle this situation. Embedded Sensor Systems for Health (ESS-H) is a research profile at Mälardalen University in Sweden, focusing on embedded sensor systems for health technology applications. The research addresses several important issues: to provide sensor systems for health monitoring at home, to provide sensor systems for health monitoring at work, to provide safe and secure infrastructure and software testing methods for physiological data management. The user perspective is important in order to solve real problems and to develop systems that are easy and intuitive to use. One of the overall aims is to enable health trend monitoring in home environments, thus being able to detect early deterioration of a patient. Sensor systems, signal processing algorithms, and decision support algorithms have been developed. Work on development of safe and secure infrastructure and software testing methods are important for an embedded sensor system aimed for health monitoring, both in home and in work applications. Patient data must be sent and received in a safe and secure manner, also fulfilling the integrity criteria.

  14. Advancing the application of systems thinking in health: sustainability evaluation as learning and sense-making in a complex urban health system in Northern Bangladesh.

    Science.gov (United States)

    Sarriot, Eric G; Kouletio, Michelle; Jahan, Dr Shamim; Rasul, Izaz; Musha, Akm

    2014-08-26

    Starting in 1999, Concern Worldwide Inc. (Concern) worked with two Bangladeshi municipal health departments to support delivery of maternal and child health preventive services. A mid-term evaluation identified sustainability challenges. Concern relied on systems thinking implicitly to re-prioritize sustainability, but stakeholders also required a method, an explicit set of processes, to guide their decisions and choices during and after the project. Concern chose the Sustainability Framework method to generate creative thinking from stakeholders, create a common vision, and monitor progress. The Framework is based on participatory and iterative steps: defining (mapping) the local system and articulating a long-term vision, describing scenarios for achieving the vision, defining the elements of the model, and selecting corresponding indicators, setting and executing an assessment plan,, and repeated stakeholder engagement in analysis and decisions . Formal assessments took place up to 5 years post-project (2009). Strategic choices for the project were guided by articulating a collective vision for sustainable health, mapping the system of actors required to effect and sustain change, and defining different components of analysis. Municipal authorities oriented health teams toward equity-oriented service delivery efforts, strengthening of the functionality of Ward Health Committees, resource leveraging between municipalities and the Ministry of Health, and mitigation of contextual risks. Regular reference to a vision (and set of metrics (population health, organizational and community capacity) mitigated political factors. Key structures and processes were maintained following elections and political changes. Post-project achievements included the maintenance or improvement 5 years post-project (2009) in 9 of the 11 health indicator gains realized during the project (1999-2004). Some elements of performance and capacity weakened, but reductions in the equity gap

  15. Action learning for health system governance: the reward and challenge of co-production.

    Science.gov (United States)

    Lehmann, Uta; Gilson, Lucy

    2015-10-01

    Health policy and systems research (HPSR) is centrally concerned with people, their relationships and the actions and practices they can implement towards better health systems. These concerns suggest that HPS researchers must work in direct engagement with the practitioners and practice central to the inquiry, acknowledging their tacit knowledge and drawing it into generating new insights into health system functioning. Social science perspectives are of particular importance in this field because health policies and health systems are themselves social and political constructs. However, how can social science methodologies such as action research and narrative and appreciative enquiry enable such research, and how can methodologies from different disciplines be woven together to construct and make meaning of evidence for 'this' field? This article seeks to present 'methodological musings' on these points, to prompt wider discussion on the practice of HPSR. It draws on one long-term collaborative action learning research project being undertaken in Cape Town, South Africa. The District Innovation and Action Learning for Health System Development project is an action research partnership between two South African academic institutions and two health authorities focused, ultimately, on strengthening governance in primary health care.Drawing on this experience, the article considers three interrelated issues: The diversity and complexities of practitioner and research actors involved in co-producing HPSR; The nature of co-production and the importance of providing space to grapple across different systems of meaning;The character of evidence and data in co-production. There is much to be learnt from research traditions outside the health sector, but HPSR must work out its own practices--through collaboration and innovation among researchers and practitioners. In this article, we provide one set of experiences to prompt wider reflection and stimulate engagement on the

  16. Health system challenges in organizing quality diabetes care for urban poor in South India.

    Science.gov (United States)

    Bhojani, Upendra; Devedasan, Narayanan; Mishra, Arima; De Henauw, Stefaan; Kolsteren, Patrick; Criel, Bart

    2014-01-01

    Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions.

  17. Health system challenges in organizing quality diabetes care for urban poor in South India.

    Directory of Open Access Journals (Sweden)

    Upendra Bhojani

    Full Text Available BACKGROUND: Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. METHODS: We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. RESULT: There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. CONCLUSIONS: Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes

  18. Building health research systems to achieve better health

    Directory of Open Access Journals (Sweden)

    González Block Miguel

    2006-11-01

    Full Text Available Abstract Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics

  19. Building National Health Research Information Systems (COHRED ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Building National Health Research Information Systems (COHRED). This grant will allow the Council on Health Research for Development (COHRED) to create, host and maintain a web-based resource on national health research in low- and middle-income countries in partnership with institutions in the South. Called ...

  20. Nociones del conflicto en actores escolares

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Valderrama H

    2001-10-01

    Full Text Available Este artículo busca contribuir a la reflexión sobre la problemática del conflicto escolar a partir de algunas nociones que ciertos actores escolares tienen sobre el mismo, sus manifestaciones, sus causas u orígenes y las maneras como afirman se resuelve en sus instituciones. Desde una perspectiva que pretende inscribirse en el campo de la comunicación-educación, se describe la heterogeneidad de las posturas manifestadas por estudiantes, docentes y directivos y se intentan comprender éstas a partir de algunos postulados teóricos planteados por la sociología del conflicto y la pedagogía crítica.This essay contributes to an ongoing debate on the problematic of school conflict, working from certain concepts that some of the actors in schools have about conflict, its manifestations, causes or origins, and the manners in which they manifest that they are resolved. From a perspective that wants to inscribe itself in the field of communication-education, it describes the heterogeneity of the different views put forward by students, teaches, and school directors, and searches to understand these based on certain theoretical postulates derived from the fields of sociology of conflict and critical pedagogy.

  1. The State Public Health Laboratory System.

    Science.gov (United States)

    Inhorn, Stanley L; Astles, J Rex; Gradus, Stephen; Malmberg, Veronica; Snippes, Paula M; Wilcke, Burton W; White, Vanessa A

    2010-01-01

    This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance. To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided.

  2. Mental health service delivery following health system reform in Colombia.

    Science.gov (United States)

    Romero-González, Mauricio; González, Gerardo; Rosenheck, Robert A

    2003-12-01

    In 1993, Colombia underwent an ambitious and comprehensive process of health system reform based on managed competition and structured pluralism, but did not include coverage for mental health services. In this study, we sought to evaluate the impact of the reform on access to mental health services and whether there were changes in the pattern of mental health service delivery during the period after the reform. Changes in national economic indicators and in measures of mental health and non-mental health service delivery for the years 1987 and 1997 were compared. Data were obtained from the National Administrative Department of Statistics of Colombia (DANE), the Department of National Planning and Ministry of the Treasury of Colombia, and from national official reports of mental health and non-mental health service delivery from the Ministry of Health of Colombia for the same years. While population-adjusted access to mental health outpatient services declined by -2.7% (-11.2% among women and +5.8% among men), access to general medical outpatient services increased dramatically by 46%. In-patient admissions showed smaller differences, with a 7% increase in mental health admissions, as compared to 22.5% increase in general medical admissions. The health reform in Colombia imposed competition across all health institutions with the intention of encouraging efficiency and financial autonomy. However, the challenge of institutional survival appears to have fallen heavily on mental health care institutions that were also expected to participate in managed competition, but that were at a serious disadvantage because their services were excluded from the compulsory standardized package of health benefits. While the Colombian health care reform intended to close the gap between those who had and those who did not have access to health services, it appears to have failed to address access to specialized mental health services, although it does seem to have promoted a

  3. Health Systems Sustainability and Rare Diseases.

    Science.gov (United States)

    Ferrelli, Rita Maria; De Santis, Marta; Egle Gentile, Amalia; Taruscio, Domenica

    2017-01-01

    The paper is addressing aspects of health system sustainability for rare diseases in relation to the current economic crisis and equity concerns. It takes into account the results of the narrative review carried out in the framework of the Joint Action for Rare Diseases (Joint RD-Action) "Promoting Implementation of Recommendations on Policy, Information and Data for Rare Diseases", that identified networks as key factors for health systems sustainability for rare diseases. The legal framework of European Reference Networks and their added value is also presented. Networks play a relevant role for health systems sustainability, since they are based upon, pay special attention to and can intervene on health systems knowledge development, partnership, organizational structure, resources, leadership and governance. Moreover, sustainability of health systems can not be separated from the analysis of the context and the action on it, including fiscal equity. As a result of the financial crisis of 2008, cuts of public health-care budgets jeopardized health equity, since the least wealthy suffered from the greatest health effects. Moreover, austerity policies affected economic growth much more adversely than previously believed. Therefore, reducing public health expenditure not only is going to jeopardise citizens' health, but also to hamper fair and sustainable development.

  4. Health policy and systems research agendas in developing countries

    Directory of Open Access Journals (Sweden)

    Gonzalez-Block Miguel A

    2004-08-01

    "Sector analysis", followed by "Disease burden" and "Management and organization". Categories at the bottom of this ranking are "Equity", "Policy process", "Economic policy and health" and "Information systems". "Disease burden" is more often funded than other topics for which there is more demand or perceived priority. Analysis suggests few although important differences across priorities, demand for funding and actual project funding. The donors' agenda coincides most with the ranking of research topics overall. Ranking across country income groups shows important differences. Topics that gain prominence in low income countries are "Disease burden" and "Accessibility". In lower middle income countries "Insurance" gains prominence. In upper middle income countries "Decentralization/local health systems", "Equity" and "Policy process" are more prominent. "Program evaluation" is the most consistently ranked topic across income regions, showing a neutral influence by donors, governments or researchers. Conclusions The framework proposed offers a basis to identify and contrast research needs, projects and products at the international level and to identify the actor agendas and their influence. Research gaps are suggested when comparing topic ranking against the challenges to health system strengthening and scaling up of disease control programs. Differences across per capita income groups suggests the need for differentiated priority setting mechanisms guiding international support. Data suggests that stakeholders have different agendas, and that donors predominate in determining the research portfolio. High-level consensus building at the national and international levels is necessary to ensure that the diverse agendas play a complementary role in support of health system objectives. The Ministerial Summit for Health Research to be held in Mexico in November 2004 should be an opportunity to analyze further data and to commit funding for priorities identified through

  5. E-health, health systems and social innovation

    DEFF Research Database (Denmark)

    Brem, Alexander; Sliwa, Sophie Isabel; Agarwal, Nivedita

    2017-01-01

    This paper explores telecare as one of the practical applications in the field of e-health. Using 11 expert interviews the study evaluates development of cross-national analogies between the different institutional contexts of health systems in Germany, Austria, and Denmark. Telecare is treated a...... to be driving socially innovative solutions. Implications for research and practice, as well as future research directions, are elaborated....... as a set of ideas regarding future processes in health and home care services, involving technological solutions, starting to change stakeholders' behaviour, work practices, and social roles. A system-centric framework is proposed to evaluate the interdependencies between telecare, the changing...

  6. A systemic integrative framework to describe comprehensively a swine health system, Flanders as an example.

    Science.gov (United States)

    Rojo-Gimeno, Cristina; Dewulf, Jeroen; Maes, Dominiek; Wauters, Erwin

    2018-06-01

    A well-functioning swine health system is crucial to ensure a sustainable pig production. Yet, little attention has been paid to understand it. The objective of this study was to unravel the complexity of a swine health system by using a systems-thinking approach for the case of Flanders (Northern part of Belgium). To that end, qualitative interviews were held with 33 relevant stakeholders. A hybrid thematic analysis was conducted which consisted of two phases. First, an inductive thematic analysis was conducted and second, the resulting themes were classified into the building blocks of a systemic framework. This framework combined a structural and a functional analysis that allowed to identify the key actors and their functions. Additionally, a transformational analysis was performed to evaluate how structures and the entire swine health system enable or disable functions. Findings revealed that the Flemish swine health system presents several merits such as the synchronization of policies and sector's agreements to reduce the antimicrobial use in the pig sector and the presence of a rich network of universities and research institutes that contribute to the education of health professionals. Nevertheless, several systemic failures were observed at different levels such as the lack of a good professional body representing the swine veterinarians, the tradition that veterinary advice is provided for 'free' by feed mill companies, and the shortage of reliable farm productivity data. Both latter failures may hinder swine practitioners to provide integrative advice. While few veterinarians are remunerated per hour or per visit by farmers, the most common business model used by veterinarians is largely based on the sale of medicines. Thus, veterinarians encounter often a conflict of interest when advising on preventive vaccinations and, in turn, farmers distrust their advice. On a positive note, alternatives to the traditional business model were suggested by both

  7. United States of America: health system review.

    Science.gov (United States)

    Rice, Thomas; Rosenau, Pauline; Unruh, Lynn Y; Barnes, Andrew J; Saltman, Richard B; van Ginneken, Ewout

    2013-01-01

    This analysis of the United States health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The US health system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditure levels per person far exceeding all other countries, poor measures on many objective and subjective measures of quality and outcomes, an unequal distribution of resources and outcomes across the country and among different population groups, and lagging efforts to introduce health information technology. It is difficult to determine the extent to which deficiencies are health-system related, though it seems that at least some of the problems are a result of poor access to care. Because of the adoption of the Affordable Care Act in 2010, the United States is facing a period of enormous potential change. Improving coverage is a central aim, envisaged through subsidies for the uninsured to purchase private insurance, expanded eligibility for Medicaid (in some states) and greater protection for insured persons. Furthermore, primary care and public health receive increased funding, and quality and expenditures are addressed through a range of measures. Whether the ACA will indeed be effective in addressing the challenges identified above can only be determined over time. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  8. Primary health care and public health: foundations of universal health systems.

    Science.gov (United States)

    White, Franklin

    2015-01-01

    The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. © 2015 S. Karger AG, Basel.

  9. Technology, conflict early warning systems, public health, and human rights.

    Science.gov (United States)

    Pham, Phuong N; Vinck, Patrick

    2012-12-15

    Public health and conflict early warning are evolving rapidly in response to technology changes for the gathering, management, analysis and communication of data. It is expected that these changes will provide an unprecedented ability to monitor, detect, and respond to crises. One of the potentially most profound and lasting expected change affects the roles of the various actors in providing and sharing information and in responding to early warning. Communities and civil society actors have the opportunity to be empowered as a source of information, analysis, and response, while the role of traditional actors shifts toward supporting those communities and building resilience. However, by creating new roles, relationships, and responsibilities, technology changes raise major concerns and ethical challenges for practitioners, pressing the need for practical guidelines and actionable recommendations in line with existing ethical principles. Copyright © 2012 Pham and Vinck. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

  10. [The French health care funding system for research and innovation in oncology].

    Science.gov (United States)

    Wiernik, Harvey; Katz, Gregory; Coulonjou, Hélène; Salagnac, André; Kletz, Frédéric; Thariat, Juliette

    2018-06-01

    This article provides an overview of the French health system with respect to allocation of public resources to hospitals, to encourage research and innovation, particularly in the field of oncology. It is explained in a historical, economic and scientific perspective. Important structural and conceptual reforms (T2A, HPST law, etc.) have been carried out. These have significantly impacted the way public funding is allocated. Funding of innovation and research has been modified into a more incentive logic, aimed at strengthening competitiveness between all health care actors. The funding allocation system has evolved towards a more ubiquitous redistribution, including non-academic and private institutions. The baseline endowment includes indicators relating to scientific publications (60% of the endowment), teaching (25%) and clinical trials (15%). Research funding is then redistributed by regional health agencies, and used in health care institutions at the discretion of the directorates. Other funding sources such as calls for grants, funding for mobile research centers and teams, tumor banks and temporary user licenses are also part of the funding by the French Ministry of health. Changes in the health research funding system have an incentive purpose. They have significantly modified the global healthcare landscape. Feedback on these changes will be necessary to assess the success of the reinforcement of the dynamics of research and innovation. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  11. Reforming the health care system: implications for health care marketers.

    Science.gov (United States)

    Petrochuk, M A; Javalgi, R G

    1996-01-01

    Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

  12. Health system strengthening in Myanmar during political reforms: perspectives from international agencies.

    Science.gov (United States)

    Risso-Gill, Isabelle; McKee, Martin; Coker, Richard; Piot, Peter; Legido-Quigley, Helena

    2014-07-01

    Myanmar has undergone a remarkable political transformation in the last 2 years, with its leadership voluntarily transitioning from an isolated military regime to a quasi-civilian government intent on re-engaging with the international community. Decades of underinvestment have left the country underdeveloped with a fragile health system and poor health outcomes. International aid agencies have found engagement with the Myanmar government difficult but this is changing rapidly and it is opportune to consider how Myanmar can engage with the global health system strengthening (HSS) agenda. Nineteen semi-structured, face-to-face interviews were conducted with representatives from international agencies working in Myanmar to capture their perspectives on HSS following political reform. They explored their perceptions of HSS and the opportunities for implementation. Participants reported challenges in engaging with government, reflecting the disharmony between actors, economic sanctions and barriers to service delivery due to health system weaknesses and bureaucracy. Weaknesses included human resources, data and medical products/infrastructure and logistical challenges. Agencies had mixed views of health system finance and governance, identifying problems and also some positive aspects. There is little consensus on how HSS should be approached in Myanmar, but much interest in collaborating to achieve it. Despite myriad challenges and concerns, participants were generally positive about the recent political changes, and remain optimistic as they engage in HSS activities with the government.

  13. Inside the Actors' Studio: Exploring Dietetics Education Practices through Dialogical Inquiry

    Science.gov (United States)

    Fox, Ann L.; Gingras, Jacqui

    2012-01-01

    Two colleagues, Ann and Jacqui, came together, within the safety of an imagined actors' studio, to explore the challenges that Ann faced in planning a new graduate program in public health nutrition. They met before, during, and after program implementation to discuss Ann's experiences, and audio-taped and transcribed the discussions. When all…

  14. Health record systems that meet clinical needs

    Directory of Open Access Journals (Sweden)

    Gabriella Negrini

    2012-10-01

    Full Text Available Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.

  15. Oleotourism: Local Actors for Local Tourism Development

    Directory of Open Access Journals (Sweden)

    Marco Tregua

    2018-05-01

    Full Text Available Olive oil consumption has grown substantially in recent years, due in part to the fact that olive oil is healthy. Much of the global olive oil production comes from the rural areas of Jaén in southern Spain. Surrounding this industry, services such as oleotourism are increasing. This paper aims to identify the key elements supporting the development of oleotourism. After a preliminary exploratory analysis of the existing data, a qualitative analysis was performed with actors directly involved in the industry in Jaén. The results helped us define the level of the stakeholders’ involvement and the sustainability, the opportunities, and the constraints affecting oleotourism in this area. The practical implications of this investigation can be useful for governing agencies, local firms, and the tourism industry in support of oleotourism development.

  16. Lone-actor Terrorism and Impulsivity.

    Science.gov (United States)

    Meloy, J Reid; Pollard, Jeffrey W

    2017-11-01

    In some recent cases of lone-actor terrorism, there is evidence the subject acted impulsively, often in response to a triggering event which contained a loss and humiliation. Evidence suggests the subjects acted precipitously, despite planning and preparation carried out in the preceding weeks or months, and their attacks failed to include the often considerable preparation that had been done. The pathway became a runway. The authors recommend the traditional assessment of impulsivity in persons of concern for lone acts of terrorism, as well as other proximal warning behaviors for targeted violence. Both indirect and direct assessment guidelines are proposed, with an emphasis upon self-report, psychological testing, collateral data gathering, and historical records. © 2017 American Academy of Forensic Sciences.

  17. The Corporation as a Political Actor

    DEFF Research Database (Denmark)

    Rasche, Andreas

    2015-01-01

    . On the other hand, European scholars have recently promoted an understanding of corporate social responsibility (CSR) emphasizing that firms often assume a political role because they increasingly provide public goods and become involved in multi-actor governance processes. This article contrasts both......This article distinguishes two approaches to study the political role of corporations. On the one hand, North American scholars have primarily understood the link between business and politics through the lens of corporate political activity (CPA) looking at how firms influence government policy...... approaches and suggests that differences in the way the political role of corporations are understood can at least, in part, be explained by the distinct nature of European/North American management scholarship as well as by the political environment in both regions. It is also suggested that both...

  18. Welcome to health information science and systems.

    Science.gov (United States)

    Zhang, Yanchun

    2013-01-01

    Health Information Science and Systems is an exciting, new, multidisciplinary journal that aims to use technologies in computer science to assist in disease diagnoses, treatment, prediction and monitoring through the modeling, design, development, visualization, integration and management of health related information. These computer-science technologies include such as information systems, web technologies, data mining, image processing, user interaction and interface, sensors and wireless networking and are applicable to a wide range of health related information including medical data, biomedical data, bioinformatics data, public health data.

  19. Environmental health risk assessment: Energy systems

    International Nuclear Information System (INIS)

    Krewski, D.; Somers, E.; Winthrop, S.O.

    1984-01-01

    Most industrialized nations have come to rely on a variety of systems for energy production, both of a conventional and non-conventional nature. In the paper, the spectrum of energy systems currently in use in Canada is outlined along with their potential health risks. Several examples of environmental health studies involving both outdoor and indoor air pollution related to energy production in Canada are reported. The limitations of current technologies for assessing health risks are discussed and possible approaches to managing energy related health risks are indicated. (author)

  20. Health care financing and the sustainability of health systems.

    Science.gov (United States)

    Liaropoulos, Lycourgos; Goranitis, Ilias

    2015-09-15

    The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.

  1. Health system's barriers hindering implementation of public-private partnership at the district level: a case study of partnership for improved reproductive and child health services provision in Tanzania.

