National self-sufficiency in reproductive resources: an innovative response to transnational reproductive travel

Transnational reproductive travel is symptomatic of insufficient supplies ofreproductive resources, including donor gametes and gestational surrogacy services,and inequities in access to these within domestic health-care jurisdictions.Here, we argue that an innovative approach to domestic policy makingusing the framework of the National Self-Sufficiency paradigm represents thebest solution to domestic challenges and the ethical hazards of the global marketplacein reproductive resources.

How to address the ethics of reproductive travel to developing countries: a comparison of national self-sufficiency and regulated market approaches

One of the areas of concern raised by cross-border reproductive travelregards the treatment of women who are solicited to provide their ova orsurrogacy services to foreign consumers. This is particularly troublesome inthe context of developing countries where endemic poverty and low standardsfor both medical care and informed consent may place these womenat risk of exploitation and harm. We explore two contrasting proposals forpolicy development regarding the industry, both of which seek to promoteethical outcomes and social justice: While one proposal advocates efforts tominimize cross-border demand for female reproductive resources throughthe pursuit of national self-sufficiency, the other defends cross-border tradeas a means for meeting the needs of vulnerable groups. Despite theconflicting objectives of the proposed strategies, the paper identifiescommon values and points of agreement between the two, including theimportance of regulations to safeguard those providing ova or surrogacyservices.

The long road from the kidney bazaar: a commentary on Pakistan’s progress towards self-sufficiency in organ transplantation

The dark history of transplant tourism in Pakistan demonstrates the hazards of unregulated cross-border markets in human organs. Trading on existing national and international social inequities, ‘transplant tourism’ offers dubious benefits for transplant recipients and attractive profits to those facilitating the industry at the expense of the world’s poor. The impact of Pakistan’s 2007 Transplantation of Human Organs and Tissue Ordinance and the sustained efforts of transplant professionals and societal groups led by the Sindh Institute of Urology and Transplantation, show that organ trading can be effectively discouraged and equitable programs of organ procurement and transplantation pursued despite multiple challenges. In this paper, the factors that have contributed to Pakistan’s progress towards self-sufficiency in organ transplantation are identified and discussed. The case of Pakistan highlights the need for countries to protect their own organ and tissue providers who may be vulnerable in the global healthcare market. Pakistan provides an excellent example for other countries in the region and throughout the world to consider when regulating their own transplantation programs and considering the pursuit of national self-sufficiency.

Healthcare in continuum for an ageing population: national self monitoring or remote offshore monitoring for Australia?

Australia is a country, similar to other developed nations, confronting an ageing population with complex demographics. Ensuring continued healthcare for the ageing, while providing sufficient support for the already aged population requiring assistance, is at the forefront of the national agenda. Varied initiatives are with foci to leverage the advantages of lCTs leading to e-Health provisioning and assisted technologies. While these initiatives increasingly put budgetary constraints on local and federal governments, there is also a case for offshore resourcing of non-critical health services, to support, streamline and enhance the continuum of care, as the nation faces acute shortages of medical practitioners and nurses. However, privacy and confidentiality concerns in this context are a significant issue in Australia. In this paper, we take the position that if the National and state electronic health records system initiatives, are fully implemented, offshore resourcing can be a feasible complementary option resulting in a win-win situation of cutting costs and enabling the continuum of healthcare.

Healthcare in continuum for an ageing population - national self monitoring or remote offshore monitoring for Australia?

Australia is a country, similar to other developed nations, confronting an ageing population with complex demographics. Ensuring continued healthcare for the ageing, while providing sufficient support for the already aged population requiring assistance, is at the forefront of the national agenda. Varied initiatives are with foci to leverage the advantages of ICTs leading to e-Health provisioning and assisted technologies. While these initiatives increasingly put budgetary constraints on local and federal governments, there is also a case for offshore resourcing of non-critical health services, to support, streamline and enhance the continuum of care, as the nation faces acute shortages of medical practitioners and nurses. However, privacy and confidentiality concerns in this context are a significant issue in Australia. In this paper, we take the position that if the National and state electronic health records system initiatives, are fully implemented, offshore resourcing can be a feasible complementary option resulting in a win-win situation of cutting costs and enabling the continuum of healthcare.

The Doha model of organ donation and transplantation: thinking beyond citizenship

This paper reviews the policy and practice of organ donation and transplantation in Qatar that has developed since January 2011. The important features of the Doha Model (the ‘Model’) are explored, including: (i) all legal residents of Qatar have an equal right to access deceased donor organs and transplantation regardless of their citizenship status; (ii) no prioritisation in organ allocation is given to Qatari citizens; (iii) a multilingual and multicultural education and promotional program about donation has been implemented to engage the diverse national communities resident within Qatar; (iv) financial incentives or fungible rewards for living or deceased donation are prohibited. The ethical framework of this policy will be examined in the light of the national self-sufficiency paradigm, which advocates reciprocity and solidarity among resident populations seeking to meet all needs for transplantation equitably. We review some preliminary evidence of the impact of the Model with respect to engagement of a highly diverse multinational population in a donation and transplantation program, and argue that the Model may inform policy and practice in other countries, particularly those with non-citizen resident populations.

Medical travel and the sale of human biological materials: suggestions for ethical policy development

The international medical travel industry includes patients seeking to access human biological materials (HBM) including gametes, organs and stem cells. Of the various niche markets, ‘transplant tourism’ has earned global condemnation and efforts to eradicate cross-border trade in organs, while other markets continue to expand. This article reviews the ethical issues raised by medical travel for HBM, in particular those concerning trade in HBM. It argues that a more consistent approach to the regulation of cross-border trade is imperative to ensure that the perils of ‘transplant tourism’ are not replicated in other markets. In addition, it discusses the role of the self-sufficiency model in assisting the development of ethical and practical policies regarding the procurement and use of human biological materials at a national level, thereby minimizing demand for medical travel.

