Finance for water and sanitation as a public service

Drawing on empirical evidence gathered through the PSIRU database, this contribution aims at addressing the potential of public finance to enhance the provision of water supply and sanitation as a public service. It highlights the problems associated with (and the disappointing results obtained from) resort to Private Sector Participation and private finance, both historically and in the last 15-20 years, in developed and developing countries. It also addresses the advantages of using public finance as a more cost-effective and equitable instrument to achieve developmental objectives such as the expansion of service coverage and development of water and sanitation infrastructure. The potential of public operations in maximising developmental impact from the social, economic and environmental points of view is then explored referring to specific examples from a variety of countries and regions. These include the in-house restructuring of public operations to enhance transparency, accountability and effectiveness, as well as the use of Public-Public Partnerships (PUPs) to build capacity. Attention is devoted to the specific financial requirements of expanding sewerage services at global level to achieve MDGs or broader developmental goals. These requirements are revisited in light of a regional breakdown of coverage gaps, available resources and development aid flows. These findings challenge the established view among international and bilateral agencies that expanding sewerage services in developing countries is excessively costly and should be abandoned as a priority because unaffordable. This contribution draws on a number of PSIRU Reports, and particularly the following. - http://www.psiru.org/reports/2008-03-W-sewers.pdf - http://boell-latinoamerica.org/download_es/agua08_privatizacion_LA_2007.pdf - http://boell-latinoamerica.org/download_es/agua08_agua_un_servicio_publico.pdf - http://www.psiru.org/reports/2006-03-W-investment.pdf All PSIRU Reports are accessible at http://www.psiru.org/publicationsindex.asp.

Fluoridation for dental public health

This article reviews the means by which fluoride is supplied to populations. Many public health authorities provide fluoridated drinking water, with typical concentrations of fluoride of between 0.5 and 1.0 ppm. This has been found to be safe and effective, though differences in caries incidence between fluoridated and non-fluoridated regions are less than they were 50 years ago, because of the wider availability of fluoridated products to the whole population. Concerns about the effect of fluoride on bone density and associated conditions are reviewed and the general conclusion from considering the literature on fluoride is that there is almost no cause for concern. Alternatives to water as a means of delivering fluoride to the general public that are being used in a number of countries are salt and milk. These alternatives are also reviewed and have been shown to give satisfactory levels of protection against caries, though milk is shown to be less satisfactory than water as a vehicle for fluoride delivery. Milk is also less effective in providing fluoride to individuals in the population, and is less likely to be consumed by people in lower socio-economic groups, precisely those who suffer most from dental caries. This study concludes that mass water fluoridation remains an important contribution to good oral health throughout the community.

Perceived and reported access to the general practitioner: an international comparison of universal access and mixed private/public systems.

Timely and convenient access to primary healthcare is essential for the health of the population as delays can incur additional health and financial costs. Access to health care is under increasing scrutiny as part of the drive to contain escalating costs, while attempting to maintain equity in service provision. The objective was to compare primary care services in Republic of Ireland and Northern Ireland, and to report on perceived and reported access to GP services in universal access and mixed private/public systems. A questionnaire study was performed in Northern Ireland (NI) and the Republic of Ireland (ROI). Patients of 20 practices in the ROI and NI were contacted (n = 22,796). Main outcome measures were overall satisfaction and the access to GP services. Individual responses and scale scores were derived using the General Practice Assessment Questionnaire (G-PAQ). The response rate was 52% (n = 11,870). Overall satisfaction with GP practices was higher in ROI than in NI (84.2% and 80.9% respectively). Access scores were higher in ROI than in NI (69.2% and 57.0% respectively) Less than 1 in 10 patients in ROI waited two or more working days to see a doctor of choice (8.1%) compared to almost half (45.0%) in NI. In NI overall satisfaction decreased as practice size increased; 82.8%, 80.4%, and 75.8%. In both systems, in large practices, accessibility is reduced when compared to smaller practices. The faster access to GP services in ROI may be due to the deterrent effect of the consultation charge freeing up services although, as it is the poorest and sickest who are deterred by the charge this improved accessibility may come at a significant cost in terms of equity. The underlying concern for policy makers centres around provision of equitable services.