    Science.gov (United States)

    Kamugumya, Denice; Olivier, Jill

    2016-10-21

    Public-private partnership (PPP) has been suggested as a tool to assist governments in lower to middle income countries fulfil their responsibilities in the efficient delivery of health services. In Tanzania, although the idea of PPP has existed for many years in the health sector, there has been limited coordination, especially at a district level - which has contributed to limited health gains or systems strengthening obviously seen as a result of PPP. This case study was conducted in the Bagamoyo district of Tanzania, and employed in-depth interviews, document reviews, and observations methods. A stakeholder analysis was conducted to understand power distribution and the interests of local actors to engage non-state actors. In total 30 in-depth interviews were conducted with key informants that were identified from a stakeholder mapping activity. The initial data analysis guided further data collection in an iterative process. The provision of Reproductive and Child Health Services was used as a context. This study draws on the decision-space framework. Study findings reveal several forms of informal partnerships, and the untapped potential of non-state actors. Lack of formal contractual agreements with private providers including facilities that receive subsidies from the government is argued to contribute to inappropriate distribution of risk and reward leading to moral hazards. Furthermore, findings highlight weak capacity of governing bodies to exercise oversight and sanctions, which is acerbated by weak accountability linkages and power differences. Disempowered Council Health Services Board, in relation to engaging non-state actors, is shown to impede PPP initiatives. Effective PPP policy implementation at a local level depends on the capacity of local government officials to make choices that would embrace relational elements dynamics in strategic plans. Orientation towards collaborative efforts that create value and enable its distribution is argued to

  2. New Reforms to the Health System

    OpenAIRE

    Tran Dai, Candice; Duchâtel, Mathieu

    2012-01-01

    Based on:– Li Ling, “Successful reform of the health system hangs on two key elements,” Zhongguo jingyingbao (China Management News), 18 April 2009.– Li Hongmei, Li Xiaohong, Wang Junping, “Ten experts comment on the new reform of the health system: Providing better and cheaper access to medical care,” Renmin ribao (People’s Daily), 15 April 2009.– Yao Qi, “The new reform of the health system must first and foremost compensate for the shortcomings in the local hospitals,” Yangcheng wanbao (Ya...

  3. Qualitative analysis of governance trends after health system reforms in Latin America: lessons from Mexico.

    Science.gov (United States)

    Arredondo, A; Orozco, E; Recaman, A L

    2018-03-01

    Health policies in Latin America are centered on the democratization of health. Since 2003, during the last generation of reforms, health systems in this region have promoted governance strategies for better agreements between governments, institutions, and civil society. In this context, we develop an evaluative research to identify trends and evidence of governance after health care reforms in six regions of Mexico. Evaluative research was developed with a retrospective design based on qualitative analysis. Primary data were obtained from 189 semi-structured interviews with purposively selected health care professionals and key informants. Secondary data were extracted from a selection of 95 official documents on results of the reform project at the national level, national health policies, and lines of action for good governance. Data processing and analysis were performed using ATLAS.ti and PolicyMaker. A list of main strengths and weaknesses is presented as evidence of health system governance. Accountability at the federal level remains prescriptive; in the regions, a system of accountability and transparency in the allocation of resources and in terms of health democratization strategies is still absent. Social protection and decentralization schemes are strategies that have allowed for improvements with a proactive role of users and civil society. Regarding challenges, there are still low levels of governance and difficulties in the effective conduct of programs and reform strategies together with a lack of precision in the rules and roles of the different actors of the health system. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  4. Digital health and the challenge of health systems transformation.

    Science.gov (United States)

    Alami, Hassane; Gagnon, Marie-Pierre; Fortin, Jean-Paul

    2017-01-01

    Information and communication technologies have transformed all sectors of society. The health sector is no exception to this trend. In light of "digital health", we see multiplying numbers of web platforms and mobile health applications, often brought by new unconventional players who produce and offer services in non-linear and non-hierarchal ways, this by multiplying access points to services for people. Some speak of a "uberization" of healthcare. New realities and challenges have emerged from this paradigm, which question the abilities of health systems to cope with new business and economic models, governance of data and regulation. Countries must provide adequate responses so that digital health, based increasingly on disruptive technologies, can benefit for all.

  5. Health for All - Italia, an informative health system

    Directory of Open Access Journals (Sweden)

    Marzia Loghi

    2008-06-01

    Full Text Available

    Background: On ISTAT website the informative system Health for All – Italia is available. It collects indicators on health coming from various sources to make up a basis for constructing an organic and joint framework on the country’s health reality. The system includes more than 4000 indicators about: demographic and socioeconomic context; causes of death; life styles; disease prevention; chronic and infectious diseases; disability; health status and life expectancy; health facilities; hospital discharges by diagnosis; health care resources. The database-related software was developed by the World Health Organization to make it easier for any user to access the information available either as tables, graphs and territorial maps.

    Methods: The system has been built considering data coming from different sources and using, if possible, the same definitions, classifications and desegregations. Time series goes from 1980 to the last year available (which can differ among the different sources. Indicators are calculated by provinces (if possible, regions, big areas and Italy. In order to compare indicators over time and space, standardised rates are calculated, using the same population reference. For each indicator metadata are available to give users additional notes necessary to correctly read and use the data, and publications or internet websites to examine more in-depth the argument.

    Results: Different kind of users find Health for All – Italia very useful for their aims: students, researchers, doctors, socio-sanitary operators, policy makers. Some examples of official reports from public institutions are briefly described in the paper.

    Conclusions: The increasing number of users of Health for All – Italia make necessary the online version and an English version for international comparisons.

  6. The psychosocial work environment and certified occupational health and safety management systems in the public sector – experience from two Danish municipalities

    DEFF Research Database (Denmark)

    Hasle, Peter; Hohnen, Pernille; Helbo, Anne

    2014-01-01

    Certified occupational health and safety management (OHSM) systems are expected to cover the psychosocial work environment. We studied certified OHSM systems implemented in two medium-sized to large Danish municipalities. The cases show that the process of adopting OHSM systems from...... their traditional base in manufacturing to a public sector with a focus on the psychosocial work environment is difficult and complex. The management system seems to help maintaining systematic OHS activities but the actors are still searching for ways to fit the systems to the peculiarities of the psychosocial...

  7. Cognitive systems engineering in health care

    CERN Document Server

    Bisantz, Ann M; Fairbanks, Rollin J

    2014-01-01

    Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...

  8. Framework to Define Structure and Boundaries of Complex Health Intervention Systems: The ALERT Project

    Directory of Open Access Journals (Sweden)

    Elena Boriani

    2017-07-01

    Full Text Available Health intervention systems are complex and subject to multiple variables in different phases of implementation. This constitutes a concrete challenge for the application of translational science in real life. Complex systems as health-oriented interventions call for interdisciplinary approaches with carefully defined system boundaries. Exploring individual components of such systems from different viewpoints gives a wide overview and helps to understand the elements and the relationships that drive actions and consequences within the system. In this study, we present an application and assessment of a framework with focus on systems and system boundaries of interdisciplinary projects. As an example on how to apply our framework, we analyzed ALERT [an integrated sensors and biosensors’ system (BEST aimed at monitoring the quality, health, and traceability of the chain of the bovine milk], a multidisciplinary and interdisciplinary project based on the application of measurable biomarkers at strategic points of the milk chain for improved food security (including safety, human, and ecosystem health (1. In fact, the European food safety framework calls for science-based support to the primary producers’ mandate for legal, scientific, and ethical responsibility in food supply. Because of its multidisciplinary and interdisciplinary approach involving human, animal, and ecosystem health, ALERT can be considered as a One Health project. Within the ALERT context, we identified the need to take into account the main actors, interactions, and relationships of stakeholders to depict a simplified skeleton of the system. The framework can provide elements to highlight how and where to improve the project development when project evaluations are required.

  9. Systemic antioxidants and skin health.

    Science.gov (United States)

    Nguyen, Gloria; Torres, Abel

    2012-09-01

    Most dermatologists agree that antioxidants help fight free radical damage and can help maintain healthy skin. They do so by affecting intracellular signaling pathways involved in skin damage and protecting against photodamage, as well as preventing wrinkles and inflammation. In today's modern world of the rising nutraceutical industry, many people, in addition to applying topical skin care products, turn to supplementation of the nutrients missing in their diets by taking multivitamins or isolated, man-made nutraceuticals, in what is known as the Inside-Out approach to skin care. However, ingestion of large quantities of isolated, fragmented nutrients can be harmful and is a poor representation of the kind of nutrition that can be obtained from whole food sources. In this comprehensive review, it was found that few studies on oral antioxidants benefiting the skin have been done using whole foods, and that the vast majority of current research is focused on the study of compounds in isolation. However, the public stands to benefit greatly if more research were to be devoted toward the impact that physiologic doses of antioxidants (obtained from fruits, vegetables, and whole grains) can have on skin health, and on health in general.

  10. Networked Biomedical System for Ubiquitous Health Monitoring

    Directory of Open Access Journals (Sweden)

    Arjan Durresi

    2008-01-01

    Full Text Available We propose a distributed system that enables global and ubiquitous health monitoring of patients. The biomedical data will be collected by wearable health diagnostic devices, which will include various types of sensors and will be transmitted towards the corresponding Health Monitoring Centers. The permanent medical data of patients will be kept in the corresponding Home Data Bases, while the measured biomedical data will be sent to the Visitor Health Monitor Center and Visitor Data Base that serves the area of present location of the patient. By combining the measured biomedical data and the permanent medical data, Health Medical Centers will be able to coordinate the needed actions and help the local medical teams to make quickly the best decisions that could be crucial for the patient health, and that can reduce the cost of health service.

  11. Big Data: Implications for Health System Pharmacy.

    Science.gov (United States)

    Stokes, Laura B; Rogers, Joseph W; Hertig, John B; Weber, Robert J

    2016-07-01

    Big Data refers to datasets that are so large and complex that traditional methods and hardware for collecting, sharing, and analyzing them are not possible. Big Data that is accurate leads to more confident decision making, improved operational efficiency, and reduced costs. The rapid growth of health care information results in Big Data around health services, treatments, and outcomes, and Big Data can be used to analyze the benefit of health system pharmacy services. The goal of this article is to provide a perspective on how Big Data can be applied to health system pharmacy. It will define Big Data, describe the impact of Big Data on population health, review specific implications of Big Data in health system pharmacy, and describe an approach for pharmacy leaders to effectively use Big Data. A few strategies involved in managing Big Data in health system pharmacy include identifying potential opportunities for Big Data, prioritizing those opportunities, protecting privacy concerns, promoting data transparency, and communicating outcomes. As health care information expands in its content and becomes more integrated, Big Data can enhance the development of patient-centered pharmacy services.

  12. Implementing the learning health care system.

    NARCIS (Netherlands)

    Verheij, R.; Barten, D.J.; Hek, K.; Nielen, M.; Prins, M.; Zwaanswijk, M.; Bakker, D. de

    2014-01-01

    Background: As computerisation of primary care facilities is rapidly increasing, a wealth of data is created in routinely recorded electronic health records (EHRs). This data can be used to create a true learning health care system, in which routinely available data are processed and analysed in

  13. Software for Intelligent System Health Management (ISHM)

    Science.gov (United States)

    Trevino, Luis C.

    2004-01-01

    The slide presentation is a briefing in four areas: overview of health management paradigms; overview of the ARC-Houston Software Engineering Technology Workshop held on April 20-22, 2004; identified technologies relevant to technical themes of intelligent system health management; and the author's thoughts on these topics.

  14. Quality systems in Dutch health care institutions.

    NARCIS (Netherlands)

    Casparie, A.F.; Sluijs, E.M.; Wagner, C.; Bakker, D.H. de

    1997-01-01

    The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire-derived

  15. Revisiting Health System Performance Assessment in Africa

    NARCIS (Netherlands)

    Achoki, Tom

    2016-01-01

    Health systems in Africa have long faced a huge burden of disease, amidst pressing resource constraints. However, despite the constraints, the last three decades have seen the region make progress in tackling some of the most critical health challenges. Notably, many countries have registered

  16. MediCoordination: a practical approach to interoperability in the Swiss health system.

    Science.gov (United States)

    Müller, Henning; Schumacher, Michael; Godel, David; Omar, Abu Khaled; Mooser, Francois; Ding, Sandrine

    2009-01-01

    Interoperability and data exchange between partners in the health sector is seen as one of the important domains that can improve care processes and in the long run also decrease costs of the health care system. Data exchange can assure that the data on the patient are as complete as possible avoiding potential mistreatments, and it can avoid double examinations if the data required are already available. On the other hand, health data is a sensible point for many people and strong protection needs to be implemented to protect patient data against misuse as well as tools to let the patient manage his/her own data. Many countries have eHealth initiatives in preparation or already implemented. However, health data exchange on a large scale still has a fairly long way to go as the political processes for global solutions are often complicated. In the MediCoordination project a pragmatic approach is selected trying to integrate several partners in health care on a regional scale. In parallel with the Swiss eHealth strategy that is currently being elaborated by the Swiss confederation, particularly medium-sized hospitals and external partners are targeted in MediCoordination to implement concrete added-value scenarios of information exchange between hospitals and external medical actors.

  17. Health-system strengthening and tuberculosis control.

    Science.gov (United States)

    Atun, Rifat; Weil, Diana E C; Eang, Mao Tan; Mwakyusa, David

    2010-06-19

    Weak health systems are hindering global efforts for tuberculosis care and control, but little evidence is available on effective interventions to address system bottlenecks. This report examines published evidence, programme reviews, and case studies to identify innovations in system design and tuberculosis control to resolve these bottlenecks. We outline system bottlenecks in relation to governance, financing, supply chain management, human resources, health-information systems, and service delivery; and adverse effects from rapid introduction of suboptimum system designs. This report also documents innovative solutions for disease control and system design. Solutions pursued in individual countries are specific to the nature of the tuberculosis epidemic, the underlying national health system, and the contributors engaged: no one size fits all. Findings from countries, including Bangladesh, Cambodia, India, Tanzania, Thailand, and Vietnam, suggest that advances in disease control and system strengthening are complementary. Tuberculosis care and control are essential elements of health systems, and simultaneous efforts to innovate systems and disease response are mutually reinforcing. Highly varied and context-specific responses to tuberculosis show that solutions need to be documented and compared to develop evidence-based policies and practice. Copyright 2010 Elsevier Ltd. All rights reserved.

  18. Improving mental health systems in Africa

    African Journals Online (AJOL)

    problematic. To comment on mental health systems in Africa, .... be an option for assisting with both de-stigmatization and ... deinstitutionalization with a reduction in both chronic and ... such as the family, societal change, bullying in schools,.

  19. Wearable Health Monitoring Systems, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — The objective of this proposal is to demonstrate the feasibility of producing a wearable health monitoring system for the human body that is functional, comfortable,...

  20. FIXING HEALTH SYSTEMS / Executive Summary (2008 update ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2010-12-14

    Dec 14, 2010 ... FIXING HEALTH SYSTEMS / Executive Summary (2008 update) ... In several cases, specific approaches recommended by the TEHIP team have been acted upon regionally and internationally, including the ... Related articles ...

  1. Wearable Health Monitoring Systems, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — The objective of this proposal is to demonstrate the feasibility of producing a wearable health monitoring system for the human body that is functional, comfortable,...

  2. The military health system's personal health record pilot with Microsoft HealthVault and Google Health.

    Science.gov (United States)

    Do, Nhan V; Barnhill, Rick; Heermann-Do, Kimberly A; Salzman, Keith L; Gimbel, Ronald W

    2011-01-01

    To design, build, implement, and evaluate a personal health record (PHR), tethered to the Military Health System, that leverages Microsoft® HealthVault and Google® Health infrastructure based on user preference. A pilot project was conducted in 2008-2009 at Madigan Army Medical Center in Tacoma, Washington. Our PHR was architected to a flexible platform that incorporated standards-based models of Continuity of Document and Continuity of Care Record to map Department of Defense-sourced health data, via a secure Veterans Administration data broker, to Microsoft® HealthVault and Google® Health based on user preference. The project design and implementation were guided by provider and patient advisory panels with formal user evaluation. The pilot project included 250 beneficiary users. Approximately 73.2% of users were Microsoft® HealthVault, and 81 (32.4%) selected Google® Health as their PHR of preference. Sample evaluation of users reflected 100% (n = 60) satisfied with convenience of record access and 91.7% (n = 55) satisfied with overall functionality of PHR. Key lessons learned related to data-transfer decisions (push vs pull), purposeful delays in reporting sensitive information, understanding and mapping PHR use and clinical workflow, and decisions on information patients may choose to share with their provider. Currently PHRs are being viewed as empowering tools for patient activation. Design and implementation issues (eg, technical, organizational, information security) are substantial and must be thoughtfully approached. Adopting standards into design can enhance the national goal of portability and interoperability.

  3. Multi-actor decision making using mixed reality technologies Urban projects and multi-actor collaboration

    OpenAIRE

    Basile,, Maria; Ozdirlik, Burcu; Terrin,, Jean-Jacques

    2009-01-01

    International audience; This paper is based on the results of an ongoing research project, IPCity, on the application of mixed reality technologies in urban environments. It questions the relevance of traditional language and communication medium such as drawings, perspectives and 3D models in the co-production of urban projects in multi-actor working environments. It then discusses the possible use of “mixed reality technologies” as alternative medium through five workshops organised within ...

  4. Examining the use of health systems and policy research in the health policymaking process in Israel: views of researchers.

    Science.gov (United States)

    Ellen, Moriah E; Lavis, John N; Shemer, Joshua

    2016-09-01

    All too often, health policy and management decisions are made without making use of or consulting with the best available research evidence, which can lead to ineffective and inefficient health systems. One of the main actors that can ensure the use of evidence to inform policymaking is researchers. The objective of this study is to explore Israeli health systems and policy researchers' views and perceptions regarding the role of health systems and policy research (HSPR) in health policymaking and the barriers and facilitators to the use of evidence in the policymaking process. A survey of researchers who have conducted HSPR in Israel was developed. The survey consisted of a demographics section and closed questions, which focused on support both within the researchers' organisations and the broader environment for KTE activities, perceptions on the policymaking process, and the potential influencing factors on the process. The survey was sent to all health systems and policy researchers in Israel from academic institutions, hospital settings, government agencies, the four health insurance funds, and research institutes (n = 107). All responses were analyzed using descriptive statistics. For close-ended questions about level of agreement we combined together the two highest categories (agree or strongly agree) for analysis. Thirty-seven respondents participated in the survey. While many respondents felt that the use of HSPR may help raise awareness on policy issues, the majority of respondents felt that the actual use of HSPR was hindered for many reasons. While facilitators do exist to support the use of research evidence in policymaking, numerous barriers hinder the process such as challenges in government/provider relations, policymakers lacking the expertise for acquiring, assessing, and applying HSPR and priorities in the health system drawing attention away from HSPR. Furthermore, it is perceived by a majority of respondents that the health insurance funds

  5. Design of an mHealth System for Maternal and Children HIV care.

    Science.gov (United States)

    Koesoema, Allya P; Ariani, Arni; Irawan, Yoke S; Soegijoko, Soegijardjo

    2017-07-01

    While progress has been made to slow down its spread and increase uptake of treatment, human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) is still a highly significant health problem for many low- and middle-income countries (LMICs). Specifically, almost half of new HIV patients in Asia Pacific were children. The prevention of mother-to-child transmission faces complex socioeconomic and other problems. With the increasing growth of mobile technologies in LMICs, especially in Asia Pacific, mHealth, the application of mobile technology for health applications, has a significant potential to help alleviate these problems. In this paper, we propose the design of an mHealth System for Maternal and Children HIV care. It includes specialized portals for patients, family/community members, healthcare providers, healthcare referral system, payers and drug supply chain. While each portal is customized towards the needs of a particular actor, such as treatment scheduling and education for patients, and epidemiological data management for healthcare referrals, all the different elements are integrated through a central server to form an integrated system with a secured data exchange environment. This proposed integrative design is aimed to facilitate efficient, timely and coordinated information dissemination, analysis, and care across the healthcare system, and is intended for application in developing countries, especially in the Asia Pacific region.

  6. The chinese health care system

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter Raahave; Yu, Yi

    2011-01-01

    We describe the structure and present situation of the Chinese healthcare system and discuss its primary problems and challenges. We discuss problems with inefficient burden sharing, adverse provider incentives and huge inequities, and seek explanations in the structural features of the Chinese...

  7. A cross-case comparative analysis of international security forces' impacts on health systems in conflict-affected and fragile states.

    Science.gov (United States)

    Bourdeaux, Margaret; Kerry, Vanessa; Haggenmiller, Christian; Nickel, Karlheinz

    2015-01-01

    Destruction of health systems in fragile and conflict-affected states increases civilian mortality. Despite the size, scope, scale and political influence of international security forces intervening in fragile states, little attention has been paid to array of ways they may impact health systems beyond their effects on short-term humanitarian health aid delivery. Using case studies we published on international security forces' impacts on health systems in Haiti, Kosovo, Afghanistan and Libya, we conducted a comparative analysis that examined three questions: What aspects, or building blocks, of health systems did security forces impact across the cases and what was the nature of these impacts? What forums or mechanisms did international security forces use to interact with health system actors? What policies facilitated or hindered security forces from supporting health systems? We found international security forces impacted health system governance, information systems and indigenous health delivery organizations. Positive impacts included bolstering the authority, transparency and capability of health system leadership. Negative impacts included undermining the impartial nature of indigenous health institutions by using health projects to achieve security objectives. Interactions between security and health actors were primarily ad hoc, often to the detriment of health system support efforts. When international security forces were engaged in health system support activities, the most helpful communication and consultative mechanisms to manage their involvement were ones that could address a wide array of problems, were nimble enough to accommodate rapidly changing circumstances, leveraged the power of personal relationships, and were able to address the tensions that arose between security and health system supporting strategies. Policy barriers to international security organizations participating in health system support included lack of mandate, conflicts

  8. Actores sociales y ambitos de construccion de politicas ambientales Social actors and scenarios in the generation of environmental politics

    Directory of Open Access Journals (Sweden)

    Eduardo Gudynas

    2001-06-01

    Full Text Available Se analiza el concepto de "actores claves" en la generación de políticas ambientales. Independientemente de la definición de actor social que se maneje, el asumir la existencia de actores claves ofrece limitaciones conceptuales y prácticas, ya que éstos son coyunturales a cada situación específica. Todos pueden ser actores claves en generar políticas ambientales cumpliendo papeles diferenciales. Como alternativa se utiliza el término de "actores destacados" y se revisan aspectos sobresalientes de varios de ellos en América Latina. Seguidamente se postula que el análisis se debe centrar en los escenarios sociales donde esos actores se pueden manifestar. Se ofrece una distinción preliminar de escenarios que permite integrar a nuevos y viejos movimientos sociales y establecer relaciones de articulación y equivalencia.The concept of "key actors" in the field of environmental politics is analyzed. Beyond the definition of social actor, the assumption of the existence of key actors implies conceptual and practical limitations, as it depends of each specific situation. Everyone could be a key actor under differential roles in the generation of environmental politics. As an alternative, the term "noteworthy actors" is used and a brief review of them in Latin America is presented. The relevant question should address the social scenarios from where these actors can express themselves. A preliminary distinction of scenarios is presented, in which old and new social movements could be integrated and relationships of articulation and equivalence could be established.

