Diagnostic de l'accessibilité aux soins de santé en Haïti

L’accessibilité aux soins de santé est une priorité de nombreux gouvernements à travers le monde. En Haïti, les gouvernements se sont succédés et ont tenté à travers les années des interventions dont les résultats ne sont souvent pas satisfaisants. Le programme d’assistance médicale cubain, actuellement appliqué dans le pays, est en œuvre dans plus d’une vingtaine de pays en développement, mais il existe très peu d’évaluations indépendantes qui permettent de l’appréhender. Cet ouvrage se donne pour objectif de vérifier le bien fondé de cette intervention en tenant compte du contexte, d’établir la plausibilité en fonction des moyens du pays et finalement, de proposer des solutions qui améliorent la situation. Pour répondre à ces objectifs, l’étude de cas a été adoptée comme stratégie de recherche. Cette technique permet de mieux analyser le contexte, et de comprendre ses effets sur le programme. Des entrevues semi-structurées ont été réalisées pour permettre de faire les analyses stratégique et logique nécessaires pour atteindre les objectifs sus-cités. Les entrevues ont visé successivement la compréhension du modèle théorique, la détermination des problèmes pertinents auxquels fait le système de santé, les causes de la difficulté de rétention des professionnels et finale l’analyse du modèle. L’évaluation a révélé que l’accessibilité aux soins de santé est complexe et qu’un grand nombre de facteurs l’influencent. En Haïti, ces facteurs ne sont pas différents de ceux recensés dans la littérature. Mais la composante géographique associée à l’aspect administratif du système de santé en général constituent les éléments qui auraient l’impact le plus important sur l’accessibilité du système de santé. Vu les conditions actuelles, la modernisation de la gestion représente l’avenue à privilégier en attendant que les moyens permettent d’agir sur les autres facteurs. La rétention des professionnels de santé est un facteur essentiel de l’accessibilité aux soins de santé. Pour être efficace, les mécanismes de rétention utilisés doivent s’accompagner de mesures comme l’amélioration des conditions de travail, ainsi qu’un salaire compétitif. Les conditions de vie dans le milieu rural haïtien ne peuvent en rien être comparées à celles des pays développés. On ne peut espérer les mêmes résultats avec les programmes de rétention utilisés par cette intervention. Tenant compte du contexte socioéconomique et du tableau épidémiologique haïtien, il serait peut-être plus efficient de créer de nouveaux corps de métier. Ces derniers devraient être en mesure de régler les problèmes de santé simples, et occasionneraient des coûts moins importants. Ce serait à court terme et même à moyen terme une solution viable dans le contexte actuel. Le programme actuel s’il semble respecter les données probantes en matière d’accessibilité aux soins, néglige d’incorporer les paramètres spécifiques au milieu haïtien, nécessaires à l’atteinte de ses objectifs. La politisation excessive est aussi un facteur qui à terme pourrait conduire à l’échec de ce programme. Si à court terme le programme parvient à augmenter le nombre de professionnels de santé dans le pays, il est peu probable que cela dure. Les moyens précaires du pays ne lui permettent pas de se payer des professionnels hautement qualifiés dans les milieux sous desservis. L’intervention pour réussir doit intégrer les caractéristiques particulières du milieu et mettre plus d’accent sur la gestion du système.

Expérience migratoire antérieure et déqualification : étude de cas portant sur des immigrants russophones à Montréal

