Tourism in the Caribbean: competitiveness, upgrading, linkages and the role of public private partnerships (PPP) and public policy

The main purpose of this paper is to explore and analyze the contributions that publicprivate partnerships and public policy have made in the development of tourism in the Caribbean as tools for enhancing competitiveness in the Caribbean tourism industry. The paper explores these contributions mainly in the context of the upgrading strategies that Caribbean countries have pursued over the past 15 years or so and using the lens of the tourism value chain and tourism cluster approach. The paper also analyzes the potential roles that public-private partnerships and public policy will continue to play in the future especially in the process of building linkages between the tourism sector and other sectors in order to increase net benefits from tourism to the Region. This paper is divided into five sections. In Section I, we define public-private partnerships (PPP) and describe the areas in tourism where PPP are most widely used, the tools used to implement PPP in tourism and the various forms of PPP. Economic arguments are then laid to motivate PPP as a determinant of tourism competitiveness using the tourism value-chain and tourism cluster approach. Specific case examples illustrating the contributions of PPP and public policy towards increasing tourism competitiveness are provided at a regional level and for specific areas in Sections II and III respectively. Section IV summarizes findings from the previous two sections and discusses ways to enhance the effectiveness of PPP and public policy in Caribbean tourism for increased competitiveness. Section V analyzes a few of the challenges that the Caribbean tourism sector is facing. The final section proposes new areas of intervention for PPP and public policy as tools for enhancing competitiveness in the Caribbean tourism sector in order to assist the region in addressing these challenges.

Tourism in the Caribbean: competitiveness, upgrading, linkages and the role of public private partnerships (PPP) and public policy

The main purpose of this paper is to explore and analyze the contributions that publicprivate partnerships and public policy have made in the development of tourism in the Caribbean as tools for enhancing competitiveness in the Caribbean tourism industry. The paper explores these contributions mainly in the context of the upgrading strategies that Caribbean countries have pursued over the past 15 years or so and using the lens of the tourism value chain and tourism cluster approach. The paper also analyzes the potential roles that public-private partnerships and public policy will continue to play in the future especially in the process of building linkages between the tourism sector and other sectors in order to increase net benefits from tourism to the Region. This paper is divided into five sections. In Section I, we define public-private partnerships (PPP) and describe the areas in tourism where PPP are most widely used, the tools used to implement PPP in tourism and the various forms of PPP. Economic arguments are then laid to motivate PPP as a determinant of tourism competitiveness using the tourism value-chain and tourism cluster approach. Specific case examples illustrating the contributions of PPP and public policy towards increasing tourism competitiveness are provided at a regional level and for specific areas in Sections II and III respectively. Section IV summarizes findings from the previous two sections and discusses ways to enhance the effectiveness of PPP and public policy in Caribbean tourism for increased competitiveness. Section V analyzes a few of the challenges that the Caribbean tourism sector is facing. The final section proposes new areas of intervention for PPP and public policy as tools for enhancing competitiveness in the Caribbean tourism sector in order to assist the region in addressing these challenges.

Analysis of quality indicators of central sterile supply departments at accredited public hospitals

O objetivo do estudo foi descrever e analisar os indicadores de qualidade de Centros de Material e Esterilização de hospitais públicos acreditados do Estado de São Paulo e sua gestão pelos responsáveis do setor. Trata-se de um estudo de casos múltiplos, onde são apresentados os dados interligados de três hospitais acreditados num relatório de casos cruzados. Os dados foram coletados por entrevista semiestruturada com o responsável e por visita técnica com análise documental. Os resultados constatam a dificuldade dos responsáveis em pontuar os indicadores específicos do setor e os referidos foram os de produção e pesquisa de satisfação do cliente que não retratam a qualidade efetiva do serviço, pois são fragmentados, sem consolidação de resultados na busca de melhorias, o que sugere baixa especificidade e baixa sensibilidade dos critérios da Organização Nacional de Acreditação à realidade deste setor.

A comparative analysis of caries and fluorosis among cities with and without public water supply fluoridation in São Paulo State, Brazil

Purpose: This population-based, cross-sectional study aimed to record the DMFT index for 12 year-old children with dental caries and fluorosis levels in cities with and without public water supply fluoridation. Methods: From the 101 municipalities belonging to the Health Regional Department XV (DRSXV-SJRP) of the São Paulo state in the Southeast region of Brazil, 85 cities were selected after exclusion of those with incomplete data and less than ten years of fluoridation treatment in 2004. The criteria adopted for the assessment of dental caries and fluorosis levels were based on the guidelines published in the WHO Manual 4th edition. The data were analyzed using Fisher’s exact tests at a significance level of 5%. Results: The prevalence of caries in 12 year-old children had no significant association with fluoridated water, and was considered “moderate” and “high” in cities without fluoridation and “low” and “moderate” in cities with fluoridation. A significant association was found between water fluoridation and fluorosis (P=0.001), but not between water fluoridation and the DMFT index (P=0.119). Conclusion: The prevalence of fluorosis was related to water fluoridation in this study. However, fluorosis was also observed in non-fluoridated cities, which may result from fluoride intake through other sources.