  9. The Rights of Private Economic Actors Under the World Trade Organization Agreements in Indonesia

    Directory of Open Access Journals (Sweden)

    Intan Soeparna

    2012-09-01

    Full Text Available Nothing in the Uruguay Round mentions directly about rights of private economic actors. It seems that the relationship to private economic actors (or may be individual does not exist within the WTO Agreements, because as a general rule, private parties are not legal subjects of the international legal order. However, this article will prevail upon this situation, by looking closer at the essence of the WTO Agreements to discern the rights of private economic actors that derive from the WTO. The main question of this article is to what extent then Indonesia is dealing with the rights of private economic actors under the WTO Agreements? The background of this questionis because four years after ratifying the WTO Agreements, Indonesia has been facing what is arguably the most serious multidimensional crisis in 1997, some difficult situations have arisen from the crisis; therefore, the society hesitated to accept the open world trading system. The society seemed look askance to the implementation of the WTO Agreements. But Indonesian Government took major step to reduce the skepticism of society toward liberalization, by readjusting its national laws conform to the WTO Agreements with the intention to support the rights of national economic actors under the WTO Agreements in order to achieve total benefits of the WTO rules.

  10. Improving the use of health data for health system strengthening

    Directory of Open Access Journals (Sweden)

    Tara Nutley

    2013-02-01

    Full Text Available Background: Good quality and timely data from health information systems are the foundation of all health systems. However, too often data sit in reports, on shelves or in databases and are not sufficiently utilised in policy and program development, improvement, strategic planning and advocacy. Without specific interventions aimed at improving the use of data produced by information systems, health systems will never fully be able to meet the needs of the populations they serve. Objective: To employ a logic model to describe a pathway of how specific activities and interventions can strengthen the use of health data in decision making to ultimately strengthen the health system. Design: A logic model was developed to provide a practical strategy for developing, monitoring and evaluating interventions to strengthen the use of data in decision making. The model draws on the collective strengths and similarities of previous work and adds to those previous works by making specific recommendations about interventions and activities that are most proximate to affect the use of data in decision making. The model provides an organizing framework for how interventions and activities work to strengthen the systematic demand, synthesis, review, and use of data. Results: The logic model and guidance are presented to facilitate its widespread use and to enable improved data-informed decision making in program review and planning, advocacy, policy development. Real world examples from the literature support the feasible application of the activities outlined in the model. Conclusions: The logic model provides specific and comprehensive guidance to improve data demand and use. It can be used to design, monitor and evaluate interventions, and to improve demand for, and use of, data in decision making. As more interventions are implemented to improve use of health data, those efforts need to be evaluated.

  11. An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

    Directory of Open Access Journals (Sweden)

    Chan Brian T

    2011-10-01

    Full Text Available Abstract Background Globally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia's experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases. Methods We conducted a historical review of Liberia's post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia's Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia's Health Sector Reform. In this case study, we examine the early reconstruction of Liberia's health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia. Results Six key lessons emerge from this analysis: (i the 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv effective strategies for HIV/AIDS care in other settings should be

  12. Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia

    Science.gov (United States)

    2011-01-01

    Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems. PMID:21539751

  13. Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia

    Directory of Open Access Journals (Sweden)

    Phua Kai Hong

    2011-05-01

    Full Text Available Abstract Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems.

  14. Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia.

    Science.gov (United States)

    Pocock, Nicola S; Phua, Kai Hong

    2011-05-04

    Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems.

  15. Los Entornos Personales de Aprendizaje como estrategia de aprendizaje desde la Teoría del Actor-Red

    OpenAIRE

    Meza Cano, José Manuel; Cejas León, Roberto

    2016-01-01

    Este trabajo pretende visualizar los Entornos Personales de Aprendizaje desde el punto de vista de la Teoría del Actor-Red. En primer lugar, se describen los elementos centrales de la Teoría del Actor-Red, la visión de aprendizaje desde este enfoque, así como el concepto de actante y de simetría generalizada. Posteriormente se exponen los elementos clave de las definiciones sobre Entornos Personales de Aprendizaje y la visión del aprendizaje que defienden, centrada principalmente en el estudi...

  16. Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach

    Directory of Open Access Journals (Sweden)

    Elisabeth Paul

    2018-01-01

    Full Text Available Background Performance-based financing (PBF is often proposed as a way to improve health system performance. In Benin, PBF was launched in 2012 through a World Bank-supported project. The Belgian Development Agency (BTC followed suit through a health system strengthening (HSS project. This paper analyses and draws lessons from the experience of BTC-supported PBF alternative approach – especially with regards to institutional aspects, the role of demand-side actors, ownership, and cost-effectiveness – and explores the mechanisms at stake so as to better understand how the “PBF package” functions and produces effects. Methods An exploratory, theory-driven evaluation approach was adopted. Causal mechanisms through which PBF is hypothesised to impact on results were singled out and explored. This paper stems from the co-authors’ capitalisation of experiences; mixed methods were used to collect, triangulate and analyse information. Results are structured along Witter et al framework. Results Influence of context is strong over PBF in Benin; the policy is donor-driven. BTC did not adopt the World Bank’s mainstream PBF model, but developed an alternative approach in line with its HSS support programme, which is grounded on existing domestic institutions. The main features of this approach are described (decentralised governance, peer review verification, counter-verification entrusted to health service users’ platforms, as well as its adaptive process. PBF has contributed to strengthen various aspects of the health system and led to modest progress in utilisation of health services, but noticeable improvements in healthcare quality. Three mechanisms explaining observed outcomes within the context are described: comprehensive HSS at district level; acting on health workers’ motivation through a complex package of incentives; and increased accountability by reinforcing dialogue with demand-side actors. Cost-effectiveness and

  17. Reusable Rocket Engine Turbopump Health Management System

    Science.gov (United States)

    Surko, Pamela

    1994-01-01

    A health monitoring expert system software architecture has been developed to support condition-based health monitoring of rocket engines. Its first application is in the diagnosis decisions relating to the health of the high pressure oxidizer turbopump (HPOTP) of Space Shuttle Main Engine (SSME). The post test diagnostic system runs off-line, using as input the data recorded from hundreds of sensors, each running typically at rates of 25, 50, or .1 Hz. The system is invoked after a test has been completed, and produces an analysis and an organized graphical presentation of the data with important effects highlighted. The overall expert system architecture has been developed and documented so that expert modules analyzing other line replaceable units may easily be added. The architecture emphasizes modularity, reusability, and open system interfaces so that it may be used to analyze other engines as well.

  18. Environmental health surveillance system; Kankyo hoken surveillance system

    Energy Technology Data Exchange (ETDEWEB)

    Ono, M. [National Inst. for Environmental Studies, Tsukuba (Japan)

    1998-02-01

    The Central Environmental Pollution Prevention Council pointed out the necessity to establish an environmental health surveillance system (hereinafter referred to as System) in its report `on the first type district specified by the Environmental Pollution Caused Health Damages Compensation Act,` issued in 1986. A study team, established in Environment Agency, has been discussing to establish System since 1986. This paper outlines System, and some of the pilot surveillance results. It is not aimed at elucidation of the cause-effect relationships between health and air pollution but at discovery of problems, in which the above relationships in a district population are monitored periodically and continuously from long-term and prospective viewpoints, in order to help take necessary measures in the early stage. System is now collecting the data of the chronic obstructive lung diseases on a nation-wide scale through health examinations of 3-year-old and preschool children and daily air pollution monitoring. 6 refs., 3 figs., 1 tab.

  19. The actors of the photovoltaic sector in France

    International Nuclear Information System (INIS)

    Houot, G.

    2010-01-01

    The author reviews the 192 actors in the French photovoltaic sector, they are classified into 9 categories: 1) the solar plant owner, 2) the developer: he sets projects and his role stops when the project is ready to be sold to an investor, 3) the design office: it leads technical studies and manages the construction works), 4) the installer: he fits the solar panels, 5) the operator of the solar plant, 6) the wholesaler of equipment, 7) the manufacturer of solar panels and photovoltaic systems, 8) the provider or manufacturer of components and materials for the photovoltaic industry, and 9) the provider of specialized services such as insurance, staff training, the follow-up of legal issues... For each company, a brief historical account, the range of activities, the strength of manpower and the turnover are reported. (A.C.)

  20. Digital health and the challenge of health systems transformation

    Science.gov (United States)

    Gagnon, Marie-Pierre; Fortin, Jean-Paul

    2017-01-01

    Information and communication technologies have transformed all sectors of society. The health sector is no exception to this trend. In light of “digital health”, we see multiplying numbers of web platforms and mobile health applications, often brought by new unconventional players who produce and offer services in non-linear and non-hierarchal ways, this by multiplying access points to services for people. Some speak of a “uberization” of healthcare. New realities and challenges have emerged from this paradigm, which question the abilities of health systems to cope with new business and economic models, governance of data and regulation. Countries must provide adequate responses so that digital health, based increasingly on disruptive technologies, can benefit for all. PMID:28894741

  1. Data liquidity in health information systems.

    Science.gov (United States)

    Courtney, Paul K

    2011-01-01

    In 2001, the Institute of Medicine report Crossing the Quality Chasm and the National Committee on Vital and Health Statistics report Information for Health were released, and they provided the context for the development of information systems used to support health-supporting processes. Both had as their goals, implicit or explicit, to ensure the right data are provided to the right person at the right time, which is one definition of "data liquidity." This concept has had some traction in recent years as a shorthand way to express a system property for health information technology, but there is not a well-defined characterization of what properties of a system or of its components give it better or worse data liquidity. This article looks at some recent work that help to identify those properties and perhaps can help to ground the concept with metrics that are assessable.

  2. Health Care Performance Indicators for Health Information Systems.

    Science.gov (United States)

    Hyppönen, Hannele; Ronchi, Elettra; Adler-Milstein, Julia

    2016-01-01

    Health Information Systems (HISs) are expected to have a positive impact on quality and efficiency of health care. Rapid investment in and diffusion of HISs has increased the importance of monitoring the adoption and impacts of them in order to learn from the initiatives, and to provide decision makers evidence on the role of HISs in improving health care. However, reliable and comparable data across initiatives in various countries are rarely available. A four-phase approach is used to compare different HIS indicator methodologies in order to move ahead in defining HIS indicators for monitoring effects of HIS on health care performance. Assessed approaches are strong on different aspects, which provide some opportunities for learning across them but also some challenges. As yet, all of the approaches do not define goals for monitoring formally. Most focus on health care structural and process indicators (HIS availability and intensity of use). However, many approaches are generic in description of HIS functionalities and context as well as their impact mechanisms on health care for HIS benchmarking. The conclusion is that, though structural and process indicators of HIS interventions are prerequisites for monitoring HIS impacts on health care outputs and outcomes, more explicit definition is needed of HIS contexts, goals, functionalities and their impact mechanisms in order to move towards common process and outcome indicators. A bottom-up-approach (participation of users) could improve development and use of context-sensitive HIS indicators.

  3. Health systems around the world - a comparison of existing health system rankings.

    Science.gov (United States)

    Schütte, Stefanie; Acevedo, Paula N Marin; Flahault, Antoine

    2018-06-01

    Existing health systems all over the world are different due to the different combinations of components that can be considered for their establishment. The ranking of health systems has been a focal points for many years especially the issue of performance. In 2000 the World Health Organization (WHO) performed a ranking to compare the Performance of the health system of the member countries. Since then other health system rankings have been performed and it became an issue of public discussion. A point of contention regarding these rankings is the methodology employed by each of them, since no gold standard exists. Therefore, this review focuses on evaluating the methodologies of each existing health system performance ranking to assess their reproducibility and transparency. A search was conducted to identify existing health system rankings, and a questionnaire was developed for the comparison of the methodologies based on the following indicators: (1) General information, (2) Statistical methods, (3) Data (4) Indicators. Overall nine rankings were identified whereas six of them focused rather on the measurement of population health without any financial component and were therefore excluded. Finally, three health system rankings were selected for this review: "Health Systems: Improving Performance" by the WHO, "Mirror, Mirror on the wall: How the Performance of the US Health Care System Compares Internationally" by the Commonwealth Fund and "the Most efficient Health Care" by Bloomberg. After the completion of the comparison of the rankings by giving them scores according to the indicators, the ranking performed the WHO was considered the most complete regarding the ability of reproducibility and transparency of the methodology. This review and comparison could help in establishing consensus in the field of health system research. This may also help giving recommendations for future health rankings and evaluating the current gap in the literature.

  4. Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform.

    Science.gov (United States)

    Guyon, Ak'ingabe; Perreault, Robert

    2016-10-20

    Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health's resources, interventions and outcomes when they need to be celebrated or defended.

  5. Special COP 21 - Stakes and actors

    International Nuclear Information System (INIS)

    Chauveau, Loic; Dupain, Julien; Descamps, Olivier; Blosseville, Thomas; Connors, Anne; Canto, Albane; Robischon, Christian; Boedec, Morgan; Tubiana, Fabian; Bomstein, Dominique

    2015-01-01

    A first set of article comments and discusses the various stakes and challenges of the 21. Conference of Parties (COP 21): the negotiation process which resulted in a synthesis which is to be signed by 95 States in Paris, the elaboration of an Agenda of solutions with the commitment of enterprises and local authorities, the issue of international financing as some promises remained not kept for the support to adaptation of developing countries. A second set of articles addresses the involved actors and their technological or economic challenges: the needed evolution of energy (electricity, heat, gas, fuel) producers away from fossil energies to reduce greenhouse gas emissions, the strategy of the French company Engie in the field of photovoltaic, wind and more generally renewable energies, innovating trends of decentralisation of energy production (offshore wind energy, hydrogen, plasma torch, flexible photovoltaic arrays, the wind tree, the floating wind turbine, new technologies for solar arrays), the perspectives for industrial sectors concerned by energy transition (with the example of Schneider Electric), emerging technologies (oil lamp, new boilers, desalination equipment, storage of wind energy, co-generation), developments and perspectives in the transport sector (example of Renault, new technologies for hybrid propulsion, bio-refineries, reduction of fuel consumption, hybrid aircraft, and heat management in railways) and in the building sector (new standards and applications, new building materials). A last article outlines the threat that climate can be for profitability and the taking of the carbon risk into account by the insurance and financial sectors

  6. Private actor accountability on international regimes

    Directory of Open Access Journals (Sweden)

    Wahyudi Purnomo

    2017-12-01

    Full Text Available Public-Private Partnerships (PPPs have emerged along with the growing role of corporations in global development. One of the largest forms of PPP today is the UN Global Compact. The UN Global Compact involves of companies, NGOs, IGOs and state governments. All of them are trying to realize globalization with a more humanist face with attention to the protection of human rights, environment, labor standards and anti-corruption. Engaging private actors in global governance, The UN Global Compact raises many issues such as power, authority, and legitimacy. The effort to tackle it all is to increase PPP accountability. This research seeks to describe what efforts can be made to enhance private accountability within the international regime. The research undertaken is a descriptive study, focuses on public-private partnerships in the UN Global Compact regime. The study found that there were two attempts that could be done. First, by involving the stakeholders in the development of procedures, mechanisms, reporting and monitoring associated with trying to improve the company’s reputation. Second, by looking at corporate relations as agent and UN Global Compact as principal in principal-agent relation in the international regime.

  7. Strengthening health systems through linking research evidence to ...

    African Journals Online (AJOL)

    informed policies. Accordingly, a critical way of addressing these challenges facing health systems in the region is through the linking of health research findings to policy. Keywords: Evidence; Sub-Saharan Africa; Health Policy; Health Systems ...

  8. Public strategies for improving eHealth integration and long‐term sustainability in public health care systems: Findings from an Italian case study

    Science.gov (United States)

    Nuti, Sabina

    2017-01-01

    Summary eHealth is expected to contribute in tackling challenges for health care systems. However, it also imposes challenges. Financing strategies adopted at national as well regional levels widely affect eHealth long‐term sustainability. In a public health care system, the public actor is among the main “buyers” eHealth. However, public interventions have been increasingly focused on cost containment. How to match these 2 aspects? This article explores some central issues, mainly related to financial aspects, in the development of effective and valuable eHealth strategies in a public health care system: How can the public health care system (as a “buyer”) improve long‐term success and sustainability of eHealth solutions? What levers are available to match in the long period different interests of different stakeholders in the eHealth field? A case study was performed in the Region of Tuscany, Italy. According to our results, win‐win strategies should be followed. Investments should take into account the need to long‐term finance solutions, for sustaining changes in health care organizations for obtaining benefits. To solve the interoperability issues, the concept of the “platform approach” emerged, based on collaboration within and between organizations. Private sector as well as beneficiaries and final users of the eHealth solutions should participate in their design, provision, and monitoring. For creating value for all, the evidence gap and the financial needs could be addressed with a pull mechanism of funding, aimed at paying according to the outcomes produced by the eHealth solution, on the base of an ongoing monitoring, measurement, and evaluation of the outcomes. PMID:28791771

  9. X-33/RLV System Health Management/Vehicle Health Management

    Science.gov (United States)

    Mouyos, William; Wangu, Srimal

    1998-01-01

    To reduce operations costs, Reusable Launch Vehicles (RLVS) must include highly reliable robust subsystems which are designed for simple repair access with a simplified servicing infrastructure, and which incorporate expedited decision-making about faults and anomalies. A key component for the Single Stage To Orbit (SSTO) RLV system used to meet these objectives is System Health Management (SHM). SHM incorporates Vehicle Health Management (VHM), ground processing associated with the vehicle fleet (GVHM), and Ground Infrastructure Health Management (GIHM). The primary objective of SHM is to provide an automated and paperless health decision, maintenance, and logistics system. Sanders, a Lockheed Martin Company, is leading the design, development, and integration of the SHM system for RLV and for X-33 (a sub-scale, sub-orbit Advanced Technology Demonstrator). Many critical technologies are necessary to make SHM (and more specifically VHM) practical, reliable, and cost effective. This paper will present the X-33 SHM design which forms the baseline for the RLV SHM, and it will discuss applications of advanced technologies to future RLVs. In addition, this paper will describe a Virtual Design Environment (VDE) which is being developed for RLV. This VDE will allow for system design engineering, as well as program management teams, to accurately and efficiently evaluate system designs, analyze the behavior of current systems, and predict the feasibility of making smooth and cost-efficient transitions from older technologies to newer ones. The RLV SHM design methodology will reduce program costs, decrease total program life-cycle time, and ultimately increase mission success.

  10. Systems Thinking for Transformational Change in Health

    Science.gov (United States)

    Willis, Cameron D.; Best, Allan; Riley, Barbara; Herbert, Carol P.; Millar, John; Howland, David

    2014-01-01

    Incremental approaches to introducing change in Canada's health systems have not sufficiently improved the quality of services and outcomes. Further progress requires 'large system transformation', considered to be the systematic effort to generate coordinated change across organisations sharing a common vision and goal. This essay draws on…

  11. Guess Where? Actor-Supervision for Spatiotemporal Action Localization

    KAUST Repository

    Escorcia, Victor

    2018-04-05

    This paper addresses the problem of spatiotemporal localization of actions in videos. Compared to leading approaches, which all learn to localize based on carefully annotated boxes on training video frames, we adhere to a weakly-supervised solution that only requires a video class label. We introduce an actor-supervised architecture that exploits the inherent compositionality of actions in terms of actor transformations, to localize actions. We make two contributions. First, we propose actor proposals derived from a detector for human and non-human actors intended for images, which is linked over time by Siamese similarity matching to account for actor deformations. Second, we propose an actor-based attention mechanism that enables the localization of the actions from action class labels and actor proposals and is end-to-end trainable. Experiments on three human and non-human action datasets show actor supervision is state-of-the-art for weakly-supervised action localization and is even competitive to some fully-supervised alternatives.

  12. The Political Context for Transnational Actor Soft Power

    DEFF Research Database (Denmark)

    Bertelsen, Rasmus Gjedssø

    2015-01-01

    There is growing awareness and understanding of the role of non-state actors for the smart power of states. However, there is not yet a clear understanding of the impact of the political context and the state for non-state actors and their soft power. We look at American missionary universities...

  13. Guess Where? Actor-Supervision for Spatiotemporal Action Localization

    KAUST Repository

    Escorcia, Victor; Dao, Cuong D.; Jain, Mihir; Ghanem, Bernard; Snoek, Cees

    2018-01-01

    This paper addresses the problem of spatiotemporal localization of actions in videos. Compared to leading approaches, which all learn to localize based on carefully annotated boxes on training video frames, we adhere to a weakly-supervised solution that only requires a video class label. We introduce an actor-supervised architecture that exploits the inherent compositionality of actions in terms of actor transformations, to localize actions. We make two contributions. First, we propose actor proposals derived from a detector for human and non-human actors intended for images, which is linked over time by Siamese similarity matching to account for actor deformations. Second, we propose an actor-based attention mechanism that enables the localization of the actions from action class labels and actor proposals and is end-to-end trainable. Experiments on three human and non-human action datasets show actor supervision is state-of-the-art for weakly-supervised action localization and is even competitive to some fully-supervised alternatives.