Malgré la politique d’ouverture à l’immigration, à la diversité et au multiculturalisme du Québec, les immigrants récents rencontrent de nombreuses barrières sur le marché du travail. Selon la vision néo-classique, le capital humain détermine l’intégration des immigrants et leur degré de déqualification. Bien que l’origine puisse influencer les caractéristiques professionnelles et personnelles des immigrants qualifiés, certains d’entre eux peuvent être de même origine mais avoir des caractéristiques différentes. L’expérience migratoire, définie comme le fait pour un individu d’avoir émigré une 1ère fois de son pays d’origine vers un pays étranger, avant d’émigrer de nouveau de ce pays vers un 3ème, pourrait modifier ces caractéristiques du capital humain et qui influence l’intégration des immigrants ainsi que leur degré de déqualification. Arrivés d’un pays très diversifié, étant instruits, et allophones, les immigrants d’ex-URSS se constituent un groupe représentatif pour cette étude. De surcroît, certains immigrants de ce groupe possèdent une expérience migratoire. Cette recherche a pour but d’examiner le rôle de l’expérience migratoire antérieure dans l’intégration des immigrants russophones sur le marché du travail québécois et de voir son impact sur la présence et le degré de déqualification. L’approche qualitative adoptée pour ce travail permet d’observer pleinement les opinions des immigrants quant à leur intégration professionnelle et d’examiner l’effet de l’expérience migratoire. Nous avons découvert que l’expérience migratoire peut modifier la situation des immigrants sur le marché du travail. D’une part, elle leur permet d’acquérir un diplôme et une expérience de pays économiquement développés, ce qui a plus de valeur au Québec que les diplômes et l’expérience de pays d’ex-URSS. En plus, cette expérience permet aux immigrants d’améliorer leurs compétences linguistiques. D’autre part, l’expérience migratoire peut modifier les caractéristiques comportementales, telles que les méthodes de recherche d’emploi ou l’adoption d’un comportement ouvert et flexible qui peut aider à l’intégration. De surcroît, l’amélioration des caractéristiques professionnelles et personnelles par une expérience migratoire peut avoir un effet de compensation qui diminue l’effet de la stratégie familiale sur la présence et le degré de déqualification. En somme, nous pouvons conclure que l’expérience migratoire antérieure a un effet sur l’intégration des immigrants russophones sur le marché du travail québécois, et particulièrement, sur la présence et le degré de déqualification.

À travers les expériences canadiennes en matière d’industries minières, les leçons à tirer pour Madagascar pour bâtir une croissance économique sans grande répercussion sur l’environnement.

L’essor économique se fait au gré de l’environnement et du développement social de la population. Le concept de « développement durable » a été discuté pour la première fois lors du Sommet de la terre à Rio de Janeiro (Brésil) en 1992. Ce concept consiste à concilier la protection de l’environnement et la croissance économique. La compagnie minière canadienne Osisko met en œuvre le projet aurifère « Canadian Malartic » au Québec. Ce projet suscite des controverses au sein de la population locale. En effet, elle craigne des effets néfastes de cette exploitation d’or sur leur environnement et leur bien-être. Analogiquement, le gouvernement malagasy a accordé l’exploitation du site Ambatovy pour l’extraction des minerais de nickel et de cobalt à des firmes multinationales. Ce site minier est situé au cœur de la forêt humide du versant Est de Madagascar, qui figure dans la liste du patrimoine naturel mondial en péril selon l’Organisation des Nations Unies pour l’Éducation, la Science et la Culture (UNESCO). Les gouvernements québécois et malagasy veulent harmoniser les règles juridiques de la protection environnementale avec celles de l’exploitation des ressources naturelles pour accomplir leurs « développements durables ». Pour ce faire, ils devraient favoriser la prise de décision décentralisée et la collaboration de toutes les parties intéressées, surtout lors de l’examen de l’évaluation environnementale des projets miniers. Ils devraient s’assurer aussi de l’application des engagements social et environnemental des entreprises minières durant l’exploitation. Enfin, ces gouvernements devraient renforcer l’exigence de l’assainissement des sites miniers à la fin de l’exploitation minière.

