'Reform' of the British national health service after the election of a labour government: Understanding the policy development process

The policy development process leading to the Labour government's white paper of December 1997—The new NHS: Modern, Dependable—is the focus of this project and the public policy development literature is used to aid in the understanding of this process. Policy makers who had been involved in the development of the white paper were interviewed in order to acquire a thorough understanding of who was involved in this process and how they produced the white paper. A theoretical framework is used that sorts policy development models into those that focus on knowledge and experience, and those which focus on politics and influence. This framework is central to understanding the evidence gathered from the individuals and associations that participated in this policy development process. The main research question to be asked in this project is to what extent do either of these sets of policy development models aid in understanding and explicating the process by which the Labour government's policies were developed. The interview evidence, along with published evidence, show that a clear pattern of policy change emerged from this policy development process, and the Knowledge-Experience and Politics-Influence policy making models both assist in understanding this process. The early stages of the policy development process were characterized as hierarchical and iterative, yet also very collaborative among those participating, with knowledge and experience being quite prevalent. At every point in the process, however, informal networks of political influence were used and noted to be quite prevalent by all of the individuals interviewed. The later stages of the process then became increasingly noninclusive, with decisions made by a select group of internal and external policy makers. These policy making models became an important tool with which to understand the policy development process. This Knowledge-Experience and Politics-Influence dichotomy of policy development models could therefore be useful in analyzing other types of policy development. ^

The Political Economy of Constitutional Choice: A Study of the 2005 Kenyan Constitutional Referendum

Recent studies of the linkages between the wealth of nations and the institutions of governance suggest that concentrating political power in a monarchy or a ruling coalition impedes economic growth and, moreover, that while power-diffusing reforms can enhance the wellbeing of society in general, opposition by groups benefitting from the status quo is predictable. In November 2005, Kenyans rejected a proposed constitution that, despite promises made by their new chief executive, would not have lessened the powers of the presidency. Using a unique, constituency-level dataset on the referendum vote, we estimate a model of the demand for power diffusion and find that ethnic groups' voting decisions are influenced by their expected gains and losses from constitutional change. The results also highlights the importance of ethnic divisions in hindering the power-diffusion process, and thus establish a channel through which ethnic fragmentation adversely impacts economic development.

Economic Rights, Human Development Effort and Institutions

This paper focuses on the link between economic rights and institutions. Simple analysis of data is used to demonstrate countries' human development effort in advancing economics rights of the citizens. A country's human development effort is evaluated on the basis of the well-being of the poorest members of the society. An analysis of data reveals that there is a wide variation in countries' pro-poor stance. While it is accepted that positive rights are pro-poor, this paper argues that so too are negative economic rights and in fact the two are complements rather than substitutes. Classifying countries into human development income deficit and human development effort deficit, it is demonstrated that a large number of countries could achieve higher welfare levels for the poor if they improved on bother positive and negative economic rights. The paper attempts to explain variations in the observed commitment to economic rights by focusing on pro-poor institutions. The basic thesis advanced in the paper is that pro-poor policies are more likely to be implemented and sustained in those institutions where power is sufficiently diffused such that even the poor have leverage over policy outcomes. The paper focuses on how institutions impact on power diffusion and therefore the adoption of pro-poor growth and policies. The failure of countries to adopt pro-poor growth and policies is attributed to institutional failures manifested in concentration of power. The policy recommendations emanating from the analysis focus on institutional reforms to enhance power diffusion. These policies include enlarging the political space through democratization, strengthening institutions and capacity to fight corruption and improve transparency, and bringing the government closer to the people through appropriate design and implementation of decentralization schemes. Some recent examples of improvements in economic rights following power diffusion are provided.