  14. Using social network analysis to understand actor participation and ...

    African Journals Online (AJOL)

    Peripheral actors advocate issues of compensation and land grabbing from buffer zone establishment and wetland resources uses for livelihoods, but are unable to influence the central actors's agenda. SNA E-I Index reveals that government organisations are more cohesive and able to form strong ties with donors to ...

  15. The semiotic actor : From signs to socially constructed meaning

    NARCIS (Netherlands)

    Helmhout, M.; Jorna, R.J.J.M.; Gazendam, H.W.M.

    A semiotic actor creates, uses and transfers or communicates meaning with the help of signs in order to interact with other actors and society. For a complete understanding of the cognitive and social phenomena related to this process, we state that social science and cognitive science cannot stay

  16. When nurses are also patients: Intimate partner violence and the health system as an enabler of women's health and agency in Johannesburg.

    Science.gov (United States)

    Sprague, Courtenay; Woollett, Nataly; Parpart, Jane; Hatcher, Abigail M; Sommers, Theresa; Brown, Shelley; Black, Vivian

    2016-01-01

    While violence against women is a recognised global health problem, women's agency in marginalised settings is poorly understood, particularly in relation to health systems. We explored agency as a practical and theoretical construct through qualitative research among 20 nurses with direct or indirect experiences of intimate partner violence (IPV) in Johannesburg. Interviews conducted from August 2013 to March 2014 generated rich descriptions from respondents in five health facilities. Nurses' self-reported IPV matched national prevalence of 24-31%. Findings revealed the way in which agency is enacted by nurses, allowing them the economic means to leave abusive partnerships, yet disabling them from agency and health promotion in their workplace. At the same time, nurses expanded agentic possibilities for patients by enabling a national response to IPV within South African health clinics - one that is largely undocumented. We posit that nurses can serve as important agentic actors in public health systems in low- and middle-income country settings by assisting patients to address IPV, even in the absence of targeted training and guidelines. To ensure the health and well-being of women experiencing IPV, nurses should be supported by the health sector to respond skilfully to patients and to safely process their own experiences of violence.

  17. The Child Health Care System in Italy.

    Science.gov (United States)

    Corsello, Giovanni; Ferrara, Pietro; Chiamenti, Gianpietro; Nigri, Luigi; Campanozzi, Angelo; Pettoello-Mantovani, Massimo

    2016-10-01

    Pediatric care in Italy has been based during the last 40 years on the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health and well-being of their children. The pediatric health care system in Italy is part of the national health system. It is made up of 3 main levels of intervention: first access/primary care, secondary care/hospital care, and tertiary care based on specialty hospital care. This overview will also include a brief report on neonatal care, pediatric preventive health care, health service accreditation programs, and postgraduate training in pediatrics. The quality of the Italian child health care system is now considered to be in serious danger because of the restriction of investments in public health caused both by the 2008 global and national economic crisis and by a reduction of the pediatric workforce as a result of progressively insufficient replacement of specialists in pediatrics. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Managing interoperability and complexity in health systems.

    Science.gov (United States)

    Bouamrane, M-M; Tao, C; Sarkar, I N

    2015-01-01

    In recent years, we have witnessed substantial progress in the use of clinical informatics systems to support clinicians during episodes of care, manage specialised domain knowledge, perform complex clinical data analysis and improve the management of health organisations' resources. However, the vision of fully integrated health information eco-systems, which provide relevant information and useful knowledge at the point-of-care, remains elusive. This journal Focus Theme reviews some of the enduring challenges of interoperability and complexity in clinical informatics systems. Furthermore, a range of approaches are proposed in order to address, harness and resolve some of the many remaining issues towards a greater integration of health information systems and extraction of useful or new knowledge from heterogeneous electronic data repositories.

  19. Child Poverty and the Health Care System.

    Science.gov (United States)

    Racine, Andrew D

    2016-04-01

    The persistence of child poverty in the United States and the pervasive health consequences it engenders present unique challenges to the health care system. Human capital theory and empirical observation suggest that the increased disease burden experienced by poor children originates from social conditions that provide suboptimal educational, nutritional, environmental, and parental inputs to good health. Faced with the resultant excess rates of pediatric morbidity, the US health care system has developed a variety of compensatory strategies. In the first instance, Medicaid, the federal-state governmental finance system designed to assure health insurance coverage for poor children, has increased its eligibility thresholds and expanded its benefits to allow greater access to health services for this vulnerable population. A second arm of response involves a gradual reengineering of health care delivery at the practice level, including the dissemination of patient-centered medical homes, the use of team-based approaches to care, and the expansion of care management beyond the practice to reach deep into the community. Third is a series of recent experiments involving the federal government and state Medicaid programs that includes payment reforms of various kinds, enhanced reporting, concentration on high-risk populations, and intensive case management. Fourth, pediatric practices have begun to make use of specific tools that permit the identification and referral of children facing social stresses arising from poverty. Finally, constituencies within the health care system participate in enhanced advocacy efforts to raise awareness of poverty as a distinct threat to child health and to press for public policy responses such as minimum wage increases, expansion of tax credits, paid family leave, universal preschool education, and other priorities focused on child poverty. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights

  20. THE E-HEALTH SYSTEMS IN POLAND

    Directory of Open Access Journals (Sweden)

    Zdzisław PÓLKOWSKI

    2013-11-01

    Full Text Available Information Technologies are disruptive technologies that have caused major changes in health system in Poland. Current digital economy is driven by modern information and new IT tools, which offer hospitals, doctors and patient access to any type of information, regardless of its form of existence, storage type or geographical location. These tools encourage the development of new activities, health services. The purpose of this article is to analyze the the current state of development of e-services in Poland in the context of nowadays health system. In the first part of the paper, the authors present various programmes, which enable the access to the medical services and patients’ data online. The next part of the paper is devoted to examining the technical aspects of the said programmes and presenting their advantages as well as the areas which might be improved.The last part of the work will be focused on the websites of the selected health institutions. According to the authors, WWW services provide much information on how the process of computer systems are being implemented, what data the services include and the capacity of the equipment as well as the software, human resources and the knowledge in this sphere. Moreover this section highlights the latest trends in e-health with particular emphasis on aspects such as the use of private and public cloud computer and t heir integration with web sites of health institutions. This study brings its contribution to the understanding of the change of health system in Poland behavior by using a new perspective e-health systems and IT tools above by doctors, officers and patients.

  1. Strengthening Rehabilitation in Health Systems Worldwide by Integrating Information on Functioning in National Health Information Systems.

    Science.gov (United States)

    Stucki, Gerold; Bickenbach, Jerome; Melvin, John

    2017-09-01

    A complete understanding of the experience of health requires information relevant not merely to the health indicators of mortality and morbidity but also to functioning-that is, information about what it means to live in a health state, "the lived experience of health." Not only is functioning information relevant to healthcare and the overall objectives of person-centered healthcare but to the successful operation of all components of health systems.In light of population aging and major epidemiological trends, the health strategy of rehabilitation, whose aim has always been to optimize functioning and minimize disability, will become a key health strategy. The increasing prominence of the rehabilitative strategy within the health system drives the argument for the integration of functioning information as an essential component in national health information systems.Rehabilitation professionals and researchers have long recognized in WHO's International Classification of Functioning, Disability and Health the best prospect for an internationally recognized, sufficiently complete and powerful information reference for the documentation of functioning information. This paper opens the discussion of the promise of integrating the ICF as an essential component in national health systems to secure access to functioning information for rehabilitation, across health systems and countries.

  2. The health production function of oral health services systems

    DEFF Research Database (Denmark)

    Vlad, R.S.; Petersen, P.E.

    2000-01-01

    Attitudes, dental status, socioeconomic factors, oral health care, production of oral health, health status, quality of life......Attitudes, dental status, socioeconomic factors, oral health care, production of oral health, health status, quality of life...

  3. Operationalizing social safeguards in REDD+: actors, interests and ideas

    International Nuclear Information System (INIS)

    McDermott, Constance L.; Coad, Lauren; Helfgott, Ariella; Schroeder, Heike

    2012-01-01

    “REDD+” is a mechanism created under the United Nations Framework Convention on Climate Change (UNFCCC) for Reducing {carbon} Emissions from Deforestation and Degradation and forest enhancement. In addition, REDD+ “safeguards” are intended to protect non-carbon forest values. While REDD+ countries are formally requested to provide information on safeguards, there is as yet no agreement on the relative priority of carbon versus non-carbon values, and the appropriate level of safeguard standardization. This, we argue, has allowed REDD+ to function as a “boundary object” spanning disparate priorities. Meanwhile, the contestation of these priorities has been displaced from intergovernmental processes to the various organizations involved in operationalizing REDD+ activities. This article applies a set of organizational, substantive and conceptual typologies to compare differences in the balance of actors, interests and ideas across these organizations. It finds that multi-lateral funding programs have drawn heavily on existing safeguards for international aid, while private certification schemes have specialized in different niche priorities at the project level. In regards to the substance of safeguard requirements, the involvement of donors and investors appears correlated with a stronger emphasis on carbon and risk mitigation while greater NGO involvement and the decoupling of safeguards design from REDD+ funding appear correlated with greater emphasis on social rights and benefits. These findings have several critical implications for future REDD+ activities. Firstly, the choice of organizations involved in defining, funding and verifying safeguard activities, and the balance of actors in their governing structures, are likely to influence the relative emphasis on non-carbon values. Secondly, a diversity of approaches to disbursing REDD+ incentives may be necessary to maintain widespread support for REDD+. Thirdly, it remains to be seen whether REDD

  4. Transformation of health system in Ecuador

    Directory of Open Access Journals (Sweden)

    Wilson Giovanni Jiménez Barbosa

    2017-05-01

    Full Text Available Objective: To describe the transformations of the structure of the health system in Ecuador, taking into account the constitutional and policy context of that country, and to reflect on the historical context in which it occurred and its implications for the welfare of the people from Ecuador. Materials and methods: A bibliographic review was made, beginning with the regulations of Ecuador since the Constitution of 1979, where health is considered as a right, passing by the Organic Law of Health, the Social Security Act, among others, including the last reform of the Constitution in 2008. Results: The transformation of the Health System of Ecuador is the result of the action of economic and political forces, both internal and external, that have affected this country throughout the studied period.

  5. A construção de colegiados de gestão: a experiência de gestão da Secretaria Municipal de Saúde analisada por um ator político implicado Construction of collegiate management: the managing experience of a Municipal Health Department through the eyes of an involved political actor

    Directory of Open Access Journals (Sweden)

    Aparecida Linhares Pimenta

    2012-05-01

    , like that faced by the country since the early 90s. The empirical field was the management of the municipal health system of Amparo, 2001 to 2006, emphasizing the analysis of the construction of collective spaces, from the documentary analysis, and the statements of managers and employees are made in focus groups . Starting from the position of managing and using empirical data were reported and analyzed the main challenges to build a model of attention with its central structuring primary care and a management model based on collective spaces. The analysis indicates the ability to produce changes in local health systems from the commitment to building management, shared spaces, particularly the shift of power by actors who have more prominent in the biomedical model still hegemonic. Among the challenges for these changes is the ability to deal with the conflict present in the collective spaces, recognizing that lack of management tools to deal with them, either in teams, whether in the teams. Another challenge is the sheer complexity of the health scene, which creates uncertainty regarding the outcome of this work, because in the daily services, the healthcare bill is always under construction. The study concludes that managers need the ability to invest in tension towards the construction of new modes of production of life at the collective level, investing in projects built on equality and democratic coexistence.

  6. Exploring the influence of the Global Fund and the GAVI Alliance on health systems in conflict-affected countries.

    Science.gov (United States)

    Patel, Preeti; Cummings, Rachael; Roberts, Bayard

    2015-01-01

    Global Health Initiatives (GHIs) respond to high-impact communicable diseases in resource-poor countries, including health systems support, and are major actors in global health. GHIs could play an important role in countries affected by armed conflict given these countries commonly have weak health systems and a high burden of communicable disease. The aim of this study is to explore the influence of two leading GHIs, the Global Fund and the GAVI Alliance, on the health systems of conflict-affected countries. This study used an analytical review approach to identify evidence on the role of the Global Fund and the GAVI Alliance with regards to health systems support to 19 conflict-affected countries. Primary and secondary published and grey literature were used, including country evaluations from the Global Fund and the GAVI Alliance. The WHO heath systems building blocks framework was used for the analysis. There is a limited evidence-base on the influence of GHIs on health systems of conflict-affected countries. The findings suggest that GHIs are increasingly investing in conflict-affected countries which has helped to rapidly scale up health services, strengthen human resources, improve procurement, and develop guidelines and protocols. Negative influences include distorting priorities within the health system, inequitable financing of disease-specific services over other health services, diverting staff away from more essential health care services, inadequate attention to capacity building, burdensome reporting requirements, and limited flexibility and responsiveness to the contextual challenges of conflict-affected countries. There is some evidence of increasing engagement of the Global Fund and the GAVI Alliance with health systems in conflict-affected countries, but this engagement should be supported by more context-specific policies and approaches.

  7. Advancing Health Literacy Measurement: A Pathway to Better Health and Health System Performance

    Science.gov (United States)

    Pleasant, Andrew

    2014-01-01

    The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy—especially when combined with a focus on prevention and integrative health—is one of the most promising approaches to advancing public health. PMID:25491583

  8. Transformation of health system in Ecuador

    OpenAIRE

    Wilson Giovanni Jiménez Barbosa; María Luisa Granda Kuffo; Diana Margoth Ávila Guzmán; Leidy Johanna Cruz Díaz; Julián Camilo Flórez Parra; Luisa Silvana Mejía; Diana Carolina Vargas Suárez

    2017-01-01

    Objective: To describe the transformations of the structure of the health system in Ecuador, taking into account the constitutional and policy context of that country, and to reflect on the historical context in which it occurred and its implications for the welfare of the people from Ecuador. Materials and methods: A bibliographic review was made, beginning with the regulations of Ecuador since the Constitution of 1979, where health is considered as a right, passing by the Organic Law of Hea...

  9. Taking stock of monitoring and evaluation systems in the health sector: findings from Rwanda and Uganda.

    Science.gov (United States)

    Holvoet, Nathalie; Inberg, Liesbeth

    2014-07-01

    In the context of sector-wide approaches and the considerable funding being put into the health sectors of low-income countries, the need to invest in well-functioning national health sector monitoring and evaluation (M&E) systems is widely acknowledged. Regardless of the approach adopted, an important first step in any strategy for capacity development is to diagnose the quality of existing systems or arrangements, taking into account both the supply and demand sides of M&E. As no standardized M&E diagnostic instrument currently exists, we first invested in the development of an assessment tool for sector M&E systems. To counter the criticism that M&E is often narrowed down to a focus on technicalities, our diagnostic tool assesses the quality of M&E systems according to six dimensions: (i) policy; (ii) quality of indicators and data (collection) and methodology; (iii) organization (further divided into iiia: structure and iiib: linkages); (iv) capacity; (v) participation of non-government actors and (vi) M&E outputs: quality and use. We subsequently applied the assessment tool to the health sector M&E systems of Rwanda and Uganda, and this article provides a comparative overview of the main research findings. Our research may have important implications for policy, as both countries receive health sector (budget) support in relation to which M&E system diagnosis and improvement are expected to be high on the agenda. The findings of our assessments indicate that, thus far, the health sector M&E systems in Rwanda and Uganda can at best be diagnosed as 'fragmentary', with some stronger and weaker elements. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

  10. Advancing the application of systems thinking in health: South African examples of a leadership of sensemaking for primary health care.

    Science.gov (United States)

    Gilson, Lucy; Elloker, Soraya; Olckers, Patti; Lehmann, Uta

    2014-06-16

    New forms of leadership are required to bring about the fundamental health system changes demanded by primary health care (PHC). Using theory about complex adaptive systems and policy implementation, this paper considers how actors' sensemaking and the exercise of discretionary power currently combine to challenge PHC re-orientation in the South African health system; and provides examples of leadership practices that promote sensemaking and power use in support of PHC. The paper draws on observational, interview, and reflective data collected as part of the District Innovation and Action Learning for Health Systems Development (DIALHS) project being implemented in Cape Town, South Africa. Undertaken collaboratively between health managers and researchers, the project is implemented through cycles of action-learning, including systematic reflection and synthesis. It includes a particular focus on how local health managers can better support front line facility managers in strengthening PHC. The results illuminate how the collective understandings of staff working at the primary level - of their working environment and changes within it - act as a barrier to centrally-led initiatives to strengthen PHC. Staff often fail to take ownership of such initiatives and experience them as disempowering. Local area managers, located between the centre and the service frontline, have a vital role to play in providing a leadership of sensemaking to mediate these challenges. Founded on personal values, such leadership entails, for example, efforts to nurture PHC-aligned values and mind-sets among staff; build relationships and support the development of shared meanings about change; instil a culture of collective inquiry and mutual accountability; and role-model management practices, including using language to signal meaning. PHC will only become a lived reality within the South African health system when frontline staff are able to make sense of policy intentions and

  11. Embedding health literacy into health systems: a case study of a regional health service.

    Science.gov (United States)

    Vellar, Lucia; Mastroianni, Fiorina; Lambert, Kelly

    2017-12-01

    Objective The aim of the present study was to describe how one regional health service the Illawarra Shoalhaven Local Health District embedded health literacy principles into health systems over a 3-year period. Methods Using a case study approach, this article describes the development of key programs and the manner in which clinical incidents were used to create a health environment that allows consumers the right to equitably access quality health services and to participate in their own health care. Results The key outcomes demonstrating successful embedding of health literacy into health systems in this regional health service include the creation of a governance structure and web-based platform for developing and testing plain English consumer health information, a clearly defined process to engage with consumers, development of the health literacy ambassador training program and integrating health literacy into clinical quality improvement processes via a formal program with consumers to guide processes such as improvements to access and navigation around hospital sites. Conclusions The Illawarra Shoalhaven Local Health District has developed an evidence-based health literacy framework, guided by the core principles of universal precaution and organisational responsibility. Health literacy was also viewed as both an outcome and a process. The approach taken by the Illawarra Shoalhaven Local Health District to address poor health literacy in a coordinated way has been recognised by the Australian Commission on Safety and Quality in Health Care as an exemplar of a coordinated approach to embed health literacy into health systems. What is known about the topic? Poor health literacy is a significant national concern in Australia. The leadership, governance and consumer partnership culture of a health organisation can have considerable effects on an individual's ability to access, understand and apply the health-related information and services available to them

  12. Defining and Theorizing Terrorism: A Global Actor-Centered Approach

    Directory of Open Access Journals (Sweden)

    Omar Lizardo

    2015-08-01

    Full Text Available Arriving at a consensual definition of the phenomenon of terrorism has been a particularly difficult undertaking. Some definitions are either too specific or too vague, concentrating on some essential “terrorist” aspect of the actions, strategies, or types of non-state organizations that engage in terrorism. In this paper I draw on global approaches from international relations and world systems theories to propose a definition of terrorism that skirts these issues by concentrating on terrorist actors rather than terrorist behavior. I argue that this approach has several advantages, including the dissolution of several empirical and analytical problems produced by more essentialist definitions, and the location of terrorism within a two dimensional continuum of collective-violence phenomena in the international system which discloses important theoretical insights. I proceed to examine the characteristics of terrorism by comparing it with other forms of violence in the international system. I propose that terrorism may be part of the cycles and trends of unrest in the world system, responding to the same broad families of global dynamics as other forms of system-level conflict.

  13. Four centuries on from Bacon: progress in building health research systems to improve health systems?

    Science.gov (United States)

    Hanney, Stephen R; González-Block, Miguel A

    2014-09-23

    In 1627, Francis Bacon's New Atlantis described a utopian society in which an embryonic research system contributed to meeting the needs of the society. In this editorial, we use some of the aspirations described in New Atlantis to provide a context within which to consider recent progress in building health research systems to improve health systems and population health. In particular, we reflect on efforts to build research capacity, link research to policy, identify the wider impacts made by the science, and generally build fully functioning research systems to address the needs identified. In 2014, Health Research Policy and Systems has continued to publish one-off papers and article collections covering a range of these issues in both high income countries and low- and middle-income countries. Analysis of these contributions, in the context of some earlier ones, is brought together to identify achievements, challenges and possible ways forward. We show how 2014 is likely to be a pivotal year in the development of ways to assess the impact of health research on policies, practice, health systems, population health, and economic benefits.We demonstrate how the increasing focus on health research systems will contribute to realising the hopes expressed in the World Health Report, 2013, namely that all nations would take a systematic approach to evaluating the outputs and applications resulting from their research investment.

  14. Optimal Sensor Selection for Health Monitoring Systems

    Science.gov (United States)

    Santi, L. Michael; Sowers, T. Shane; Aguilar, Robert B.

    2005-01-01

    Sensor data are the basis for performance and health assessment of most complex systems. Careful selection and implementation of sensors is critical to enable high fidelity system health assessment. A model-based procedure that systematically selects an optimal sensor suite for overall health assessment of a designated host system is described. This procedure, termed the Systematic Sensor Selection Strategy (S4), was developed at NASA John H. Glenn Research Center in order to enhance design phase planning and preparations for in-space propulsion health management systems (HMS). Information and capabilities required to utilize the S4 approach in support of design phase development of robust health diagnostics are outlined. A merit metric that quantifies diagnostic performance and overall risk reduction potential of individual sensor suites is introduced. The conceptual foundation for this merit metric is presented and the algorithmic organization of the S4 optimization process is described. Representative results from S4 analyses of a boost stage rocket engine previously under development as part of NASA's Next Generation Launch Technology (NGLT) program are presented.