The dynamics of adult education : effectiveness of financial education seminars

This study examines the impact of adult education seminars in superannuation investments for retirement has on the investment intentions and decision making of those adults attending the seminars.  The socio-political context of the data is that of an aging population and a future government being unable to afford the current level of age pensions being paid, and attempting to encourage individuals to plan and provide for their own financial well-being in retirement.  Three themes emerged from the data and were seen to be representative of the major issues found in adult education for financial self-sufficiency: education for knowledge, education for decision making, and education for action.  In an attempt to measure the immediate impact of the seminar on the attendees decision making, the investment intentions of seminar attendees were captured at the start and end of the seminar. This was followed up three months later to see whether the intentions expressed at the end of the seminar had been implemented.  The immediate impact of the seminar was to encourage the respondents to express an intention to increase their investment strategy, however when the follow-up was done three months later, the results were mixed. Some respondents who did not express an intention to change their investment strategy actually made changes, and other respondents who did express an intention to make a change, did not do so.

Case study of the integration of ICT's into the school curriculum

This study, conducted in a laptop environment, found many factors mediate teachers' integration of information and communication technologies (ICTs) into the curriculum. Successful integration of ICTs was not so much related to pedagogical style and teachers' self-sufficiency with computers, as to the principle of 'teachers first' and professional development which utilizes a 'situative-learning' model.

Aiming for world peace by promoting 'violence' in education

In order to contribute towards UNESCO’s goal of pursuing world peace, aims of education must transcend the limited scope of national self-interest which has dominated schooling systems in the West for the last two centuries and further back when the survival of each polis in Ancient Greece was of paramount importance. Aims must therefore become different and the environment that is thought best for this to occur is a democratic one. The case is made that such a democratic environment should involve opportunities to evaluate the value of current aims of education and to explore others in light of the pressing need to pursue peace on a global scale. In order to promote such a democratic environment of discussion and debate the notion of ‘violence’ is considered as a potential framework for such a re-evaluation. The sort of ‘violence’ that is called for is in reference to its use by Emmanual Levinas who employed it emotively to misinterpret Kierkegaard. The use of this misapplied term ‘violence’ may nevertheless be of use in initiating the sort of inquiry of a Deweyean type regarded here to be necessary to improve aims of education democratically in order to pursue world peace.

The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey

Objective
To quantify the benefits that people receive from participating in self-management courses and identify subgroups that benefit most.

Methods
People with a wide range of chronic conditions attending self-management courses (N = 1341 individuals) were administered the Health Education Impact Questionnaire (heiQ). Baseline and follow-up data were collected resulting in 842 complete responses. Outcomes were categorized as substantial improvement (effect size, ES ≥ 0.5), minimal/no change (ES −0.49 to 0.49) and substantial decline (ES ≤ −0.5).

Results
On average, one third of participants reported substantial benefits at the end of a course and this ranged from 49% in the heiQ subscale Skill and technique acquisition to 27% in the heiQ subscale Health service navigation. Stratification by gender, age and education showed that younger participants were more likely to benefit, particularly young women. No further subgroup differences were observed.

Conclusion
While the well-being of people with chronic diseases tends to decline, about one third of participants from a wide range of backgrounds show substantial improvements in a range of skills that enable them to self-manage.

Practice implications
These data support the application of self-management courses indicating that they are a useful adjunct to usual care for a modest proportion of attendees.

Acceptability, impact and sustainability of the national pilot quality assurance system for self management programs

Chronic condition self-management education and training interventions such as the Stanford Self Management Programs (SMP) have the capacity to improve health and quality of life of people with chronic conditions whilst reducing the use of health services. This is in line with the outcomes from the recent Council of Australian Governments’ meeting where it was indicated that self-management will be a centrepiece in forthcoming chronic disease initiatives.
Aim: report on a large national pilot quality assurance program involving the implementation and of an evaluation and quality monitoring system for SMPs including the provision of structured feedback to courses course leaders and service providers. During 2005/06 the quality assurance program was implemented at 11 diverse organisations across Australia. The program involved assisting organisations apply the 42-item Health Education Impact Questionnaire (HEIQ), a chronic disease health education outcome measure, and then observe and evaluate the value and impact of the quality program. Interviews with course leaders (n=60) and course participants (n=35) have elicited views about course quality and feedback processes.
Results: The evaluation revealed enablers and barriers to effective implementation and sustainability. Important enablers were:
- Course Leaders and organisations valued an Australia-wide system that provided feedback on course
quality and the impact on participants.
- Course Leaders were strongly personally motivated to respond appropriately to HEI-Q course
report feedback.
- Completing the questionnaire provided participants with the opportunity to reflect on issues that
emerge in the course content and reflect on their progression at the end of the SSMP.
Sustainability issues included:
- Organisations and course leaders require support, training and flexibility on how to administer and
manage the use of the HEI-Q.
- Availability of administrative resources in organisations to support the quality assurance activities.
- The requirement that course leaders are trained in interpreting HEI-Q course report data.
A quality improvement framework was developed which identified the actions required of key stakeholders to
support effective implementation.
Discussion: With the increasing endorsement of SMP across sectors it is important that course quality is known, is acceptable, and is communicated to stakeholders to inform and engender confidence in the SSMP. To effectively implement and sustain a quality improvement program for SMP, the processes and tools for measuring outcomes need to be responsive, flexible and easily integrated into the organisation and delivery of programs.