A critical assessment of the National Institutes of Health Consensus Development Program against the eras which shaped it

This research study offers a critical assessment of NIH's Consensus Development Program (CDP), focusing upon its historical and valuative bases and its institutionalization in response to social and political forces. The analysis encompasses systems-level, as well as interpersonal factors in the adoption of consensus as the mechanism for resolving scientific controversies in clinical practice application. Further, the evolution of the CDP is also considered from an ecological perspective as a reasoned adaptation by NIH to pressures from its supporters and clients for translating biomedical research into medical practice. The assessment examines federal science policy and institutional designs for the inclusion of the public interest and democratic deliberation.^ The study relies on three distinct approaches to social research. Conventional historical methods were utilized in the interpretation of social and political influences across eras on the evolution of the National Institutes of Health and its response to demands for accountability and relevance through its Consensus Development Program. An embedded single-case study was utilized for an empirical examination of the CDP mechanism through five exemplar conferences. Lastly, a sociohistorical approach was taken to the CDP in order to consider its responsiveness to the values of the eras which created and shaped it. An exploration of organizational behavior with considerations for institutional reform as a response to continuing political and social pressure, it is a study of organizational birth, growth, and response to demands from its environment. The study has explanatory import in its attempt to account for the creation, timing, and form of the CDP, relative to political, institutional, and cultural pressures, and predictive import thorough its historical view which provides a basis for informed speculation on the playing out of tensions between extramural and intermural scientists and the current demands for health care reform. ^

STRATEGIES FOR THE TRANSFER OF APPROPRIATE TECHNOLOGY TO DEVELOPING COUNTRIES: THE IMPLEMENTATION AND DEVELOPMENT OF ENVIRONMENTAL HEALTH PROGRAMS IN TUNISIA

This dissertation focuses on Project HOPE, an American medical aid agency, and its work in Tunisia. More specifically this is a study of the implementation strategies of those HOPE sponsored projects and programs designed to solve the problems of high morbidity and infant mortality rates due to environmentally related diarrheal and enteric diseases. Several environmental health programs and projects developed in cooperation with Tunisian counterparts are described and analyzed. These include (1) a paramedical manpower training program; (2) a national hospital sanitation and infection control program; (3) a community sewage disposal project; (4) a well reconstruction project; and (5) a solid-waste disposal project for a hospital.^ After independence, Tunisia, like many developing countries, encountered several difficulties which hindered progress toward solving basic environmental health problems and prompted a request for aid. This study discusses the need for all who work in development programs to recognize and assess those difficulties or constraints which affect the program planning process, including those latent cultural and political constraints which not only exist within the host country but within the aid agency as well. For example, failure to recognize cultural differences may adversely affect the attitudes of the host staff towards their work and towards the aid agency and its task. These factors, therefore, play a significant role in influencing program development decisions and must be taken into account in order to maximize the probability of successful outcomes.^ In 1969 Project HOPE was asked by the Tunisian government to assist the Ministry of Health in solving its health manpower problems. HOPE responded with several programs, one of which concerned the training of public health nurses, sanitary technicians, and aids at Tunisia's school of public health in Nabeul. The outcome of that program as well as the strategies used in its development are analyzed. Also, certain questions are addressed such as, what should the indicators of success be, and when is the time right to phase out?^ Another HOPE program analyzed involved hospital sanitation and infection control. Certain generic aspects of basic hospital sanitation procedures were documented and presented in the form of a process model which was later used as a "microplan" in setting up similar programs in other Tunisian hospitals. In this study the details of the "microplan" are discussed. The development of a nation-wide program without any further need of external assistance illustrated the success of HOPE's implementation strategies.^ Finally, although it is known that the high incidence of enteric disease in developing countries is due to poor environmental sanitation and poor hygiene practices, efforts by aid agencies to correct these conditions have often resulted in failure. Project HOPE's strategy was to maximize limited resources by using a systems approach to program development and by becoming actively involved in the design and implementation of environmental health projects utilizing "appropriate" technology. Three innovative projects and their implementation strategies (including technical specifications) are described.^ It is advocated that if aid agencies are to make any progress in helping developing countries basic sanitation problems, they must take an interdisciplinary approach to progrm development and play an active role in helping counterparts seek and identify appropriate technologies which are socially and economically acceptable. ^

Cuba's social policy after the disintegration of the Soviet Union -- social development as legitimacy of regime and its economy effectiveness

Since the disintegration of the Soviet Union, Cuba has experienced a severe economic crisis, and the country's social policy has played an important role in showing the people a raison-d'etre for the revolution. This role has become even stronger in recent years, as internal and external actors demand political reforms and economic liberalization. This article first examines the Cuban government's use of social development to counter the demands for changes. It then looks at the extent that government social policy contributes economically to improving the Cuban living standard. The article demonstrates empirically how the leadership emphasizes their social accomplishments whenever demands for change come, and then shows that after the suspension of Soviet aid, Cuban social policy has been able to provide services mainly by relying on human capital and reducing quality materially because of the shortage of foreign reserves. This has limited the economic effectiveness of the services.