  15. Dealing with Health and Health Care System Challenges in China: assessing health determinants and health care reforms

    NARCIS (Netherlands)

    H. Zhang (Hao)

    2017-01-01

    markdownabstractThis dissertation investigates the challenges faced by China around 2010 in two domains – population health and the health care system. Specifically, chapters 2 and 3 are devoted to health challenges, explaining the female health disadvantage in later life and assessing the effect

  16. System impact research - increasing public health and health care system performance.

    Science.gov (United States)

    Malmivaara, Antti

    2016-01-01

    Interventions directed to system features of public health and health care should increase health and welfare of patients and population. To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. System Impact Research - creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population. Key messages The new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features. SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and equality of services. SIR creates the

  17. System impact research – increasing public health and health care system performance

    Science.gov (United States)

    Malmivaara, Antti

    2016-01-01

    Abstract Background Interventions directed to system features of public health and health care should increase health and welfare of patients and population. Aims To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). Methods The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. Results The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. Conclusions System Impact Research – creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population.Key messagesThe new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features.SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency

  18. Proposal for Requirement Validation Criteria and Method Based on Actor Interaction

    Science.gov (United States)

    Hattori, Noboru; Yamamoto, Shuichiro; Ajisaka, Tsuneo; Kitani, Tsuyoshi

    We propose requirement validation criteria and a method based on the interaction between actors in an information system. We focus on the cyclical transitions of one actor's situation against another and clarify observable stimuli and responses based on these transitions. Both actors' situations can be listed in a state transition table, which describes the observable stimuli or responses they send or receive. Examination of the interaction between both actors in the state transition tables enables us to detect missing or defective observable stimuli or responses. Typically, this method can be applied to the examination of the interaction between a resource managed by the information system and its user. As a case study, we analyzed 332 requirement defect reports of an actual system development project in Japan. We found that there were a certain amount of defects regarding missing or defective stimuli and responses, which can be detected using our proposed method if this method is used in the requirement definition phase. This means that we can reach a more complete requirement definition with our proposed method.

  19. Prognostics and health management of photovoltaic systems

    Science.gov (United States)

    Johnson, Jay; Riley, Daniel

    2018-04-10

    The various technologies presented herein relate to providing prognosis and health management (PHM) of a photovoltaic (PV) system. A PV PHM system can eliminate long-standing issues associated with detecting performance reduction in PV systems. The PV PHM system can utilize an ANN model with meteorological and power input data to facilitate alert generation in the event of a performance reduction without the need for information about the PV PHM system components and design. Comparisons between system data and the PHM model can provide scheduling of maintenance on an as-needed basis. The PHM can also provide an approach for monitoring system/component degradation over the lifetime of the PV system.

  20. Radiometric system for clinical applications in the National Health System

    International Nuclear Information System (INIS)

    Mesa Perez, G.; Arteche Diaz, R.; Camejo Batista, A.; Fonfria Bragado, C.

    2013-01-01

    In this paper it is presented the radiometric detection system SRNIC-02, manufactured at CEADEN. The system has three major components: a well-type Nal(TI) scintillator detector with its collimator, a measurement module, and the application software, which allows fixing the working parameters of the system, as well as the acquisition and processing of data. The system has two main applications in the National Health System, one for the quality control in Radiopharmacy, and in RIA/IRMA blood tests. There are 16 systems installed, in 13 provinces of the country up to this date. (Author)

  1. The Child Health Care System of Croatia.

    Science.gov (United States)

    Mestrovic, Julije; Bralic, Irena; Simetin, Ivana Pavic; Mujkic, Aida; Radonić, Marija; Rodin, Urelija; Trošelj, Mario; Stevanović, Ranko; Benjak, Tomislav; Pristaš, Ivan; Mayer, Dijana; Tomić, Branimir

    2016-10-01

    The Republic of Croatia is a Parliamentary Republic with a population of 4.2 million people that sits on the Adriatic coast within Central Europe. Gross domestic product is approximately 60% of the European Union average, which in turn, limits health service spending. The health system is funded through universal health insurance administered by the Croatian Health Insurance Fund based on the principles of social solidarity and reciprocity. The children of Croatia are guaranteed access to universal primary, hospital, and specialist care provided by a network of health institutions. Pediatricians and school medicine specialists provide comprehensive preventive health care for both preschool and school-aged children. Despite the Croatian War of Independence in the late 20th century, indicators of child health and measures of health service delivery to children and families are steadily improving. However, similar to many European countries, Croatia is experiencing a rise in the "new morbidities" and is responding to these new challenges through a whole society approach to promote healthy lifestyles and insure good quality of life for children. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Marketing in Greek National Health System

    Directory of Open Access Journals (Sweden)

    Maria Tseroni

    2009-01-01

    Full Text Available Introduction: The international financial situation in combination with an aging population and the appropriation of health services imposes the management of hospital services as a necessity for the survival of hospitals.Aim: To examine the perceptions of 450 upper administrative hospital executives (Nursing, Medicine and Administrative services in the wider region of Attica, on marketing, communication, and public relations in health-care.Population study: Four hundred and fifty (450 higher health executives from the three basic fields of services in health institutions (medical, nursing, administration constituted the total sample of the research. These people are employed at 9 of the 36 hospitals in the 3 Health Regions of Attica (H.Re.Materials and method:The type of design that was chosen (to gather data for the study of attitudes and perceptions of the health personnel of the health institutions of G.S.H (Greek System of Health is a cross- sectional survey.Results: The participating subjects, even though expressed some reservations at first, formed a favorable attitude towards marketing and its application in the field of health-care. Statistically important correlations emerged between the perceptions of executives and their socio-demographic background including age, sex, education, and profession, work experience in health-care and specifically in their current position in the services as well as statistically important differences between doctors, nurses and administrators as to their perceptions of some issues in marketing.Conclusions: From the comments in the survey it appears there is a need to apply marketing correctly when providing quality care, respecting the patients’ rights and using human and not financial criteria as a guide. Based on the results of the research, important proposals are being submitted in the areas of health-care research, education and clinical practice.

  3. Resolving the challenges in the international comparison of health systems: the must do's and the trade-offs.

    Science.gov (United States)

    Forde, Ian; Morgan, David; Klazinga, Niek S

    2013-09-01

    Countries are increasingly publishing health system performance statistics alongside those of their peers, to identify high performers and achieve a continuously improving health system. The aim of the paper is to identify, and discuss resolution of, some key methodological challenges, which arise when comparing health system performance. To illustrate the issues, we focus on two OECD flagship initiatives: the System of Health Accounts (SHA) and the Health Care Quality Indicators (HCQI) project and refer to two main actors: a coordinating agency, which proposes and collates performance data and second, data correspondents in constituent health systems, who submit data to the coordinating centre. Discussion is structured around two themes: a set of must-do's (legitimacy of the coordinating centre, validity of proposed indicators, feasibility of data collection and technical support for data correspondents) and a set of trade-offs (depth vs. breadth in the number of system elements compared, aggregation vs. granularity of data, flexibility vs. consistency of indicator definitions and inclusion criteria). Robust fulfillment of the must-do's and transparent resolution of the trade-offs both depend upon effective collaboration between the coordinating centre and data correspondents, and a close working relationship between a technical secretariat and a body of experts. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  4. Health promotion and health systems: some unfinished business.

    Science.gov (United States)

    Ziglio, Erio; Simpson, Sarah; Tsouros, Agis

    2011-12-01

    One of the five action domains in the Ottawa Charter was Reorienting Health Services. In this paper, we reflect on why progress in this domain has been somewhat lethargic, particularly compared with some of the other action domains, and why now it is important to renew our commitment to this domain. Reorienting health services has been largely overlooked and opportunities missed, although good exceptions do exist. The occasion of the 25th anniversary of the Ottawa Charter represents an important opportunity for health promotion to: (i) renew its active voice in current policy debate and action and (ii) enhance achievements made to date by improving our efforts to advocate, enable and mediate for the reorientation of health services and systems. We outline six steps to reactivate and invest more in this action domain so as to be in a better position to promote health equitably and sustainably in today's fast changing world. Though our experience is mainly based in the European context, we hope that our reflections will be of some value to countries outside of this region.

  5. Sistema de salud de Brasil The health system of Brazil

    Directory of Open Access Journals (Sweden)

    Víctor Becerril Montekio

    2011-01-01

    , hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households, medical cooperatives, the so called Self-Administered Plans (companies and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.

  6. A false dichotomy? Mental illness and lone-actor terrorism.

    Science.gov (United States)

    Corner, Emily; Gill, Paul

    2015-02-01

    We test whether significant differences in mental illness exist in a matched sample of lone- and group-based terrorists. We then test whether there are distinct behavioral differences between lone-actor terrorists with and without mental illness. We then stratify our sample across a range of diagnoses and again test whether significant differences exist. We conduct a series of bivariate, multivariate, and multinomial statistical tests using a unique dataset of 119 lone-actor terrorists and a matched sample of group-based terrorists. The odds of a lone-actor terrorist having a mental illness is 13.49 times higher than the odds of a group actor having a mental illness. Lone actors who were mentally ill were 18.07 times more likely to have a spouse or partner who was involved in a wider movement than those without a history of mental illness. Those with a mental illness were more likely to have a proximate upcoming life change, more likely to have been a recent victim of prejudice, and experienced proximate and chronic stress. The results identify behaviors and traits that security agencies can utilize to monitor and prevent lone-actor terrorism events. The correlated behaviors provide an image of how risk can crystalize within the individual offender and that our understanding of lone-actor terrorism should be multivariate in nature.

  7. Using attractiveness model for actors ranking in social media networks.

    Science.gov (United States)

    Qasem, Ziyaad; Jansen, Marc; Hecking, Tobias; Hoppe, H Ulrich

    2017-01-01

    Influential actors detection in social media such as Twitter or Facebook can play a major role in gathering opinions on particular topics, improving the marketing efficiency, predicting the trends, etc. This work aims to extend our formally defined T measure to present a new measure aiming to recognize the actor's influence by the strength of attracting new important actors into a networked community. Therefore, we propose a model of the actor's influence based on the attractiveness of the actor in relation to the number of other attractors with whom he/she has established connections over time. Using an empirically collected social network for the underlying graph, we have applied the above-mentioned measure of influence in order to determine optimal seeds in a simulation of influence maximization. We study our extended measure in the context of information diffusion because this measure is based on a model of actors who attract others to be active members in a community. This corresponds to the idea of the IC simulation model which is used to identify the most important spreaders in a set of actors.

  8. Strengthening global health security by embedding the International Health Regulations requirements into national health systems.

    Science.gov (United States)

    Kluge, Hans; Martín-Moreno, Jose Maria; Emiroglu, Nedret; Rodier, Guenael; Kelley, Edward; Vujnovic, Melitta; Permanand, Govin

    2018-01-01

    The International Health Regulations (IHR) 2005, as the overarching instrument for global health security, are designed to prevent and cope with major international public health threats. But poor implementation in countries hampers their effectiveness. In the wake of a number of major international health crises, such as the 2014 Ebola and 2016 Zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, it has become clear that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response. WHO is working directly with its Member States to promote this approach, more specifically around how to better embed the IHR (2005) core capacities into the main health system functions. This paper looks at how and where the intersections between the IHR and the health system can be best leveraged towards developing greater health system resilience. This merging of approaches is a key component in pursuit of Universal Health Coverage and strengthened global health security as two mutually reinforcing agendas.

  9. The right to health, health systems development and public health policy challenges in Chad.

    Science.gov (United States)

    Azétsop, Jacquineau; Ochieng, Michael

    2015-02-15

    There is increasing consensus that the right to health can provide ethical, policy and practical groundings for health systems development. The goals of the right to health are congruent with those of health systems development, which are about strengthening health promotion organizations and actions so as to improve public health. The poor shape and performance of health systems in Chad question the extent of realization of the right to health. Due to its comprehensiveness and inclusiveness, the right to health has the potential of being an organizational and a normative backbone for public health policy and practice. It can then be understood and studied as an integral component of health systems development. This paper uses a secondary data analysis of existing documents by the Ministry of Public Health, Institut National de la Statistique, des Etudes Economiques et Démographiques (INSEED), the Ministry of Economy and Agence Française de Cooperation to analyze critically the shape and performance of health systems in Chad based on key concepts and components of the right to health contained in article 12 of the International Covenant on Economic, Social and Cultural Rights, and on General Comment 14. The non-realization of the right to health, even in a consistently progressive manner, raises concerns about the political commitment of state officials to public health, about the justice of social institutions in ensuring social well-being and about individual and public values that shape decision-making processes. Social justice, democratic rule, transparency, accountability and subsidiarity are important groundings for ensuring community participation in public affairs and for monitoring the performance of public institutions. The normative ideals of health systems development are essentially democratic in nature and are rooted in human rights and in ethical principles of human dignity, equality, non-discrimination and social justice. These ideals are grounded

  10. Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

    Science.gov (United States)

    Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

    2012-04-01

    This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

  11. FAILSAFE Health Management for Embedded Systems

    Science.gov (United States)

    Horvath, Gregory A.; Wagner, David A.; Wen, Hui Ying; Barry, Matthew

    2010-01-01

    The FAILSAFE project is developing concepts and prototype implementations for software health management in mission- critical, real-time embedded systems. The project unites features of the industry-standard ARINC 653 Avionics Application Software Standard Interface and JPL s Mission Data System (MDS) technology (see figure). The ARINC 653 standard establishes requirements for the services provided by partitioned, real-time operating systems. The MDS technology provides a state analysis method, canonical architecture, and software framework that facilitates the design and implementation of software-intensive complex systems. The MDS technology has been used to provide the health management function for an ARINC 653 application implementation. In particular, the focus is on showing how this combination enables reasoning about, and recovering from, application software problems.

  12. Integrated Systems Health Management (ISHM) Toolkit

    Science.gov (United States)

    Venkatesh, Meera; Kapadia, Ravi; Walker, Mark; Wilkins, Kim

    2013-01-01

    A framework of software components has been implemented to facilitate the development of ISHM systems according to a methodology based on Reliability Centered Maintenance (RCM). This framework is collectively referred to as the Toolkit and was developed using General Atomics' Health MAP (TM) technology. The toolkit is intended to provide assistance to software developers of mission-critical system health monitoring applications in the specification, implementation, configuration, and deployment of such applications. In addition to software tools designed to facilitate these objectives, the toolkit also provides direction to software developers in accordance with an ISHM specification and development methodology. The development tools are based on an RCM approach for the development of ISHM systems. This approach focuses on defining, detecting, and predicting the likelihood of system functional failures and their undesirable consequences.

  13. Using actor-network theory to study an educational situation: an ...

    African Journals Online (AJOL)

    Actor-network theory allows a researcher to analyse a complex social setting involving both human and non-human actors. An actor network can be used to model a dynamic and complex set of relationships between these actors. This article describes actor-network theory and shows how it was applied to study and model ...

  14. Think about and intervene in the territory through the Actor Network Theory Pensar e intervenir el territorio a traves de la Teoria del Actor-Red

    Directory of Open Access Journals (Sweden)

    Juan E. Cabrera

    2011-03-01

    Full Text Available The purpose of this article is to think about the similarities between the ways of seeing the territory as a network, some theoretical positions about the territory concept and actor network theory.
    After focusing on proposing a way of understanding the relationships between actors when they will intervene in the territory through the public policies and territorial planning, i ll try to apply the ANT model of public policy management through the guidance of ANT El propósito de este artículo es reflexionar sobre las coincidencias entre la forma de ver el territorio como red, algunas posturas teóricas sobre su concepto y la teoría del actor-red.
    Sobre lo anterior se centra en proponer una forma de entender las relaciones entre actores cuando se va a intervenir el territorio a través de políticas públicas como la planificación utilizando un modelo de gestión territorial a través de las orientaciones de la TAR.   

  15. Understanding The Resistance to Health Information Systems

    OpenAIRE

    David Ackah; Angelito E Alvarado; Heru Santoso Wahito Nugroho; Sanglar Polnok; Wiwin Martiningsih

    2017-01-01

    User resistance is users’ opposition to system implementation. Resistance often occurs as a result of a mismatch between management goals and employee preferences. There are two types of resistance to health iformation system namely active resistance and passive resistance. The manifestation of active resistance are being critical,  blaming/accusing, blocking, fault finding, sabotaging, undermining, ridiculing, intimidating/threatening, starting rumors, appealing to fear, manipulating arguing...

  16. The personal health record paradox: health care professionals' perspectives and the information ecology of personal health record systems in organizational and clinical settings.

    Science.gov (United States)

    Nazi, Kim M

    2013-04-04

    documents revealed a multidimensional dynamic between the trajectory of secure messaging implementation and its impact on organizational actors and their use of technology, influencing workflow, practices, and the flow of information. In effect, secure messaging was the missing element of complex information ecology and its implementation acted as a catalyst for change. Secure messaging was found to have important consequences for access, communication, patient self-report, and patient/provider relationships. Study findings have direct implications for the development and implementation of PHR systems to ensure adequate training and support for health care professionals, alignment with clinical workflow, and features that enable information sharing and communication. Study findings highlight the importance of clinician endorsement and engagement, and the need to further examine both intended and unintended consequences of use. This research provides an integral step toward better understanding the social and organizational context and impact of PHR and secure messaging use in clinical practice settings.

  17. Extended mind and after: socially extended mind and actor-network.

    Science.gov (United States)

    Kono, Tetsuya

    2014-03-01

    The concept of extended mind has been impressively developed over the last 10 years by many philosophers and cognitive scientists. The extended mind thesis (EM) affirms that the mind is not simply ensconced inside the head, but extends to the whole system of brain-body-environment. Recently, some philosophers and psychologists try to adapt the idea of EM to the domain of social cognition research. Mind is socially extended (SEM). However, EM/SEM theory has problems to analyze the interactions among a subject and its surroundings with opposition, antagonism, or conflict; it also tends to think that the environment surrounding the subject is passive or static, and to neglect the power of non-human actants to direct and regulate the human subject. In these points, actor-network theory (ANT) proposed by Latour and Callon is more persuasive, while sharing some important ideas with EM/SEM theory. Actor-network is a hybrid community which is composed of a series of heterogeneous elements, animate and inanimate for a certain period of time. I shall conclude that EM/SEM could be best analyzed as a special case of actor-network. EM/SEM is a system which can be controlled by a human agent alone. In order to understand collective behavior, philosophy and psychology have to study the actor-network in which human individuals are situated.

  18. A Critique of Health System Performance Measurement.

    Science.gov (United States)

    Lynch, Thomas

    2015-01-01

    Health system performance measurement is a ubiquitous phenomenon. Many authors have identified multiple methodological and substantive problems with performance measurement practices. Despite the validity of these criticisms and their cross-national character, the practice of health system performance measurement persists. Theodore Marmor suggests that performance measurement invokes an "incantatory response" wrapped within "linguistic muddle." In this article, I expand upon Marmor's insights using Pierre Bourdieu's theoretical framework to suggest that, far from an aberration, the "linguistic muddle" identified by Marmor is an indicator of a broad struggle about the representation and classification of public health services as a public good. I present a case study of performance measurement from Alberta, Canada, examining how this representational struggle occurs and what the stakes are. © The Author(s) 2015.

  19. Scaling Health Information Systems in Developing Countries

    DEFF Research Database (Denmark)

    Mengiste, Shegaw Anagaw; Neilsen, Petter

    2006-01-01

    This article addresses the issues of scaling health information system in the context of developing countries by taking a case study from Ethiopia. Concepts of information infrastructure have been used as an analytical lens to better understand scaling of Health Information systems. More...... specifically, we question the fruitfulness of focusing on not being installed base hostile and suggest focusing on how to be installed base “friendly” by underscoring how the installed base can also be draw upon and shaped by human agents. The paper conceptualizes health information infrastructure (HII......) building as an intertwined process of the evolution of the installed base and the construction activities of human agents. Overall, we argue that it is not only the adverse situation that determines how things develop, but HII builders need to navigate and take into account a wide range of issues related...

  20. Designing and Conducting Health Systems Research Projects ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Home · Resources · Publications. Designing and Conducting Health Systems Research Projects Volume 1: Proposal Development and Fieldwork ... IDRC and the United Kingdom's Global AMR Innovation Fund—managed by the ... New website will help record vital life events to improve access to services for all.

  1. Health Occupations Module. The Integumentary System.

    Science.gov (United States)

    Temple Univ., Philadelphia, PA. Div. of Vocational Education.

    This module on the integumentary system is one of eight modules designed for individualized instruction in health occupations education programs at both the secondary and postsecondary levels. This module contains an introduction to the module topic, objectives (e.g., list and describe the types of glands formed in the skin, and explain the…

  2. Activity monitoring systems in health care

    NARCIS (Netherlands)

    Kröse, B.; van Oosterhout, T.; van Kasteren, T.; Salah, A.A.; Gevers, T.

    2011-01-01

    This chapter focuses on activity monitoring in a home setting for health care purposes. First the most current sensing systems are described, which consist of wearable and ambient sensors. Then several approaches for the monitoring of simple actions are discussed, like falls or therapies. After

  3. Governance for Equity in Health Systems Deadline

    International Development Research Centre (IDRC) Digital Library (Canada)

    Jean-Claude Dumais

    2012-09-12

    Sep 12, 2012 ... of training and mentorship in research, research management, and grant administration allows awardees to pursue their research goals in a dynamic team environment in one of the world's leaders in generating new knowledge to meet global challenges. IDRC's Governance for Equity in Health Systems ...

  4. Can "giving preference to my patients" be explained as a role related duty in public health care systems?

    Science.gov (United States)

    Holm, Søren

    2011-03-01

    Most of us have two strong intuitions (or sets of intuitions) in relation to fairness in health care systems that are funded by public money, whether through taxation or compulsory insurance. The first intuition is that such a system has to treat patients (and other users) fairly, equitably, impartially, justly and without discrimination. The second intuition is that doctors, nurses and other health care professionals are allowed to, and may even in some cases be obligated to give preference to the interests of their particular patients or clients over the interests of other patients or clients of the system. These two intuitions are in potential conflict. One of the most obvious ways in which to ensure impartiality in a health care system is to require impartiality of all actors in the system, i.e. to give health care professionals a duty to treat everyone impartially and to deny them the 'right' to give their patients preferential treatment. And one of the possible side-effects of allowing individual health care professionals to give preference to 'their clients' is to create inequality in health care. This paper explores the conflict and proposes that it can be right to give preference to 'your' patients in certain circumstances.