Sélection in vivo par phage display dans un modèle de sténose valvulaire aortique chez la souris pour la découverte de nouveaux peptides ciblant la valve aortique

La sténose valvulaire aortique (SVA) est la maladie des valves cardiaques la plus répandue dans les pays développés qui touche les personnes âgées. La SVA est un processus actif caractérisé par des dépôts de lipides, de l’inflammation, de la fibrose et une calcification active des feuillets qui progresse vers un épaississement et durcissement de la valve aortique et une diminution de l’aire de la valve aortique. Nous avons émis l’hypothèse que la pathogénèse de la SVA modifie progressivement l’endothélium de la valve aortique, ce qui engendre l’expression de biomarqueurs spécifiques aux tissus et à la maladie. On rapporte dans cet étude, l’utilisation de la technique de sélection in vivo par phage display d’une librairie de peptides aléatoires afin de trouver de nouveaux peptides candidats qui se lieraient à des biomarqueurs spécifiques à la valve aortique malade d’une souris. Des souris ATX (LDLr-/-;Tg(hApoB+/+)) âgées atteintes de la SVA ont été utilisées pour la sélection in vivo d’une librairie de peptides aléatoires de 7 acides aminés contraints ou linéaires. Après 4 tours de criblage, on a caractérisé 14 phages différents qui ont été séparés en 5 motifs consensus pour la librairie linéaire et 11 phages différents qui représentent 5 différents motifs consensus pour la libraire de peptides contraints. La spécificité de 4 phages candidats de la librairie linéaire et de 5 phages de la librairie contrainte a été étudiée par l’immunomarquage des peptides d’intérêt exprimés par les phages sur les coupes de tissus de la valve aortique malade par rapport aux tissus contrôles du foie, du rein, de la rate, du ventricule et du poumon. Parmi eux, 6 phages représentent des peptides candidats intéressants qui ont besoin d’être testés davantage pour évaluer leur spécificité in vivo à la valve. Bien qu’il reste encore de la validation à effectuer, les peptides candidats spécifiques trouvés peuvent représenter des agents moléculaires d’imagerie utiles ou des transporteurs dans la livraison de drogue qui ciblent la valve aortique malade.

Foreign exchange reserves in India and China

Professor Irma Glicman Adelman, an Irish Economist working in California University at Berkely, in her research work on ‘Development Over Two Centuries’, which is published in the Journal of Evolutionary Economics, 1995, has identified that India, along with China, would be one of the largest economies in this 21st Century. She has stated that the period 1700 - 1820 is the period of Netherlands, the period 1820 - 1890 is the period of England the period 1890 - 2000 is the period of America and this 21st Century is the century of China and India. World Bank has also identified India as one of the leading players of this century after China. India will be third largest economy after USA and China. India will challenge the Global Economic Order in the next 15 years. India will overtake Italian economy in 2015, England economy in 2020, Japan economy in 2025 and USA economy in 2050 (China will overtake Japan economy in 2016 and USA economy in 2027). India has the following advantages compared with other economies. India is 4th largest GDP in the world in terms of Purchasing Power. India is third fastest growing economy in the world after China and Vietnam. Service sector contributes around 57% of GDP. The share of agriculture is around 17% and Manufacture is 16% in 2005 - 2006. This is a character of a developed country. Expected GDP growth rate is 10% shortly (It has come down from 9.2% in 2006 - 2007 to 6.2% during 2008 - 2009 due to recession. It is only a temporary phenomenon). India has $284 billion as Foreign Exchange Reserve as on today. India had just $1 billion as Foreign Exchange Reserve when it opened its economy in the year 1991. In this research paper an attempt has been made to study the two booming economies of the globe with respect to their foreign exchange reserves. This study mainly based on secondary data published by respective governments and various studies done on this area

The evolution and heterogeneity of outward foreign direct investment from Latin America