Key Factors to Successful Community Development: The Korean Experience

The Saemaul Undong of the Republic of Korea has been world-widely recognized as a successful model of rural community development. The Saemaul Undong was a pure Korean way of community development program which was initiated by the political will of the top national leadership in order to escape from poverty. There are several key factors to the success of the Saemaul Undong. First, the national government's guidance and support for the movement played a very important role in the whole period of the movement. Second, there was a wide range of people's participation in the implementation process. Third, the Saemaul Undong could make a big success by nurturing community leadership which was selected by rural residents themselves. Finally, as a movement for the spiritual reform, the Saemaul Undong imbued the people with the spirits of diligence, the self-reliance, and cooperation.

The Sandinista Revolution and Post-Conflict Development--Key Issues

Following Daniel Ortega's victory in the presidential election held in November 2006, Nicaragua has been undergoing a transition from a democratic to authoritarian system. In the 1980s, Ortega served as President of the Sandinista government and implemented a Cuban-type socialist system, but the system failed and democracy was established during 1990-2007. Considering this failure, why did Ortega succeed in taking power again? This paper provides a brief history of modern Nicaragua and gives some insights into the twists of Latin American politics. The paper was prepared for the international seminar on Helping Failed States Recover: The Role of Business in Promoting Stability and Development, organized by the University of Kansas Center for International Business Education and Research (CIBER), held on April 4-6, 2007 in Lawrence. The opinions and views expressed herein are those of the author. All mistakes and/or errors are entirely the author's responsibility.

Sustainable Development and Poverty Reduction under Mubarak's Program

This paper describes and analyzes the major features of economic development and poverty reduction in Egypt during its transition to a market Economy. It focuses on the changes in the situation of poverty and economic policies pursued as remedies by the government of Egypt and the ruling NDP. Sustainable development and poverty reduction is the core of the President Mubarak’s election campaign for his fifth term for the presidency. We attempt to explain the obstacles encountered by the Egyptian economy in terms of adjustments and general economic arguments on poverty. Finally, we refer to the necessity for enhanced accountability in the society to accomplish the goal.

The misconception of political lessons : how UMNO perceives the fall of LDP in Japan

2012 marks the thirtieth anniversary of Malaysia’s Look East Policy (LEP). This article argues that the strong relationship between Malaysia and Japan is stimulated by symbiotic ties binding together both countries’ respective major political parties, viz. the United Malays National Organisation (UMNO) and the Liberal Democratic Party (LDP). UMNO, especially under the leadership of Prime Minister Mahathir Mohamad (1981-2003), derived political lessons from developments affecting LDP in Japan. Two forms of lessons may be discerned. First, emulation of Japan’s success in economic development, which become the basis of LEP launched in 1981. Second, on which our article focuses, lessons from the failure of LDP to retain power twice in 1993 and 2009. Since 1993, DP’s defeat has been a poignant reminder for UMNO to be in alert mode in facing any electoral possibility. When LDP was again ousted from power in 2009, UMNO was a most psychologically affected party owing to the unprecedented setback it suffered at Malaysia’s Twelfth General Elections (GE) of 2008. Yet, although LDP’s reversal of fortunes served as a landmark for UMNO in situating changes to its trajectory since 1999, the analogical reasoning and political lessons applied by UMNO leaders were, to a large extent, flawed. Arguably, politicians frequently do misjudge in analogising between different situations which at a glance seem to be comparable.