  5. Trail-Based Search for Efficient Event Report to Mobile Actors in Wireless Sensor and Actor Networks.

    Science.gov (United States)

    Xu, Zhezhuang; Liu, Guanglun; Yan, Haotian; Cheng, Bin; Lin, Feilong

    2017-10-27

    In wireless sensor and actor networks, when an event is detected, the sensor node needs to transmit an event report to inform the actor. Since the actor moves in the network to execute missions, its location is always unavailable to the sensor nodes. A popular solution is the search strategy that can forward the data to a node without its location information. However, most existing works have not considered the mobility of the node, and thus generate significant energy consumption or transmission delay. In this paper, we propose the trail-based search (TS) strategy that takes advantage of actor's mobility to improve the search efficiency. The main idea of TS is that, when the actor moves in the network, it can leave its trail composed of continuous footprints. The search packet with the event report is transmitted in the network to search the actor or its footprints. Once an effective footprint is discovered, the packet will be forwarded along the trail until it is received by the actor. Moreover, we derive the condition to guarantee the trail connectivity, and propose the redundancy reduction scheme based on TS (TS-R) to reduce nontrivial transmission redundancy that is generated by the trail. The theoretical and numerical analysis is provided to prove the efficiency of TS. Compared with the well-known expanding ring search (ERS), TS significantly reduces the energy consumption and search delay.

  6. Integrated Systems Health Management for Space Exploration

    Science.gov (United States)

    Uckun, Serdar

    2005-01-01

    Integrated Systems Health Management (ISHM) is a system engineering discipline that addresses the design, development, operation, and lifecycle management of components, subsystems, vehicles, and other operational systems with the purpose of maintaining nominal system behavior and function and assuring mission safety and effectiveness under off-nominal conditions. NASA missions are often conducted in extreme, unfamiliar environments of space, using unique experimental spacecraft. In these environments, off-nominal conditions can develop with the potential to rapidly escalate into mission- or life-threatening situations. Further, the high visibility of NASA missions means they are always characterized by extraordinary attention to safety. ISHM is a critical element of risk mitigation, mission safety, and mission assurance for exploration. ISHM enables: In-space maintenance and repair; a) Autonomous (and automated) launch abort and crew escape capability; b) Efficient testing and checkout of ground and flight systems; c) Monitoring and trending of ground and flight system operations and performance; d) Enhanced situational awareness and control for ground personnel and crew; e) Vehicle autonomy (self-sufficiency) in responding to off-nominal conditions during long-duration and distant exploration missions; f) In-space maintenance and repair; and g) Efficient ground processing of reusable systems. ISHM concepts and technologies may be applied to any complex engineered system such as transportation systems, orbital or planetary habitats, observatories, command and control systems, life support systems, safety-critical software, and even the health of flight crews. As an overarching design and operational principle implemented at the system-of-systems level, ISHM holds substantial promise in terms of affordability, safety, reliability, and effectiveness of space exploration missions.

  7. Outcome mapping for health system integration

    Directory of Open Access Journals (Sweden)

    Tsasis P

    2013-03-01

    Full Text Available Peter Tsasis,1 Jenna M Evans,2 David Forrest,3 Richard Keith Jones4 1School of Health Policy and Management, Faculty of Health, York University, Toronto, Canada; 2Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Canada; 3Global Vision Consulting Ltd, Victoria, Canada; 4R Keith Jones and Associates, Victoria, Canada Abstract: Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care. Keywords: integrated care, integrated delivery systems, complex adaptive systems, social capital

  8. Rocket Testing and Integrated System Health Management

    Science.gov (United States)

    Figueroa, Fernando; Schmalzel, John

    2005-01-01

    Integrated System Health Management (ISHM) describes a set of system capabilities that in aggregate perform: determination of condition for each system element, detection of anomalies, diagnosis of causes for anomalies, and prognostics for future anomalies and system behavior. The ISHM should also provide operators with situational awareness of the system by integrating contextual and timely data, information, and knowledge (DIaK) as needed. ISHM capabilities can be implemented using a variety of technologies and tools. This chapter provides an overview of ISHM contributing technologies and describes in further detail a novel implementation architecture along with associated taxonomy, ontology, and standards. The operational ISHM testbed is based on a subsystem of a rocket engine test stand. Such test stands contain many elements that are common to manufacturing systems, and thereby serve to illustrate the potential benefits and methodologies of the ISHM approach for intelligent manufacturing.

  9. THE QATAR HEALTH SYSTEM: CHALLENGES AND OPPORTUNITIES

    Directory of Open Access Journals (Sweden)

    Shaher ALSHAMARI

    2017-06-01

    Full Text Available Qatar’s healthcare system is comparatively new and has experienced noteworthy developments over its brief history. In this paper, our aim is to look at the unique challenges this small nation has faced in building that system. This paper will describe the accomplishments of Qatar’s medical authorities and the challenges they faced. It will also compare public and private healthcare providers. Today, the government of Qatar has financed all the health care for this rapidly-developing, multicultural nation, but it is now planning to introduce medical insurance. This report of its experience will benefit other nations wanting to develop their own healthcare systems.

  10. Peak Oil, Food Systems, and Public Health

    Science.gov (United States)

    Parker, Cindy L.; Kirschenmann, Frederick L.; Tinch, Jennifer; Lawrence, Robert S.

    2011-01-01

    Peak oil is the phenomenon whereby global oil supplies will peak, then decline, with extraction growing increasingly costly. Today's globalized industrial food system depends on oil for fueling farm machinery, producing pesticides, and transporting goods. Biofuels production links oil prices to food prices. We examined food system vulnerability to rising oil prices and the public health consequences. In the short term, high food prices harm food security and equity. Over time, high prices will force the entire food system to adapt. Strong preparation and advance investment may mitigate the extent of dislocation and hunger. Certain social and policy changes could smooth adaptation; public health has an essential role in promoting a proactive, smart, and equitable transition that increases resilience and enables adequate food for all. PMID:21778492

  11. Towards Feature Selection in Actor-Critic Algorithms

    National Research Council Canada - National Science Library

    Rohanimanesh, Khashayar; Roy, Nicholas; Tedrake, Russ

    2007-01-01

    .... They demonstrate that two popular representations for value methods -- the barycentric interpolators and the graph Laplacian proto-value functions -- can be used to represent the actor so as to satisfy these conditions...

  12. Research on virtual actor action editing and movement control

    Institute of Scientific and Technical Information of China (English)

    Wenhu QIN; Yuhui WU; Zhengxu ZHAO

    2008-01-01

    To directly use a virtual surface model for action editing and movement control, a general method for creating virtual actor skeleton models and controlling movement is presented. The method includes judging borderlines of the block virtual surface model, calculat-ing the joints, confirming the above block, and using the block hierarchical layout to create the skeleton model. Then, according to the virtual actor model and move-ment restriction, the study focuses on the generation of movement animation using the key frame technique and smoothing movement technique by automatically adding animation and adjusting the actor's pose by different weights on movement amplitude. Finally, movement control of the actor in the virtual environment is implemented by real-time control and path point control, which achieve a good result.

  13. Soft Power in Central Asia: Actors and Its Activities

    Directory of Open Access Journals (Sweden)

    Marina M. Lebedeva

    2014-01-01

    Full Text Available Article considers theoretical aspects of soft power concept and its use by various actors in Central Asia. It is noted that scholars as well as practitioners are paying insufficient attention to such key concepts position J. Nye, as an attraction. As a result the efficiency of the use of soft power is significantly reduced. It also shows that the attractiveness is not a universal characteristic. For this reason, attractiveness and hence soft power of different actors are different and aimed at different segments of the population. These differences lead to competition of actors, but they do not reduce interaction in the region to zero-sum game. Specific forms and directions of the soft power of Russia, the U.S., the EU and China in Central Asia are discussed. The article emphasizes that the Central Asian states are not just recipients of soft power of external actors, but also themselves form behavioral strategies that are attractive to others.

  14. REPUTATIONAL CAPITAL OF POLITICAL ACTORS AS PUBLIC PROCUREMENT

    Directory of Open Access Journals (Sweden)

    A. E. Rudakova

    2015-01-01

    Full Text Available The author examines the reputational characteristics of the formation of political actors at the expense of the state budget, the specificity of the mechanism of implementation of government procurement and modern Russian practice.

  15. Understanding Obstacles to Peace: Actors, Interests, and Strategies ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2011-02-24

    Feb 24, 2011 ... Understanding Obstacles to Peace: Actors, Interests, and Strategies in Africa's ... The case studies all employ methods of “thick description” process tracing ... Addressing Africa's unmet need for family planning by intensifying ...

  16. Transnational Diaspora and Civil Society Actors Driving MNE Internationalisation

    DEFF Research Database (Denmark)

    Rana, Mohammad Bakhtiar; Elo, Maria

    2016-01-01

    Multinational enterprises (MNEs) are viewed as proactive global economic actors that enter new and emerging markets with intentional strategies, building on their inherent resources and firm-specific advantages. However, an international joint venture involves numerous actors in the market entry...... and civil society actors. It provides evidence of the reactive internationalisation of an MNE, showing how the transnational diaspora drove the MNE’s internationalisation and how a civil society actor, in conjunction with a diaspora member, facilitated the creation of an international joint venture (IJV...... and organisational capability base for this process, which would not have happened without their market-driving and enabling influence. The findings illustrate the central role of transnational diaspora entrepreneurship and the related innovation, motivation, contextual intelligence, networking and funding...

  17. Elegant Coercion and Iran: Beyond the Unitary Actor Model

    National Research Council Canada - National Science Library

    Moss, J. C

    2005-01-01

    .... At its core, then, coercion is about state decision-making. Most theories of coercion describe states as if they were unitary actors whose decision-making results from purely rational cost-benefit calculations...

  18. Interface Between Research, Development and Local Actors in ...

    African Journals Online (AJOL)

    Interface Between Research, Development and Local Actors in Enhancing ... Open Access DOWNLOAD FULL TEXT ... Environmental sustainability is a key area of focus in academic and development circles mainly because of the role that the ...

  19. Resenha: Power, Interdependence and Nonstate Actors in World Politics

    Directory of Open Access Journals (Sweden)

    Katiuscia Moreno Galhera Espósito

    2011-10-01

    Full Text Available Resenha do livro: Moravcsik, Andrew; Milner, Helen V. (org.. Power, Interdependence and Nonstate Actors in World Politics. New Jersey: Princeton University Press, 2009. ISBN 978-0-691-14027-8

  20. Efficient model learning methods for actor-critic control.

    Science.gov (United States)

    Grondman, Ivo; Vaandrager, Maarten; Buşoniu, Lucian; Babuska, Robert; Schuitema, Erik

    2012-06-01

    We propose two new actor-critic algorithms for reinforcement learning. Both algorithms use local linear regression (LLR) to learn approximations of the functions involved. A crucial feature of the algorithms is that they also learn a process model, and this, in combination with LLR, provides an efficient policy update for faster learning. The first algorithm uses a novel model-based update rule for the actor parameters. The second algorithm does not use an explicit actor but learns a reference model which represents a desired behavior, from which desired control actions can be calculated using the inverse of the learned process model. The two novel methods and a standard actor-critic algorithm are applied to the pendulum swing-up problem, in which the novel methods achieve faster learning than the standard algorithm.

  1. Utilization of Health Information System at District Level in Jimma ...

    African Journals Online (AJOL)

    Therefore, in-service training and updating of staff involved in health information system (HIS) at district, strengthening health information system inputs, timely and concrete feedbacks with establishment of functional health management information system (HMIS). KEY WORDS: Health Management Information System, ...

  2. Sustainable quality systems for every Health Service

    International Nuclear Information System (INIS)

    Touzet, Rodolfo; Pittaluga, Roberto R.

    2008-01-01

    The implementation of a Quality system is an indispensable requirement to assure the protection and the radiological safety, especially in those facilities where the potential risks are important. One of the 'general conclusions' of the Conference of Malaga (to achieve the RPP) is also the implementation of quality systems. Lamentably the great majority of the Services of Health in the world, more than 95 %, has not nowadays any formal quality system but only any elements what can be named a 'natural quality system' that includes protocols of work, records of several processes, certified of training of the personnel and diverse practices that are realized in systematic form but that not always are documented. Most health services do not have the necessary means available to adhere quickly to international standards. At the same time the health services do not have either qualified or trained personnel to lead a certification or accreditation project and most of them do not have the resources available to hire external consultants, especially the public hospitals. The scenario described represents a challenge for the Regulatory Authorities who must determine 'how to ensure that installations comply with an acceptable standard of quality without it placing an impossible strain on their budget?' Due to these circumstances a 'Basic Guide' has developed for the implementation of a quality system in every Health Service that takes the elements as a foundation of the standard ISO - 9000:2000 and the standard for systems management GSR-3 of the IAEA. The criteria and the methodologies are showed in the presentation. (author)

  3. Innovation barriers originating from the differing logics of network actors:

    DEFF Research Database (Denmark)

    Aarikka-Stenroos, Leena; Alaranta, Mar

    2016-01-01

    The recent IMP and innovation network research has highlighted that diverse aspects of actors' heterogeneity such as differing goals, knowledge bases, capabilities and competences, perceptions, power, position, and culture play a role in the development of collaborative innovation....../organization, inter-organizational and ecosystem levels. Our results advance knowledge on the diversity of barriers in collaborative innovation and commercializing science and how they relate to the different actors: a body of knowledge that is increasingly discussed among IMP stream....

  4. Logistics Performance of Actors in the Wine Supply Chain

    OpenAIRE

    Chandes , Jerôme; Estampe , Dominique

    2003-01-01

    International audience; In an environment marked by ever-greater international competition, wine sector companies have been seriously questioning the structure of their entire logistics chain. This is due to the emergence of new actors (i.e., large retailers); the diversification of service providers' product offers; and the different rapprochements between actors in this branch. These are all signals that have caused companies to question their logistics strategies as shown in the ISLI survey.

  5. Actor roles in transition: Insights from sociological perspectives

    OpenAIRE

    Wittmayer, Julia; Avelino, Flor; van Steenbergen, F.; Loorbach, Derk

    2016-01-01

    textabstractTo date, the field of transition research lacks a suitable vocabulary to analyse the (changing) interactions and relations of actors as part of a sustainability transition. This article addresses this knowledge gap by exploring the potential of the concept of 'roles' from social interaction research. The role concept is operationalized for transition research to allow the analysis of (changing) roles and relations between actor roles as indicative of changes in the social fabric a...

  6. Health systems research in the time of health system reform in India: a review.

    Science.gov (United States)

    Rao, Krishna D; Arora, Radhika; Ghaffar, Abdul

    2014-08-09

    Research on health systems is an important contributor to improving health system performance. Importantly, research on program and policy implementation can also create a culture of public accountability. In the last decade, significant health system reforms have been implemented in India. These include strengthening the public sector health system through the National Rural Health Mission (NRHM), and expansion of government-sponsored insurance schemes for the poor. This paper provides a situation analysis of health systems research during the reform period. We reviewed 9,477 publications between 2005 and 2013 in two online databases, PubMed and IndMED. Articles were classified according to the WHO classification of health systems building blocks. Our findings indicate the number of publications on health systems progressively increased every year from 92 in 2006 to 314 in 2012. The majority of papers were on service delivery (40%), with fewer on information (16%), medical technology and vaccines (15%), human resources (11%), governance (5%), and financing (8%). Around 70% of articles were lead by an author based in India, the majority by authors located in only four states. Several states, particularly in eastern and northeastern India, did not have a single paper published by a lead author located in a local institution. Moreover, many of these states were not the subject of a single published paper. Further, a few select institutions produced the bulk of research. Of the foreign author lead papers, 77% came from five countries (USA, UK, Canada, Australia, and Switzerland). The growth of published research during the reform period in India is a positive development. However, bulk of this research is produced in a few states and by a few select institutions Further strengthening health systems research requires attention to neglected health systems domains like human resources, financing, and governance. Importantly, research capacity needs to be strengthened in

  7. Branching points for transition pathways: assessing responses of actors to challenges on pathways to a low carbon future

    International Nuclear Information System (INIS)

    Foxon, Timothy J.; Pearson, Peter J.G.; Arapostathis, Stathis; Carlsson-Hyslop, Anna; Thornton, Judith

    2013-01-01

    This paper describes initial analysis of branching points on a set of transition pathways to a UK low carbon electricity future by 2050. As described in other papers in this special issue, we are exploring and analysing a set of core transition pathways, based on alternative governance patterns in which the ‘logics’ of market actors, government actors and civil society actors, respectively dominate. This core pathway analysis is enhanced by analyses of branching points within and across the pathways, which informs how competition between different logics plays out at key decision points. Branching points are defined as key decision points at which choices made by actors, in response to internal or external stresses or triggers, determine whether and in what ways the pathway is followed. A set of initial branching points for our three core transition pathways is identified through project and stakeholder workshops, and drawing on analysis of actors’ choices and responses at past branching points in energy system transitions. The potential responses of the actors are identified at these branching points, and risk mitigation strategies are formulated for the dominant actors to reinforce that pathway, as well as opportunities for actors to move away from the pathway. - Highlights: Transition Pathways is analysing three potential pathways to a low carbon future. ► Stresses lead to branching points, where actors make choices, creating pathways. ► These choices may lead to path-dependency. ► Differences in governance logics within transition pathways are also analysed. ► Studying branching points adds theoretical understanding and policy relevance to TP.

  8. Thinking about complexity in health: A systematic review of the key systems thinking and complexity ideas in health.

    Science.gov (United States)

    Rusoja, Evan; Haynie, Deson; Sievers, Jessica; Mustafee, Navonil; Nelson, Fred; Reynolds, Martin; Sarriot, Eric; Swanson, Robert Chad; Williams, Bob

    2018-01-30

    As the Sustainable Development Goals are rolled out worldwide, development leaders will be looking to the experiences of the past to improve implementation in the future. Systems thinking and complexity science (ST/CS) propose that health and the health system are composed of dynamic actors constantly evolving in response to each other and their context. While offering practical guidance for steering the next development agenda, there is no consensus as to how these important ideas are discussed in relation to health. This systematic review sought to identify and describe some of the key terms, concepts, and methods in recent ST/CS literature. Using the search terms "systems thinkin * AND health OR complexity theor* AND health OR complex adaptive system* AND health," we identified 516 relevant full texts out of 3982 titles across the search period (2002-2015). The peak number of articles were published in 2014 (83) with journals specifically focused on medicine/healthcare (265) and particularly the Journal of Evaluation in Clinical Practice (37) representing the largest number by volume. Dynamic/dynamical systems (n = 332), emergence (n = 294), complex adaptive system(s) (n = 270), and interdependent/interconnected (n = 263) were the most common terms with systems dynamic modelling (58) and agent-based modelling (43) as the most common methods. The review offered several important conclusions. First, while there was no core ST/CS "canon," certain terms appeared frequently across the reviewed texts. Second, even as these ideas are gaining traction in academic and practitioner communities, most are concentrated in a few journals. Finally, articles on ST/CS remain largely theoretical illustrating the need for further study and practical application. Given the challenge posed by the next phase of development, gaining a better understanding of ST/CS ideas and their use may lead to improvements in the implementation and practice of the Sustainable Development

  9. [Organization development of the public health system].

    Science.gov (United States)

    Pfaff, Holger; Klein, Jürgen

    2002-05-15

    Changes in the German health care system require changes in health care institutions. Organizational development (OD) techniques can help them to cope successfully with their changing environment. OD is defined as a collective process of learning aiming to induce intended organizational change. OD is based on social science methods and conducted by process-oriented consultants. In contrast to techniques of organizational design, OD is characterized by employee participation. One of the most important elements of OD is the so-called "survey-feedback-technique". Five examples illustrate how the survey-feedback-technique can be used to facilitate organisational learning. OD technique supports necessary change in health care organizations. It should be used more frequently.

  10. Wearable medical systems for p-Health.

    Science.gov (United States)

    Teng, Xiao-Fei; Zhang, Yuan-Ting; Poon, Carmen C Y; Bonato, Paolo

    2008-01-01

    Driven by the growing aging population, prevalence of chronic diseases, and continuously rising healthcare costs, the healthcare system is undergoing a fundamental transformation, from the conventional hospital-centered system to an individual-centered system. Current and emerging developments in wearable medical systems will have a radical impact on this paradigm shift. Advances in wearable medical systems will enable the accessibility and affordability of healthcare, so that physiological conditions can be monitored not only at sporadic snapshots but also continuously for extended periods of time, making early disease detection and timely response to health threats possible. This paper reviews recent developments in the area of wearable medical systems for p-Health. Enabling technologies for continuous and noninvasive measurements of vital signs and biochemical variables, advances in intelligent biomedical clothing and body area networks, approaches for motion artifact reduction, strategies for wearable energy harvesting, and the establishment of standard protocols for the evaluation of wearable medical devices are presented in this paper with examples of clinical applications of these technologies.

  11. The organic food supply chain in relation to information management and the interaction between actors

    OpenAIRE

    Kottila, Marja-Riitta; Maijala, Adeline; Rönni, Päivi

    2005-01-01

    Conventional retailers play a significant role in selling organic food, and therefore, it is important to understand how the demand - supply chain of organic food works as an element of the conventional food system. The proportion of organic food in the conventional food chains is small, and this poses a great challenge to the performance of the chain. Surveys and case specific studies on consumers and supply chain actors indicate that the changes in the conventional food system have an impac...