The PhD dissertation investigates the rise of emerging country multinationals (EMNEs), a phenomenon that has opened up a series of research themes and debates. The main debate in this field is the extent to which the theories/frameworks on foreign direct investment (FDI), which have been developed from investigations on multinationals from developed countries, is relevant in explaining outward FDI from EMNEs. This debate is sparked by research suggesting that EMNEs supposedly do not hold the characteristics that are seen as a prerequisite to engaging in FDI. The underlying theme in this PhD is that the field should move away from a one size fit all categorisation of EMNEs, and explore the heterogeneity within EMNEs. Collecting data through various databases, archival articles and annual reports, there was an examination of the internationalisation process of 136 Latin American Multinationals (LAMNEs). The research explores the differences in internationalisation trajectories and global strategies and classifies firms into one of four categories. The four categories that LAMNEs fall into are: Natural-Resource Vertical Integrator, which are firms that are in resource seeking sectors; Accelerated Global, which depict firms that have become global over a very short period of time; Traditional Global, which are EMNEs that have internationalised at the same pace as developed country MNEs and Local Optimisers that only acquire or internationalise to developing countries. The analysis also looks at which decade LAMNEs engaged in FDI, to see if LAMNEs that internationalised during the 1970s and 1980s, during a time when Latin America had a closed economy, was different to LAMNEs that internationalised during the Washington consensus era of the 1990s or to firms that have only just internationalised within the last decade. The findings show that LAMNEs that internationalised before 1990 were more likely to adopt Local Optimiser strategies. However, more LAMNEs that started to internationalise during the 1990s started to adopt Traditional Global strategies, although Local Optimisers were the most prominent strategy. From 2002, there was more prominence of Accelerated Global strategies and a lot more heterogeneity among LAMNEs. Natural-Resource Vertical Integrator LAMNEs, tended to start to internationalisation process during the 1970s/1980s. Despite the rise of EMNEs, and by extension LAMNEs opting to use cross border merger and acquisitions (M&A), there is little research on whether this entry mode has been successful. Contrary to the argument that EMNEs are “internationalising successfully” through this strategy, the findings show that these firms are highly geared and are running less efficiently against their Western competitors. In comparison, LAMNEs internationalising through a more gradual approach, are outperforming their Western competitors on efficiency and are not highly geared- i.e. do not hold a lot of debt. The conclusion of the thesis is the emphasis of moving away from evaluating firms from their country or region of origin, but rather through the global strategy they are using. This will give a more a robust firm level of analysis, and help develop the understanding of EMNEs and international business theory.

Communicating the ethos of codes of ethics within the organization : a comparison of the largest private sector organizations in Sweden and Turkey

Purpose – The purpose of the paper is to examine the ways that the largest private sector organizations in Sweden and Turkey communicate the intent of their codes of ethics to their employees.

Design/methodology/approach – Primary data were obtained via a self-administered mail questionnaire distributed to a census of the top 500 private sector organizations based on revenue in each country.

Findings – The research identified some interesting findings that showed that the small group of companies in Turkey that have a code may appear to be more “advanced” in ethics artifacts usage than Sweden. Such a conclusion is counter-intuitive as one would have expected a developed nation like Sweden to be more advanced in these measures than a developing nation such as Turkey. Culture may play a large role in the implementation of ethics artifacts in corporations and could be a major reason for this difference.

Research limitations/implications – As this is such a new area of investigation in Turkey, the responses amount to only 32 companies that have a code. The small sample is indicative of the formative evolution toward having codes of ethics within companies operating within Turkey.

Practical implications – This study enables those organizations that comprise corporate Turkey to view the current state of codes of ethics in Turkish companies and to compare these with the responses of a developed country of the European Union. Originality and value – A review of the literature indicates that this is the first time that such an international study specifically focused upon codes of ethics and the artifacts to inculcate the ethos of the code into every day corporate affairs has included Turkey as one of the participating countries.

The burden of disease and injury in Australia

An overview of the results of the Australian Burden of Disease (ABD) study is presented. The ABD study was the first to use methodology developed for the Global Burden of Disease study to measure the burden of disease and injury in a developed country. In 1996, mental disorders were the main causes of disability burden, responsible for nearly 30% of total years of life lost to disability (YLD), with depression accounting for 8% of the total YLD. Ischaemic heart disease and stroke were the main contributors to the disease burden disability-adjusted life years (DALYs), together causing nearly 18% of the total disease burden. Risk factors such as smoking, alcohol consumption, physical inactivity, hypertension, high blood cholesterol, obesity and inadequate fruit and vegetable consumption were responsible for much of the overall disease burden in Australia. The lessons learnt from the ABD study are discussed, together with methodological issues that require further attention.