Critical analysis of the regulations regarding the disposal of medication waste

Expired or unused medication at people's homes is normally disposed of in normal garbage, sewage system or, in certain cases, returned to the public health system. There is still no specific legislation regarding this leftover medication to regulate and orient the handling and correct disposal of medication waste. However, there is defined regulation regarding health services' solid waste. This article has the objective of discussing management models for the disposal of medication waste and the recommendations made by pertinent national and international legislation. By means of literature reviews, the management structure for medication waste of international legislation and the regulations regarding the environment, as well as the national legislation for the solid waste from health services was analyzed. Through the analysis it was possible to present better clarifications as to the possible impacts to the environment, to the public's health and alternatives in order to obtain the efficient disposal of medication, reducing and/or avoiding sanitary risk, guaranteeing the quality and safety of public health.

A comparative analysis of outpatient costs in HIV treatment programs

OBJECTIVE: To analyze the costs of human immunodeficiency virus (HIV) outpatient treatment for individuals with different CD4 cell counts in the Brazilian public health system, and to compare to costs in other national health systems. METHODS: A retrospective survey was conducted in five public outpatient clinics of the Brazilian national HIV program in the city of São Paulo. Data on healthcare services provided for a period of one year of HIV outpatient treatment were gathered from randomly selected medical records. Prices of inputs used were obtained through market research and public sector databases. Information on costs of HIV outpatient treatment in other national health systems were gathered from the literature. Annual costs of HIV outpatient treatment from each country were converted into 2010 U.S. dollars. RESULTS: Annual cost of HIV outpatient treatment for the Brazilian national public program was US$ 2,572.92 in 2006 in São Paulo, ranging from US$ 1,726.19 for patients with CD4 cell count > 500 to US$ 3,693.28 for patients with 51 < CD4 cell count < 200. Antiretrovirals (ARVs) represented approximately 62.0% of annual HIV outpatient costs. Comparing among different health systems during the same period, HIV outpatient treatment presented higher costs in countries where HIV treatment is provided by the private sector. CONCLUSION: The main cost drivers of HIV outpatient treatment in different health systems were: ARVs, other medications, health professional services, and diagnostic exams. Nevertheless, the magnitude of cost drivers varied among HIV outpatient treatment programs due to health system efficiency. The data presented may be a valuable tool for public policy evaluation of HIV treatment programs worldwide.

An Analysis Of U.S.- Economic Policy Toward Chile During The Cold War

This examination of U.S. economic policy directed toward Chile centered on the political and economic changes that occurred within Chile between 1960 and 1988. During this time, U.S. economic policy directed toward Chile was crafted by members of the American government uneasy with Cold War concerns with the most important of which being the spread of Communism throughout the globe. By viewing U.S. policy toward Chile through this Cold War lens, this thesis explores the different ways in which economic policy was used to advance the political and economic goals within not only Chile, but also Latin America as a whole. The Cold Warriors that crafted and enacted these economic policies were motivated by a variety of factors, and influenced by events outside of their control. From President John F. Kennedy to Ronald Reagan, American policymakers utilized economic policy as a means to achieve regional goals. This project sheds light on an understudied section of U.S. foreign policy history by exploring the way that economic policy helped achieve Cold War objectives in the Southern Cone.

The Role of Monetary Policy in Pursuing Economic Activity in Selected Transition Countries

The process of transition has brought an urgent need to develop many new market-oriented institutions or in some cases to reconstruct existing ones. One of the most important institutions of western-type economies is a central bank. It fulfils several "public good" functions, the most important of which are the achievement of stable price levels and assuring the financial stability of the economy. Nevertheless, even in economies with a long-standing market tradition, the question of whether a central bank is able to stimulate economic activity or whether all its cyclical actions lead only to changes in price levels remains open. The main purpose of this analysis was to empirically prove or disprove the relation between monetary policy and economic activity in more advanced transition countries. Basing his findings on commonly used econometric methods (causality tests, VAR modelling and simulations, simultaneous equations models), Delakorda concludes that the relation between money and economic activity is a mutual one, as there are significant differences between different countries in the conduct of monetary policy and in the environment of central banks. It is the latter which determines the relation between money and economic activity.