  12. Operating health analysis of electric power systems

    Science.gov (United States)

    Fotuhi-Firuzabad, Mahmud

    The required level of operating reserve to be maintained by an electric power system can be determined using both deterministic and probabilistic techniques. Despite the obvious disadvantages of deterministic approaches there is still considerable reluctance to apply probabilistic techniques due to the difficulty of interpreting a single numerical risk index and the lack of sufficient information provided by a single index. A practical way to overcome difficulties is to embed deterministic considerations in the probabilistic indices in order to monitor the system well-being. The system well-being can be designated as healthy, marginal and at risk. The concept of system well-being is examined and extended in this thesis to cover the overall area of operating reserve assessment. Operating reserve evaluation involves the two distinctly different aspects of unit commitment and the dispatch of the committed units. Unit commitment health analysis involves the determination of which unit should be committed to satisfy the operating criteria. The concepts developed for unit commitment health, margin and risk are extended in this thesis to evaluate the response well-being of a generating system. A procedure is presented to determine the optimum dispatch of the committed units to satisfy the response criteria. The impact on the response wellbeing being of variations in the margin time, required regulating margin and load forecast uncertainty are illustrated. The effects on the response well-being of rapid start units, interruptible loads and postponable outages are also illustrated. System well-being is, in general, greatly improved by interconnection with other power systems. The well-being concepts are extended to evaluate the spinning reserve requirements in interconnected systems. The interconnected system unit commitment problem is decomposed into two subproblems in which unit scheduling is performed in each isolated system followed by interconnected system evaluation

  13. Eschewing New World Order Tensions: Interpretations and Metaphors for Colombian Health System

    Directory of Open Access Journals (Sweden)

    Juan Carlos Aceros Gualdrón

    2003-11-01

    Full Text Available This article exemplifies a kind of tension that has been caused by the emergent world order; specifically, the one that has been established between the economic and social rationalities. In order to do so, it portrays the description that the ?Asociación Nacional Pro-Referendo Ley 100? (ANPR made of the Colombia?s Health System in an article called: ?Documento Parcial Preparatorio?. From this article we can highlight some metaphores that exemplify the before metioned tension, the actors involve in it and the proposed political action. In addition to that, there is a use of the cyborg image (Haraway,1991, the idea of the symbiotic contract (Serres, 1990, and the concept of the organizational government (Schvarstein, 2003 to translate the ANPR`s discourse and seek new ways of thinking. This article should not be taken as a reflection of the Health System?s reality. Instead, it should be taken as a possible reading to be given a second thought in order to produce a broader vision of the situation and a new point of view.

  14. The health and health system of South Africa: historical roots of current public health challenges.

    Science.gov (United States)

    Coovadia, Hoosen; Jewkes, Rachel; Barron, Peter; Sanders, David; McIntyre, Diane

    2009-09-05

    The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.

  15. Toward systems epidemiology of coffee and health.

    Science.gov (United States)

    Cornelis, Marilyn C

    2015-02-01

    Coffee is one of the most widely consumed beverages in the world and has been associated with many health conditions. This review examines the limitations of the classic epidemiological approach to studies of coffee and health, and describes the progress in systems epidemiology of coffee and its correlated constituent, caffeine. Implications and applications of this growing body of knowledge are also discussed. Population-based metabolomic studies of coffee replicate coffee-metabolite correlations observed in clinical settings but have also identified novel metabolites of coffee response, such as specific sphingomyelin derivatives and acylcarnitines. Genome-wide analyses of self-reported coffee and caffeine intake and serum levels of caffeine support an overwhelming role for caffeine in modulating the coffee consumption behavior. Interindividual variation in the physiological exposure or response to any of the many chemicals present in coffee may alter the persistence and magnitude of their effects. It is thus imperative that future studies of coffee and health account for this variation. Systems epidemiological approaches promise to inform causality, parse the constituents of coffee responsible for health effects, and identify the subgroups most likely to benefit from increasing or decreasing coffee consumption.

  16. Capital investment strategies in health care systems.

    Science.gov (United States)

    Reiter, K L; Smith, D G; Wheeler, J R; Rivenson, H L

    2000-01-01

    Capital investment decisions are among the most important decisions made by firms. They determine the firm's capacity for providing services and commit the firm's cash for an extended period of time. Interviews with chief financial officers of leading health care systems reveal capital investment strategies that generally follow the recommendations of modern finance theory. Still, there is substantial variation in capital budgeting techniques, methods of risk adjustment, and the importance of qualitative considerations in investment decision making. There is also variation in delegation of investment decision making to operating units and methods of performance evaluation. Health care systems face the same challenges as other organizations in developing and implementing capital investment strategies that use consistent methods for evaluation of projects that have inconsistent aims and outcomes.

  17. Making Technology Ready: Integrated Systems Health Management

    Science.gov (United States)

    Malin, Jane T.; Oliver, Patrick J.

    2007-01-01

    This paper identifies work needed by developers to make integrated system health management (ISHM) technology ready and by programs to make mission infrastructure ready for this technology. This paper examines perceptions of ISHM technologies and experience in legacy programs. Study methods included literature review and interviews with representatives of stakeholder groups. Recommendations address 1) development of ISHM technology, 2) development of ISHM engineering processes and methods, and 3) program organization and infrastructure for ISHM technology evolution, infusion and migration.

  18. Trail-Based Search for Efficient Event Report to Mobile Actors in Wireless Sensor and Actor Networks †

    Science.gov (United States)

    Xu, Zhezhuang; Liu, Guanglun; Yan, Haotian; Cheng, Bin; Lin, Feilong

    2017-01-01

    In wireless sensor and actor networks, when an event is detected, the sensor node needs to transmit an event report to inform the actor. Since the actor moves in the network to execute missions, its location is always unavailable to the sensor nodes. A popular solution is the search strategy that can forward the data to a node without its location information. However, most existing works have not considered the mobility of the node, and thus generate significant energy consumption or transmission delay. In this paper, we propose the trail-based search (TS) strategy that takes advantage of actor’s mobility to improve the search efficiency. The main idea of TS is that, when the actor moves in the network, it can leave its trail composed of continuous footprints. The search packet with the event report is transmitted in the network to search the actor or its footprints. Once an effective footprint is discovered, the packet will be forwarded along the trail until it is received by the actor. Moreover, we derive the condition to guarantee the trail connectivity, and propose the redundancy reduction scheme based on TS (TS-R) to reduce nontrivial transmission redundancy that is generated by the trail. The theoretical and numerical analysis is provided to prove the efficiency of TS. Compared with the well-known expanding ring search (ERS), TS significantly reduces the energy consumption and search delay. PMID:29077017

  19. Integrated System Health Management (ISHM) and Autonomy

    Science.gov (United States)

    Figueroa, Fernando; Walker, Mark G.

    2018-01-01

    Systems capabilities on ISHM (Integrated System Health Management) and autonomy have traditionally been addressed separately. This means that ISHM functions, such as anomaly detection, diagnostics, prognostics, and comprehensive system awareness have not been considered traditionally in the context of autonomy functions such as planning, scheduling, and mission execution. One key reason is that although they address systems capabilities, both ISHM and autonomy have traditionally individually been approached as independent strategies and models for analysis. Additionally, to some degree, a unified paradigm for ISHM and autonomy has been difficult to implement due to limitations of hardware and software. This paper explores a unified treatment of ISHM and autonomy in the context of distributed hierarchical autonomous operations.

  20. Security for decentralized health information systems.

    Science.gov (United States)

    Bleumer, G

    1994-02-01

    Health care information systems must reflect at least two basic characteristics of the health care community: the increasing mobility of patients and the personal liability of everyone giving medical treatment. Open distributed information systems bear the potential to reflect these requirements. But the market for open information systems and operating systems hardly provides secure products today. This 'missing link' is approached by the prototype SECURE Talk that provides secure transmission and archiving of files on top of an existing operating system. Its services may be utilized by existing medical applications. SECURE Talk demonstrates secure communication utilizing only standard hardware. Its message is that cryptography (and in particular asymmetric cryptography) is practical for many medical applications even if implemented in software. All mechanisms are software implemented in order to be executable on standard-hardware. One can investigate more or less decentralized forms of public key management and the performance of many different cryptographic mechanisms. That of, e.g. hybrid encryption and decryption (RSA+DES-PCBC) is about 300 kbit/s. That of signing and verifying is approximately the same using RSA with a DES hash function. The internal speed, without disk accesses etc., is about 1.1 Mbit/s. (Apple Quadra 950 (MC 68040, 33 MHz, RAM: 20 MB, 80 ns. Length of RSA modulus is 512 bit).

  1. Organizational Structure and Management in Romanian Health System

    OpenAIRE

    Boldureanu Daniel; Boldureanu Gabriela

    2010-01-01

    The health system in Romania in a continuous transformation from a centralized system (type Semashko) exists before 1989 year to one based on social health insurance (type Bismark). This paper examines the management and the organizational structure of the health system in Romania, and the relations between them in the context of the Health Reform Law.

  2. 42 CFR 438.242 - Health information systems.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Health information systems. 438.242 Section 438.242... Measurement and Improvement Standards § 438.242 Health information systems. (a) General rule. The State must ensure, through its contracts, that each MCO and PIHP maintains a health information system that collects...

  3. Bridging evidence, policy, and practice to strengthen health systems for improved maternal and newborn health in Pakistan.

    Science.gov (United States)

    Hirose, Atsumi; Hall, Sarah; Memon, Zahid; Hussein, Julia

    2015-11-25

    Policy and decision making should be based on evidence, but translating evidence into policy and practice is often sporadic and slow. It is recognised that the relationship between research and policy uptake is complex and that dissemination of research findings is necessary, but insufficient, for policy uptake. Political, social, and economic context, use of (credible) data and dialogues between and across networks of researchers and policymakers play important roles in evidence uptake. Advocacy is the process of mobilising political and public opinions to achieve specific aims and its role is crucial in mobilising key actors to push for policy uptake. Advocacy and research groups (i.e. those who would like to see research evidence used by policymakers) may use different approaches and tools to stimulate the diffusion of research findings. The use of mass- and social media, communication with study participants, and the involvement of stakeholders at the early stages of research development are examples of the approaches that can be employed to stimulate diffusion of evidence and increase evidence uptake. The Research and Advocacy Fund (RAF) for Maternal and Newborn Health (MNH) worked within the health system context in Pakistan with the aim of espousing the principles of evidence, advocacy, and dissemination to improve MNH outcomes. The articles included in this special issue are outputs of RAF and highlight where RAF's approaches contributed to MNH policy reforms. The papers discuss critical health system issues facing Pakistan, including service delivery components, demand creation, equitable access, transportation interventions for improved referrals, availability of medicines and equipment, and health workforce needs. In addition to these tangible elements, the health system 'software', i.e. the power and the political and social contexts, is also represented in the collection. These articles highlight three considerations for the future: the growing

  4. Full House: A Retrospective Analysis of High Sexually Transmitted Infection Prevalence among Adult Film Actors at a Singular Residence.

    Science.gov (United States)

    Kendrick, Katherine; Brown, Veronica; Lords, Caleb; Matthias, James; Henning, Ian; Blackmore, Carina; Likos, Anna

    2016-09-01

    During a routine human immunodeficiency virus (HIV) investigation, Florida Department of Health staff identified a house (house A) in which over 150 individuals had resided at least briefly. Further investigation revealed that house A is used by the producer of a small adult film production company to board his actors. This report describes sexually transmitted infection (STI) prevalence among male actors in gay adult films residing in a common Florida residence. LexisNexis Accurint was used to identify house A residents since October 2002 when the producer arrived. Information on STIs and interview data were obtained from Florida's STI surveillance system. An infection was considered to be associated with residence in house A if the date of diagnosis occurred 6 months before an individual's residence start date through 6 months after his residence end date. Excluding the producer, 150 men resided in house A starting from September 2003 to July 2015. Forty-six individuals had a reported case of HIV, syphilis, gonorrhea, and/or chlamydia with 92 infections total. Forty-two (46%) infections among 24 men were considered associated with residence in house A. LexisNexis Accurint was a useful tool for identifying house A residents, a highly mobile and highly sexually active population. There is a high prevalence of STIs among residents, but it is unclear where transmission is occurring. Settings like house A are good candidates for HIV pre-exposure prophylaxis and active STI screenings and may be an opportunity for public health officials to intervene in high-risk groups to reduce STI rates in the community.

  5. Occupational Safety and Health Management System (OSHMS)

    International Nuclear Information System (INIS)

    Shyen, A.K.S.; Mohd Khairul Hakimin; Manisah Saedon

    2011-01-01

    Safe work environment has always been one of the major concerns at workplace. For this, Occupational Safety and Health Act 1994 has been promulgated for all workplaces to ensure the Safety, Health and Welfare of its employees and any person at workplaces. Malaysian Nuclear Agency therefore has started the initiative to review and improve the current Occupational Safety and Health Management System (OSHMS) by going for OHSAS 18001:2007 and MS 1722 standards certification. This would also help in our preparation to bid as the TSO (Technical Support Organization) for the NPP (Nuclear Power Plant) when it is established. With a developed and well maintained OSHMS, it helps to create a safe working condition and thus enhancing the productivity, quality and good morale. Ultimately, this will lead to a greater organization profit. However, successful OSHMS requires full commitment and support from all level of the organization to work hand in hand in implementing the safety and health policy. Therefore it is essential for all to acknowledge the progress of the implementation and be part of it. (author)

  6. [Implementing strategies to improve the institutional governance of the Spanish National Health System].

    Science.gov (United States)

    Repullo, José Ramón; Freire, José Manuel

    2016-11-01

    The 2008 economic crisis made the issue of good governance more present and visible, but the debate risks stalling in an academic and political discourse that barely exceeds the declarative. We acknowledge the existence of noteworthy documents from scientific medical societies and some institutional proposals that point towards promising changes. Viewing good governance as accountability, participation, transparency, intelligence and integrity, our objective is to identify the determinants of inaction and remove the barriers that prevent the adoption of rational and widely agreed-upon proposals. This led us: 1) to allocate the proposals to their appropriate governance level (macro, meso, micro and system environment) so as to more directly engage the agents of change; and 2) to highlight some decision nodes that can act as levers to catalyse selective transformations and to initiate the change processes. Taking into account the diversity of actors and scenarios, a top-down rational, integrated and reformist strategy for the whole Spanish National Health System does not seem likely or viable. Therefore, the purpose of this paper is to promote changes, setting a targeted and reasoned agenda to visualise key issues and to enable multilevel and multidimensional thinking and advocacy of health-sector and society stakeholders. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Agriculture, health, and wealth convergence: bridging traditional food systems and modern agribusiness solutions.

    Science.gov (United States)

    Dubé, Laurette; Webb, Patrick; Arora, Narendra K; Pingali, Prabhu

    2014-12-01

    The causes of many vexing challenges facing 21st-century society are at the nexus of systems involved in agriculture, health and wealth production, consumption, and distribution. Using food as a test bed, and on the basis of emerging roadmaps that set achievable objectives over a 1- to 3-year horizon, we introduce this special feature with convergence thinking and practice at its core. Specifically, we discuss academic papers structured around four themes: (1) evidence for a need for convergence and underlying mechanisms at the individual and societal levels; (2) strategy for mainstreaming convergence as a driver of business engagement and innovation; (3) convergence in policy and governance; (4) convergence in metrics and methods. Academic papers under each theme are accompanied by a roadmap paper reporting on the current status of concrete transformative convergence-building projects associated with that theme. We believe that the insights provided by these papers have the potential to enable all actors throughout society to singly and collectively work to build supply and demand for nutritious food, in both traditional and modern food systems, while placing the burdens of malnutrition and ill health on their core strategic agendas. © 2014 New York Academy of Sciences.

  8. The role of health system governance in strengthening the rural health insurance system in China.

    Science.gov (United States)

    Yuan, Beibei; Jian, Weiyan; He, Li; Wang, Bingyu; Balabanova, Dina

    2017-05-23

    Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. China's success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes' designs, coverage, and funding

  9. Pilot Implementation of Health Information Systems

    DEFF Research Database (Denmark)

    Bansler, Jørgen P.; Havn, Erling C.

    2009-01-01

    Pilot implementation is a powerful and widely used approach in identifying design flaws and implementation issues before the full-scale deployment of new health information systems. However, pilot implementations often fail in the sense that they say little about the usability and usefulness...... of the proposed system designs. This calls for studies that seek to uncover and analyze the reasons for failure, so that guidelines for conducting such pilots can be developed. In this paper, we present a qualitative field study of an ambitious, but unsuccessful pilot implementation of a Danish healthcare...... information system. Based on the findings from this study, we identify three main challenges: (1) defining an appropriate scope for pilot implementation, (2) managing the implementation process, and (3) ensuring commitment to the pilot. Finally, recommendations for future research and implications...

  10. The Grand Strategy of Nonstate Actors: Theory and Implications

    Directory of Open Access Journals (Sweden)

    Garrett Pierman

    2015-12-01

    Full Text Available This article addresses the Realist assumption that only actors that are states can be considered to have a strategic culture. The primary issue raised is the question of the ability of non-state actors to have a strategic culture. Al-Qaida is used as a theoretical case study. Ultimately this article rejects the idea of territoriality in strategic culture formulation and calls for academics and policymakers alike to adopt a broader conception of actors on the international, stage. This broader conception of actors would necessitate rich case studies to be done in the future in order to seek an understanding of the strategic culture of the non-state actors which academics and policymakers must deal with in the modern security environment. In particular, the article finds that the assumptions held about al-Qaida thus far are wrong and, in reality, the group has ambitions that are cosmic in nature, which will necessitate change in the strategies used to fight against terrorism.

  11. Exploring agency beyond humans: the compatibility of Actor-Network Theory (ANT and resilience thinking

    Directory of Open Access Journals (Sweden)

    Angga Dwiartama

    2014-09-01

    Full Text Available At first glance, the compatibility of social theory and resilience thinking is not entirely evident, in part because the ontology of the former is rooted in social interactions among human beings rather than ecological process. Despite this difference, resilience thinking engages with particular aspects of social organization that have generated intense debates within social science, namely the role of humans as integral elements of social-ecological systems and the processes through which given social structures (including material relations are either maintained or transformed. Among social theoretical approaches, Actor-Network Theory (ANT is noted for its distinctive approach to these aspects. ANT proposes that human and nonhuman components (both referred to as actants have the same capacity to influence the development of social-ecological systems (represented as actor-networks by enacting relations and enrolling other actors. We explore the notion of agency that is employed in resilience thinking and ANT in order to extend our understandings of human-environment relationships through complementary insights from each approach. The discussion is illustrated by reference to ongoing assessment of resilience as it is experienced and expressed in two distinctive agricultural production systems: Indonesian rice and New Zealand kiwifruit. We conclude by establishing the potential for ANT to provide more profound theoretical conceptualizations of agency, both human and nonhuman, in analyses of social ecological systems.

  12. Social health insurance in Nepal: A health system departure toward the universal health coverage.

    Science.gov (United States)

    Pokharel, Rajani; Silwal, Pushkar Raj

    2018-04-10

    The World Health Organization has identified universal health coverage (UHC) as a key approach in reducing equity gaps in a country, and the social health insurance (SHI) has been recommended as an important strategy toward it. This article aims to analyze the design, expected benefits and challenges of realizing the goals of UHC through the recently launched SHI in Nepal. On top of the earlier free health-care policy and several other vertical schemes, the SHI scheme was implemented in 2016 and has reached population coverage of 5% in the implemented districts in just within a year of implementation. However, to achieve UHC in Nepal, in addition to operationalizing the scheme, several other requirements must be dealt simultaneously such as efficient health-care delivery system, adequate human resources for health, a strong information system, improved transparency and accountability, and a balanced mix of the preventive, health promotion, curative, and rehabilitative services including actions to address the social determinants of health. The article notes that strong political commitment and persistent efforts are the key lessons learnt from countries achieving progressive UHC through SHI. Copyright © 2018 John Wiley & Sons, Ltd.

  13. The link between UHC reforms and health system governance: lessons from Asia.

    Science.gov (United States)

    Hort, Krishna; Jayasuriya, Rohan; Dayal, Prarthna

    2017-05-15

    Purpose The purpose of this paper is to examine how and to what extent the design and implementation of universal health coverage (UHC) reforms have been influenced by the governance arrangements of health systems in low- and middle-income countries (LMIC); and how governments in these countries have or have not responded to the challenges of governance for UHC. Design/methodology/approach Comparative case study analysis of three Asian countries with substantial experience of UHC reforms (Thailand, Vietnam and China) was undertaken using data from published studies and grey literature. Studies included were those which described the modifications and adaptations that occurred during design and implementation of the UHC programme, the actors and institutions involved and how these changes related to the governance of the health system. Findings Each country adapted the design of their UHC programmes to accommodate their specific institutional arrangements, and then made further modifications in response to issues arising during implementation. The authors found that these modifications were often related to the impacts on governance of the institutional changes inherent in UHC reforms. Governments varied in their response to these governance impacts, with Thailand prepared to adopt new governance modes (which the authors termed as an "adaptive" response), while China and Vietnam have tended to persist with traditional hierarchical governance modes ("reactive" responses). Originality/value This study addresses a gap in current knowledge on UHC reform, and finds evidence of a complex interaction between substantive health sector reform and governance reform in the LMIC context in Asia, confirming recent similar observations on health reforms in high-income countries.

  14. Health and environmental risks of energy systems

    International Nuclear Information System (INIS)

    Hamilton, L.D.