Epidemiology of acute rheumatic fever in New Zealand 1996-2005

Aim: Acute rheumatic fever (ARF) and its sequela chronic rheumatic heart disease remain significant causes of morbidity and mortality in New Zealand, particularly among Māori and Pacific peoples. Despite its importance, ARF epidemiology has not been reviewed recently. The aims of this study were to assess trends in ARF incidence rates between 1996 and 2005 and the extent to which ARF is concentrated in certain populations based on age, sex, ethnicity and geographical location.

Methods: This descriptive epidemiological study examined ARF incidence rates using hospitalisation data (1996–2005) and population data from the 1996 and 2001 censuses. Rates were compared by using rate ratios and 95% confidence intervals.

Results: New Zealand's annual ARF rate was 3.4 per 100 000. ARF was concentrated in certain populations: 5- to 14-year-olds, Māori and Pacific peoples and upper North Island areas. From 1996 to 2005, the New Zealand European and Others ARF rate decreased significantly while Māori and Pacific peoples’ rates increased. Compared with New Zealand European and Others, rate ratios were 10.0 for Māori and 20.7 for Pacific peoples. Of all cases, 59.5% were Māori or Pacific children aged 5–14 years, yet this group comprised only 4.7% of the New Zealand population.

Conclusion: ARF rates in New Zealand have failed to decrease since the 1980s and remain some of the highest reported in a developed country. There are large, and now widening, ethnic disparities in ARF incidence. ARF is so concentrated by age group, ethnicity and geographical area that highly targeted interventions could be considered, based on these characteristics.

Aquaculture : a newly emergent food production sector-and perspectives of its impacts on biodiversity and conservation

The fisheries sector in the course of the last three decades have been transformed from a developed country to a developing country dominance. Aquaculture, the farming of waters, though a millennia old tradition during this period has become a significant contributor to food fish production, currently accounting for nearly 50 % of global food fish consumption; in effect transforming our dependence from a hunted to a farmed supply as for all our staple food types. Aquaculture and indeed the fisheries sector as a whole is predominated in the developing countries, and accordingly the development strategies adopted by the sector are influenced by this. Aquaculture also being a newly emerged food production sector has being subjected to an increased level of public scrutiny, and one of the most contentious aspects has been its impacts on biodiversity. In this synthesis an attempt is made to assess the impacts of aquaculture on biodiversity. Instances of major impacts on biodiversity conservation arising from aquaculture, such as land use, effluent discharge, effects on wild populations, alien species among others are highlighted and critically examined. The influence of paradigm changes in development strategies and modern day market forces have begun to impact on aquaculture developments. Consequently, improvements in practices and adoption of more environmentally friendly approaches that have a decreasing negative influence on biodiversity conservation are highlighted. An attempt is also made to demonstrate direct and or indirect benefits of aquaculture, such as through being a substitute to meet human needs for food, particularly over-exploited and vulnerable fish stocks, and for other purposes (e.g. medicinal ingredients), on biodiversity conservation, often a neglected entity.

Banking on ICT : how the Tuvalu financial services industry benefits from investment in ICT

Financial service industries in every country have made substantial investments in information and communication technologies (ICTs). What have been the benefits from this investment? This research extends the decades of research into the relationship between ICT investment and organisational performance in several ways. First the study uses the resource-based value framework to propose an ICT Investment Model to comprehensively describe the relationship between ICT investment and organisational performance. Second, the research identifies nine specific benefits the Tuvalu financial services industry (TFSI) has received from ICT investment. Third, the study does so with a qualitative research methodology in a specific industry in a developing country (most studies in this area are quantitative and have a national or multi-industry perspective in an economically developed country). Key benefits from ICT investment in the TFSI include improvements in collaboration, efficiency, data monitoring and communication.