Political economy of low sulfurization and air pollution control policy in Japan : SOx emission reduction by fuel conversion

In the early stages of the development of Japan’s environmental policy, sulfur oxide (SOx) emissions, which seriously damage health, was the most important air pollution problem. In the second half of the 1960s and the first half of the 1970s, the measures against SOx emissions progressed quickly, and these emissions were reduced drastically. The most important factor of the reduction was the conversion to a low-sulfur fuel for large-scale fuel users, such as the electric power industry. However, industries started conversion to low-sulfur fuel not due to environmental concerns, but simply to reduce costs. Furthermore, the interaction among the various interests of the electric power industry, oil refineries, the central government, local governments, and citizens over the energy and environmental policies led to the measures against SOx emissions by fuel conversion.

Development and institutionalization of communitarian thought in Thailand

In Thailand, communitarian ideas have been widely accepted and even institutionalized as a principle of national development plans and the Constitution of Thailand. This paper examines how and why the communitarian body of thought, described as "community culture thought," and originally created and shared within a small circle of social activists and academics in the early 1980s, came to be disseminated and authorized in Thai society. Contributors and participants, ways of expression, and avenues for disseminating this paradigm are the main topics in this paper. The paper reveals that these thoughts and concepts have been diversified and used as guiding principles by state elites, anti-state activists, and social reformists since the late 1980s. These people with such different political ideologies were connected through some key individuals. These critical connections networked them onto the same side for promoting communitarian thought in Thailand. When such leading advocates assumed key political positions, it was easy for them to push communitarian ideas into the guidelines and principles of state administration.

Infrastructure Finance in Developing Countries by State and Multilateral Development Banks

Infrastructure concession is an alternative widely used by governments to increase investment. In the case of the road sector, the main characteristics of the concessions are: long-term projects, high investments in the early years of the contract and high risks. A viability analysis must be carried out for each concession and consider the characteristics of the project. When the infrastructure is located in a developing country, political and market growth uncertainties should be add in the concession project analysis, as well as economic instability, because they present greater risks. This paper is an analysis of state bank participation in road infrastructure finance in developing countries. For this purpose, we studied road infrastructure financing and its associated risks, and also the features of developing countries. Furthermore, we considered the issue of state banks and multilateral development banks that perform an important role by offering better credit lines than the private banks, in terms of cost, interest and grace period. Based on this study, we analyzed the Brazilian Development Bank - BNDES – and their credit supply to road infrastructure concessions. The results show that BNDES is the main financing agent for long-term investment in the sector, offering loans with low interest rates in Brazilian currency. From this research we argue that a single state bank should not alone support the increasing demand for finance in Brazil. Therefore, we conclude that there is a need to expand the supply of credit in Brazil, by strengthening private banks in the long-term lending market.

Resilence, rural development and suistainable management: a working with people model approach

Nowadays, it has become evident the need to seek sustainable development models that address challenges arising in a variety of contexts. The resilience concept appears connected to the ability of people to cope with adversities that inevitably arise due to context dynamics, at different spatial and temporal scales. This concept is related to the model known as Working With People (WWP), focused on rural development projects planning, management and evaluation, from the integration of three dimensions: technical-entrepreneurial, ethical-social and political-contextual. The research reported is part of the RETHINK European Project, whose overall aim is farm modernization and rural resilience. The resilience concept has been analyzed, in the scope of rural development projects management, and a relationship with the WWP model has been established. To this end, a thorough review of the scientific literature concerning this topic has been addressed, in order to develop the state of the art of the different concepts and models involved. A conceptual proposal for the integration of resilience in rural development projects sustainable management, through the three-dimensional WWP model is presented.

Development of a genre-dependent TTS system with cross-speaker speaking-style transplantation

One of the biggest challenges in speech synthesis is the production of contextually-appropriate naturally sounding synthetic voices. This means that a Text-To-Speech system must be able to analyze a text beyond the sentence limits in order to select, or even modulate, the speaking style according to a broader context. Our current architecture is based on a two-step approach: text genre identification and speaking style synthesis according to the detected discourse genre. For the final implementation, a set of four genres and their corresponding speaking styles were considered: broadcast news, live sport commentaries, interviews and political speeches. In the final TTS evaluation, the four speaking styles were transplanted to the neutral voices of other speakers not included in the training database. When the transplanted styles were compared to the neutral voices, transplantation was significantly preferred and the similarity to the target speaker was as high as 78%.