    1984-01-01

    This paper gives four examples of health risk assessments of energy systems: (1) Comparative risk assessment of the health effects of the coal and nuclear fuel cycles. Estimates differ from previous values chiefly by inclusion of ranges of uncertainty, but some coal-cycle numbers were re-estimated. Upper-boundary public disease risks of air pollution from coal-fired plants dominate. Reactors probably account for most of the potential effect of major nuclear accidents. Accidental death rates in electricity generation are low for reactors and higher for coal. (2) Upper boundary air pollution health risks of existing fossil-based energy technologies in the United States. Preliminary mortality estimates were obtained combining potential impacts of three index pollutants - SO 4 , NO 2 , and CO - as independent measures of risk. Four fuel cycle trajectories leading to three end-uses were analyzed. Example results: domestic wood burning has substantial potential impact, with an upper boundary exceeding that of coal; upper-boundary air pollution impacts of gas can exceed those of oil, because of NO 2 . (3) Health risks of acid deposition and other transported air pollutants, carried out as part of an assessment of the US Congress Office of Technology Assessment (OTA) Acid Rain and Transported Air Pollutants - Implications for Public Policy. Three scenarios were examined, leading to estimates of 40,000 to 50,000 annual premature deaths, depending on year (1978 vs 2000) and scenario (holding total emissions constant vs 30% reduction). (4) health effects of uranium mill tailings piles. Mortality risk is estimated to be minuscule (8.7 x 10 -9 average individual lifetime cancer risk from a model mill, compared with 9.5 x 10 -4 for background radiation). Methods that sum risks over the indefinite future are shown to be to be unrealistic. 39 references, 7 figures, 15 tables

  15. Health and environmental risks of energy systems

    International Nuclear Information System (INIS)

    Hamilton, L.D.

    1984-01-01

    The paper gives four examples of health risk assessments of energy systems: (1) Comparative risk assessment of the health effects of the coal and nuclear fuel cycles. Estimates differ from previous values chiefly by inclusion of ranges of uncertainty, but some coal-cycle numbers were re-estimated. Upper-boundary public disease risks of air pollution from coal-fired plants dominate. Reactors probably account for most of the potential effect of major nuclear accidents. Accidental death rates in electricity generation are low for reactors and higher for coal. (2) Upper-boundary air pollution health risks of existing fossil-fuel-based energy technologies in the United States of America. Preliminary mortality estimates were obtained combining potential impacts of three index pollutants - SO 4 , NO 2 , and CO - as independent measures of risk. Four fuel cycle trajectories leading to three end-uses were analysed. (3) Health risks of acid deposition and other transported air pollutants, carried out as part of an assessment of the US Congress Office of Technology Assessment (OTA) 'Acid Rain and Transported Air Pollutants. (4) Health effects of uranium mill tailings piles. Mortality risk is estimated to be minuscule (8.7x10 -9 average individual lifetime cancer risk from a model mill, compared with 9.5x10 -4 for background radiation). Methods that sum risks over the indefinite future are shown to be unrealistic. As a final example of risk analysis, the cost-effectiveness analysis for proposed EPA standards for radionuclides is shown to be deficient by an analysis concluding that the cost per potential cancer avoided could range from US $70 million to US $140 billion

  16. Highlight: Improving health systems research in West Africa | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-04-15

    Apr 15, 2016 ... ... by the University of Ghana School of Public Health, in partnership with WAHO and IDRC. Health systems research experts and partners from across the ... adopted direct payment for health services as the primary means.

  17. Privacy, confidentiality and automated health information systems.

    Science.gov (United States)

    Vuori, H

    1977-12-01

    Professor Vuori's paper, first presented at the fourth Medico-legal Conference in Prague in the spring of this year, deals with the problem of the maintenance of confidentiality in computerized health records. Although more and more information is required, the hardware of the computer systems is so sophisticated that it would be very expensive indeed to 'break in' and steal from a modern data bank. Those concerned with programming computers are becoming more aware of their responsibilities concerning confidentiality and privacy, to the extent that a legal code of ethics for programmers is being formulated. They are also aware that the most sensitive of all relationships--the doctor-patient relationship--could be in danger if they failed to maintain high standards of integrity. An area of danger is where administrative boundaries between systems must be crossed--say between those of health and employment. Protection of privacy must be ensured by releasing full information about the type of data being stored, and by maintaining democratic control over the establishment of information systems.

  18. Biosecurity through Public Health System Design.

    Energy Technology Data Exchange (ETDEWEB)

    Beyeler, Walter E. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Finley, Patrick D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Arndt, William [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Walser, Alex Christian [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Mitchell, Michael David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-11-01

    We applied modeling and simulation to examine the real-world tradeoffs between developingcountry public-health improvement and the need to improve the identification, tracking, and security of agents with bio-weapons potential. Traditionally, the international community has applied facility-focused strategies for improving biosecurity and biosafety. This work examines how system-level assessments and improvements can foster biosecurity and biosafety. We modeled medical laboratory resources and capabilities to identify scenarios where biosurveillance goals are transparently aligned with public health needs, and resource are distributed in a way that maximizes their ability to serve patients while minimizing security a nd safety risks. Our modeling platform simulates key processes involved in healthcare system operation, such as sample collection, transport, and analysis at medical laboratories. The research reported here extends the prior art by provided two key compone nts for comparative performance assessment: a model of patient interaction dynamics, and the capability to perform uncertainty quantification. In addition, we have outlined a process for incorporating quantitative biosecurity and biosafety risk measures. Two test problems were used to exercise these research products examine (a) Systemic effects of technological innovation and (b) Right -sizing of laboratory networks.

  19. [Methodology for construction of a panel of indicators for monitoring and evaluation of unified health system (SUS) management].

    Science.gov (United States)

    Tamaki, Edson Mamoru; Tanaka, Oswaldo Yoshimi; Felisberto, Eronildo; Alves, Cinthia Kalyne de Almeida; Drumond Junior, Marcos; Bezerra, Luciana Caroline de Albuquerque; Calvo, Maria Cristina Marino; Miranda, Alcides Silva de

    2012-04-01

    This study sought to develop methodology for the construction of a Panel for the Monitoring and Evaluation of Management of the Unified Health System (SUS). The participative process used in addition to the systematization conducted made it possible to identify an effective strategy for building management tools in partnership with researchers, academic institutions and managers of the SUS. The final systematization of the Panel selected indicators for the management of the SUS in terms of Demand, Inputs, Processes, Outputs and Outcomes in order to provide a simple, versatile and useful tool for evaluation at any level of management and more transparent and easier communication with all stakeholders in decision-making. Taking the management of the SUS as the scope of these processes and practices in all normative aspects enabled dialog between systemic theories and those which consider the centrality of the social actor in the decision-making process.

  20. Static Safety for an Actor Dedicated Process Calculus by Abstract Interpretation

    OpenAIRE

    Garoche, Pierre-Loïc; Pantel, Marc; Thirioux, Xavier

    2006-01-01

    International audience; The actor model eases the definition of concurrent programs with non uniform behaviors. Static analysis of such a model was previously done in a data-flow oriented way, with type systems. This approach was based on constraint set resolution and was not able to deal with precise properties for communications of behaviors. We present here a new approach, control-flow oriented, based on the abstract interpretation framework, able to deal with communication of behaviors. W...

  1. Actors in Corruption: Business Politicians in Italy.

    Science.gov (United States)

    della Porta, Donatella

    1996-01-01

    Argues that the development of political corruption brings about important changes in the political system and in the characteristics of the political class. Describes the emergence and activities of a group of "business politicians" in Italy who have transformed political parties into socializing agencies for illicit activities. (MJP)

  2. Disappearing computers, social actors and embodied agents

    NARCIS (Netherlands)

    Nijholt, Antinus; Kunii, T.L.; Hock Soon, S.; Sourin, A.

    2003-01-01

    Presently, there are user interfaces that allow multimodal interactions. Many existing research and prototype systems introduced embodied agents, assuming that they allow a more natural conversation or dialogue between user and computer. Here we will first take a look at how in general people react

  3. Quasi-experimental study designs series-paper 12: strengthening global capacity for evidence synthesis of quasi-experimental health systems research.

    Science.gov (United States)

    Rockers, Peter C; Tugwell, Peter; Grimshaw, Jeremy; Oliver, Sandy; Atun, Rifat; Røttingen, John-Arne; Fretheim, Atle; Ranson, M Kent; Daniels, Karen; Luiza, Vera Lucia; Bärnighausen, Till

    2017-09-01

    Evidence from quasi-experimental studies is often excluded from systematic reviews of health systems research despite the fact that such studies can provide strong causal evidence when well conducted. This article discusses global coordination of efforts to institutionalize the inclusion of causal evidence from quasi-experiments in systematic reviews of health systems research. In particular, we are concerned with identifying opportunities for strengthening capacity at the global and local level for implementing protocols necessary to ensure that reviews that include quasi-experiments are consistently of the highest quality. We first describe the current state of the global infrastructure that facilitates the production of systematic reviews of health systems research. We identify five important types of actors operating within this infrastructure: review authors; synthesis collaborations that facilitate the review process; synthesis interest groups that supplement the work of the larger collaborations; review funders; and end users, including policymakers. Then, we examine opportunities for intervening to build the capacity of each type of actors to support the inclusion of quasi-experiments in reviews. Finally, we suggest practical next steps for proceeding with capacity building efforts. Because of the complexity and relative nascence of the field, we recommend a carefully planned and executed approach to strengthening global capacity for the inclusion of quasi-experimental studies in systematic reviews. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Engaging Actors in Co-Designing Heterogeneous Innovations

    DEFF Research Database (Denmark)

    Jørgensen, Ulrik; Lindegaard, Hanne; Rosenqvist, Tanja Schultz

    2011-01-01

    In this paper we share and analyze our experiences staging a co-design process in which we through different interventions engage important actors in designing. Our experiences are taking from an innovation and research project about user-involvement in textile design processes. As the project...... in our project’s agenda by going through the different stages of translation. The paper is finalized with reflections on the difficulties in engaging actors in a co-design process and transporting results into the existing framed context of design and architectural work....... related to translating and transporting the results of these different events due to the institutional and professional framing of projects and design processes. We are analyzing these through an actor network approach and use the translation term to describe how the participants slowly became engaged...

  5. The Eu as a strategic global policy actor

    DEFF Research Database (Denmark)

    Chatzopoulou, Sevasti; Ansell, Christopher

    that shapes and is being shaped by the EU strategic choices. This process is facilitated by the existing EU institutions and structures, the administrative and technical expertise capacity when it responds to the internal and external challenges (environment, sustainable development climate and circular......This article aims to complement the existing literature on the EU as a global actor and demonstrates that the EU’s entrepreneurship on policy, ideas and knowledge production contributes to the evolution of the EU as a strategic global policy actor. While the number of significant studies on the EU...... as a global actor proliferated the last decades, these studies concentrate on the EU’s role in a fragmented manner, focusing either on specific normative or more economic and trade issues, and thus often competing between themselves. This article acknowledges these contributions and aims to take them further...

  6. Two-actor conflict with time delay: A dynamical model

    Science.gov (United States)

    Qubbaj, Murad R.; Muneepeerakul, Rachata

    2012-11-01

    Recent mathematical dynamical models of the conflict between two different actors, be they nations, groups, or individuals, have been developed that are capable of predicting various outcomes depending on the chosen feedback strategies, initial conditions, and the previous states of the actors. In addition to these factors, this paper examines the effect of time delayed feedback on the conflict dynamics. Our analysis shows that under certain initial and feedback conditions, a stable neutral equilibrium of conflict may destabilize for some critical values of time delay, and the two actors may evolve to new emotional states. We investigate the results by constructing critical delay surfaces for different sets of parameters and analyzing results from numerical simulations. These results provide new insights regarding conflict and conflict resolution and may help planners in adjusting and assessing their strategic decisions.

  7. EU–Hamas actors in a state of permanent liminality

    DEFF Research Database (Denmark)

    Pace, Michelle; Pallister-Wilkins, Polly

    2018-01-01

    This article contributes to the debate on liminality within International Relations (IR) theory by focusing on the actorness of the European Union (EU) and Hamas. The concept of liminality as a transitional process is applied to frame the situation of both the EU and Hamas as political actors in......-between socially established categories. This article explores how the liminal identity of these two actors impacts, on the one hand, their relations with each other and, on the other hand, their relations of ‘self’. Exploring the procedural relations of the EU and Hamas, it argues for the necessity of recognising...... liminal categories in IR theory and practice, while, at the same time, it highlights the limits of such in-between categories in a world order still structured around the state....

  8. Actor-Network Theory as a sociotechnical lens to explore the relationship of nurses and technology in practice: methodological considerations for nursing research.

    Science.gov (United States)

    Booth, Richard G; Andrusyszyn, Mary-Anne; Iwasiw, Carroll; Donelle, Lorie; Compeau, Deborah

    2016-06-01

    Actor-Network Theory is a research lens that has gained popularity in the nursing and health sciences domains. The perspective allows a researcher to describe the interaction of actors (both human and non-human) within networked sociomaterial contexts, including complex practice environments where nurses and health technology operate. This study will describe Actor-Network Theory and provide methodological considerations for researchers who are interested in using this sociotechnical lens within nursing and informatics-related research. Considerations related to technology conceptualization, levels of analysis, and sampling procedures in Actor-Network Theory based research are addressed. Finally, implications for future nursing research within complex environments are highlighted. © 2015 John Wiley & Sons Ltd.

  9. Humanoids Learning to Walk: A Natural CPG-Actor-Critic Architecture.

    Science.gov (United States)

    Li, Cai; Lowe, Robert; Ziemke, Tom

    2013-01-01

    The identification of learning mechanisms for locomotion has been the subject of much research for some time but many challenges remain. Dynamic systems theory (DST) offers a novel approach to humanoid learning through environmental interaction. Reinforcement learning (RL) has offered a promising method to adaptively link the dynamic system to the environment it interacts with via a reward-based value system. In this paper, we propose a model that integrates the above perspectives and applies it to the case of a humanoid (NAO) robot learning to walk the ability of which emerges from its value-based interaction with the environment. In the model, a simplified central pattern generator (CPG) architecture inspired by neuroscientific research and DST is integrated with an actor-critic approach to RL (cpg-actor-critic). In the cpg-actor-critic architecture, least-square-temporal-difference based learning converges to the optimal solution quickly by using natural gradient learning and balancing exploration and exploitation. Futhermore, rather than using a traditional (designer-specified) reward it uses a dynamic value function as a stability indicator that adapts to the environment. The results obtained are analyzed using a novel DST-based embodied cognition approach. Learning to walk, from this perspective, is a process of integrating levels of sensorimotor activity and value.

  10. Humanoids Learning to Walk: a Natural CPG-Actor-Critic Architecture

    Directory of Open Access Journals (Sweden)

    CAI eLI

    2013-04-01

    Full Text Available The identification of learning mechanisms for locomotion has been the subject of much researchfor some time but many challenges remain. Dynamic systems theory (DST offers a novel approach to humanoid learning through environmental interaction. Reinforcement learning (RL has offered a promising method to adaptively link the dynamic system to the environment it interacts with via a reward-based value system.In this paper, we propose a model that integrates the above perspectives and applies it to the case of a humanoid (NAO robot learning to walk the ability of which emerges from its value-based interaction with the environment. In the model,a simplified central pattern generator (CPG architecture inspired by neuroscientific research and DST is integrated with an actor-critic approach to RL (cpg-actor-critic. In the cpg-actor-critic architecture, least-square-temporal-difference (LSTD based learning converges to the optimal solution quickly by using natural gradient and balancing exploration and exploitation. Futhermore, rather than using a traditional (designer-specified reward it uses a dynamic value function as a stability indicator (SI that adapts to the environment.The results obtained are analyzed and explained by using a novel DST embodied cognition approach. Learning to walk, from this perspective, is a process of integrating sensorimotor levels and value.

  11. Cooperation of return-to-work professionals: the challenges of multi-actor work disability management.

    Science.gov (United States)

    Liukko, Jyri; Kuuva, Niina

    2017-07-01

    This article explores which concrete factors hinder or facilitate the cooperation of return-to-work (RTW) professionals in a complex system of multiple stakeholders. The empirical material consists of in-depth interviews with 24 RTW professionals from various organizations involved in work disability management in Finland. The interviews were analyzed using thematic content analysis. The study revealed several kinds of challenges in the cooperation of the professionals. These were related to two partly interrelated themes: communication and distribution of responsibility. The most difficult problems were connected to the cooperation between public employment offices and other stakeholders. However, the study distinguished notable regional differences depending primarily on the scale of the local network. The main areas of improvement proposed by the interviewees were related to better networking of case managers and expansion of expertise. The article argues for the importance of systematic networking and stresses the role of public employment services in the multi-actor management of work disabilities. The article contributes to existing work disability case management models by suggesting the employment administration system as an important component in addition to health care, workplace and insurance systems. The study also highlights the need for expansion of expertise in the field. Implications for Rehabilitation Cooperation between RTW professionals in public employment offices and other organizations involved in work disability management was considered inadequate. In order to improve the cooperation of RTW professionals, the stakeholders need to create more systematic ways of communication and networking with professionals in other organizations. There is a need to expand the expertise in work disability management and rehabilitation, partly by increasing the role of other professionals than physicians.

  12. Social Workers' Role in the Canadian Mental Health Care System

    Science.gov (United States)

    Towns, Ashley M.; Schwartz, Karen

    2012-01-01

    Objective: Using Canadian survey data this research provides social workers in Canada with a better understanding of their role in the Canadian mental health care system. Methods: By analyzing data from the Canadian Community Health Survey, Cycle 1.2 Mental Health and Well-being, the role of social workers in the Canadian mental health system was…

  13. Social movements and the construction of crisis actors

    DEFF Research Database (Denmark)

    Bourne, Angela; Chatzopoulou, Sevasti

    2015-01-01

    of social movements occurs when they collaborate with similar movements in other countries, claim a European identity, invoke Europe-wide solidarity, contest authorities beyond the state and ascribe responsibility for solving the crisis to European Union (EU). By targeting EU authorities, social movements......This article examines the Europeanization of social movements following the European sovereign debt crisis. It develops a theoretical framework to measure degrees of social movement Europeanization, incorporating targets, participants, and issue frame dimensions of mobilization. Europeanization...... may contribute to the construction of the EU as a crisis actor and through deliberative processes define the roles and identities of such actors....

  14. Learning to Run with Actor-Critic Ensemble

    OpenAIRE

    Huang, Zhewei; Zhou, Shuchang; Zhuang, BoEr; Zhou, Xinyu

    2017-01-01

    We introduce an Actor-Critic Ensemble(ACE) method for improving the performance of Deep Deterministic Policy Gradient(DDPG) algorithm. At inference time, our method uses a critic ensemble to select the best action from proposals of multiple actors running in parallel. By having a larger candidate set, our method can avoid actions that have fatal consequences, while staying deterministic. Using ACE, we have won the 2nd place in NIPS'17 Learning to Run competition, under the name of "Megvii-hzw...

  15. Understanding The Resistance to Health Information Systems

    Directory of Open Access Journals (Sweden)

    David Ackah

    2017-07-01

    Full Text Available User resistance is users’ opposition to system implementation. Resistance often occurs as a result of a mismatch between management goals and employee preferences. There are two types of resistance to health iformation system namely active resistance and passive resistance. The manifestation of active resistance are being critical,  blaming/accusing, blocking, fault finding, sabotaging, undermining, ridiculing, intimidating/threatening, starting rumors, appealing to fear, manipulating arguing, using facts selectively, distorting facts and  raising objections. The manifestation of passive resistance are agreeing verbally but not following through, failing to implement change, procrastinating/dragging feet, feigning ignorance, withholding information, suggestions, help or support, and standing by and allowing the change to fail.

  16. A VME based health monitoring system

    International Nuclear Information System (INIS)

    Huang Yiming; Wang Chunhong

    2011-01-01

    It introduces a VME based health system for monitoring the working status of VME crates in the BEPCⅡ. It consists of a PC and a VME crate where a CMM (Classic Monitor System) is installed. The CMM module is responsible for collecting data from the power supply and temperature as well as fan speed inside the VME crate and send these data to the PC via the serial port. The author developed EPICS asynchronous driver by using a character-based device protocol StreamDevice. The data is saved into EPICS IOC database in character. Man-machine interface which is designed by BOY displays the running status of the VME crate including the power supply and temperature as well as fan speed. If the value of records display unusual, the color of the value will be changed into red. This can facilitate the maintenance of the VME crates. (authors)

  17. Canadian initiative leading the way for equitable health systems and ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-04-27

    Apr 27, 2016 ... Home · Resources · Publications ... The field of health systems research has grown into a vibrant community. IDRC grantees are actively involved in Health Systems Global, a newinternational agency that gathers researchers, ...

  18. Health financing: Who pays for equitable health systems? | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2012-10-24

    Oct 24, 2012 ... Countries rich and poor face difficult choices in funding quality health care for ... while 31 member states of the World Health Organization pay less than ... on how poor families are benefiting from services – or being excluded.

  19. ActorScript™ extension of C#®, Java®, Objective C®, JavaScript®, and SystemVerilog using iAdaptive™ concurrency for antiCloud™ privacy and security : One computer is no computer in IoT

    OpenAIRE

    Hewitt , Carl

    2015-01-01

    International audience; ActorScript(TM) is a general purpose programming language for efficiently implementing robust applications (with no single point of failure) using discretionary, adaptive concurrency that manages resources and demand.It is differentiated from previous languages by the following:- Universality* Ability to specify what Actors can do* Specify interface between hardware and software* Everything in the language is accomplished using message passing including the very defini...

  20. Health information systems: failure, success and improvisation.

    Science.gov (United States)

    Heeks, Richard

    2006-02-01

    The generalised assumption of health information systems (HIS) success is questioned by a few commentators in the medical informatics field. They point to widespread HIS failure. The purpose of this paper was therefore to develop a better conceptual foundation for, and practical guidance on, health information systems failure (and success). Literature and case analysis plus pilot testing of developed model. Defining HIS failure and success is complex, and the current evidence base on HIS success and failure rates was found to be weak. Nonetheless, the best current estimate is that HIS failure is an important problem. The paper therefore derives and explains the "design-reality gap" conceptual model. This is shown to be robust in explaining multiple cases of HIS success and failure, yet provides a contingency that encompasses the differences which exist in different HIS contexts. The design-reality gap model is piloted to demonstrate its value as a tool for risk assessment and mitigation on HIS projects. It also throws into question traditional, structured development methodologies, highlighting the importance of emergent change and improvisation in HIS. The design-reality gap model can be used to address the problem of HIS failure, both as a post hoc evaluative tool and as a pre hoc risk assessment and mitigation tool. It also validates a set of methods, techniques, roles and competencies needed to support the dynamic improvisations that are found to underpin cases of HIS success.