Expatriate skills training strategies of Chinese multinationals operating in Australia

Recent years have witnessed a phenomenal growth in outward foreign direct investment (FDI) by Chinese multinationals. In contrast to their developed country counterparts, Chinese multinationals lack experience in foreign expansion and international operation. Although there has been increasing academic attention placed on Chinese outward FDI, little research on expatriate skills training of Chinese multinational enterprises (MNEs) has been conducted. Since the mainstream research focuses on expatriate pre-departure training rather than on learning during assignment, this study aims to bridge this gap by exploring how Chinese MNEs cope with expatriate training and skill enhancement when operating in an advanced economy such as Australia. The study utilises cross-level, in-depth interviews to analyse expatriate training in seven Chinese multinationals. Drawing on social learning theory, some patterns of Chinese expatriate skills training strategies are revealed, such as internationalisation as learning, the use of subsidiaries as a training tool, and learning as belonging.

Estudo comparativo entre a subvenção econômica à inovação operada pela Finep e programas correlatos de subsídio em países desenvolvidos

A inovação tecnológica é um dos principais fatores de competitividade das economias modernas e, em todos os países desenvolvidos, é objeto de políticas oficiais para sua promoção. No Brasil, a Financiadora de Estudos e Projetos (Finep) apóia o desenvolvimento tecnológico das empresas desde 1976. A partir de 2006, passou a operar também subsídios diretos na forma de subvenção econômica. Este estudo caracteriza a subvenção econômica no marco legal brasileiro, apresentando exemplos de sua utilização como política pública e, especificamente, a subvenção à inovação operada pela Finep no período de 2006 a 2009. Em seguida, o instrumento da Finep é comparado, por análise de conteúdo, com programas de subsídio correlatos em países desenvolvidos. Para tal, foram selecionados os programas norte americanos SBIR, ATP e TIP, e aqueles operados pela OSEO na França e CDTI na Espanha. São abordados aspectos relativos à lógica de intervenção, dando ênfase a questões como risco tecnológico, intensidade no apoio, modelos institucionais e integração de instrumentos de apoio.

Transformation of brain drain of brain gain: incentives to attract talented workforce

The key for the future of any country, firm or group lies in the talent, skills, experience, knowledge and capabilities of its people. Migration of human capital resource on an international level depicts the impact on the developing country having its highly educated individuals migrating to developed countries known as “Brain Drain.” Therefore, evaluation of short-term and long-term talent needs and impacts on any country is critical. This paper aims to complement the existing theoretical brain drain and brain gain literature, focusing on the interaction between investment in education, training, healthcare and government to attract highly talented individuals to a developing a country. The migration study is inclusive of the analysis of the highly talented resources that have committed to or are planning to resettle in their developing native countries after investing in themselves through education. The motivational factors of these highly talented individuals are evaluated to determine key needs and drives attracting these individuals back to China from a developed country (aka. reserve migration).

Care arrangements for people with dementia in developing countries

Background: Rapid demographic ageing will soon lead to large increases in the numbers of persons with dementia in developing countries. This study is the first comprehensive assessment of care arrangements for people with dementia in those regions. Methods: A descriptive and comparative study of dementia care; caregiver characteristics, the nature of care provided, and the practical, psychological (Zarit Burden Interview, General Health Questionnaire) and economic impact upon the caregiver in 24 centres in India, China and South East Asia, Latin America and the Caribbean and Africa. Results: We interviewed 706 persons with dementia, and their caregivers. Most caregivers were women, living with the person with dementia in extended family households. One-quarter to one-half of households included a child. Larger households were associated with lower caregiver strain, where the caregiver was co-resident. However, despite the traditional apparatus of family care, levels of caregiver strain were at least as high as in the developed world. Many had cutback on work to care and faced the additional expense of paid carers and health services. Families from the poorest countries were particularly likely to have used expensive private medical services, and to be spending more than 10% of the per capita GNP on health care. Conclusions: Older people in developing countries are indivisible from their younger family members. The high levels of family strain identified in this study feed into the cycle of disadvantage and should thus be a concern for policymakers in the developing world. Copyright © 2004 John Wiley & Sons, Ltd.