Public awareness and views on unlicensed use of medicines in children.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT center dot There is increasing concern about the use of those medicines in children which have not been fully studied and licensed for childhood use. Such use is not uncommon, due in large part to a lack of availability of fully licensed products and formulations that are suitable for children. center dot There is little published information on the views of the public on this important area of paediatric care. WHAT THIS STUDY ADDS center dot A survey of 1000 members of the public in Northern Ireland indicated that such use of medicines in children is not well known. center dot However, when informed about this practice, the majority believed that it would compromise safety and increase the likelihood of adverse effects. They also believed that parents/guardians should be told if their child was prescribed a medicine that had not been fully tested in children. center dot Participants in the survey indicated that they would be reluctant to involve their child in a clinical trial to help with the licensing process unless the child was suffering from a life-threatening illness. To explore awareness and views of the general public on unlicensed use of medicines in children and on the participation of children in clinical trials. Members of the public completed a questionnaire survey administered by face-to-face interview in public areas in N. Ireland. The main outcome measures were the views on unlicensed use of medicines in children and on clinical trials in children. One thousand participants (59.2% female) took part; 610 were parents. Most participants (86%) had no previous knowledge about unlicensed use of medicines in children. Being a parent did not influence this nor did being a parent of a child who suffered from a health problem (P > 0.05). Most participants (92%) felt that parents should be told about unlicensed use of medicines, with the doctor most frequently selected as the person who should inform parents. At the outset, only 1.8% of participants felt that the use of medicines in children was unsafe. However, having been informed about unlicensed use of medicines, this proportion increased dramatically (62.4%; P <0.001). Views on whether participants would enter a child of their own into a clinical trial varied according to the health status of the child (P <0.05) i.e. a child in good health (3.9%) vs a child with a life-threatening condition (41.9%). There is limited public knowledge of unlicensed use of medicines in children and a general reluctance to involve children in clinical trials unless the child to be involved has a life-threatening condition.

Reflecting the Public Value of Sport: A game of two halves

This article draws on qualitative research that explores the concept of public value in the delivery of sport services by the organization Sport England. The research took place against a backdrop of shifting priorities following the award of the 2012 Olympic Games to London. It highlights the difficulties that exist in measuring the qualitative nature of the public value of sport and suggests there is a need to understand better the idea. Research with organizations involved alongside Sport England in the delivery of sport is described. This explores the potential to create a public value vision, how to measure it and how to focus public value on delivery beyond the aim of ‘sport for sports sake’ and more towards ‘sport for the greater good’. The article argues that this represents a game of ‘two halves’ in which the first half focuses on 2012 with the second half concerned with its legacy.

Dogs in the paradise: The influence of the cynical philosophy in the construction of the myth of the good savage

This paper studies the influence of cynic philosophy in the construction of the myth of the good savage. In the first part it studies the importance of cynicism in the XVI century and how the cynic influence of Erasmus, More and Montaigne was fundamental to the way that Europe approached the American indigenous. In the second part it studies the cynic motives that could have influenced in the construction of the myth of the good savage.

Do environmental and task characteristics matter in the control of externalized local public services? Unveiling the relevance of party characteristics and citizens’ offstage voice

Purpose: The purpose of this paper is to investigate the mechanisms adopted by cities to control the provision of externalized public services and to explore the determinants of such control choices.

Design/methodology/approach: The paper presents the results of a multiple case study based on the experiences of three cities and three public services (transport, solid waste collection and home care services for the elderly), where control mechanisms and their possible antecedents were analyzed.

Findings: The results show that the control models found in the cases analyzed do not correspond to the "pure" patterns described in the private sector literature and that the factors identified by management control contributions do not seem to be exhaustive in explaining the configuration of control systems in the public sector. While environmental and task characteristics only partially explain the adoption of certain configurations of control, the features of the control systems seem to be rather influenced by variables that are related to party characteristics.

Originality/value: The paper shows that the combinations of control mechanisms are more multifaceted than those presented in the literature, and that the factors identified in the private sector literature do not seem to explain comprehensively the configuration of control systems in the public sector. © Emerald Group Publishing Limited.

Why do people non-demand reveal in hypothetical double referenda for public goods?

Hypothetical contingent valuation surveys used to elicit values for environmental and other public goods often employ variants of the referendum mechanism due to the cognitive simplicity and familiarity of respondents with this voting format. One variant, the double referendum mechanism, requires respondents to state twice how they would vote for a given policy proposal given their cost of the good. Data from these surveys often exhibit anomalies inconsistent with standard economic models of consumer preferences. There are a number of published explanations for these anomalies, mostly focusing on problems with the second vote. This article investigates which aspects of the hypothetical task affect the degree of nondemand revelation and takes an individual-based approach to identifying people most likely to non-demand reveal. A clear profile emerges from our model of a person who faces a negative surplus i.e. a net loss in the second vote and invokes non self-interested, non financial motivations during the decision process.

Using public procurement to achieve social outcomes

The use of public procurement to achieve social outcomes is widespread, but detailed information about how it operates is often sketchy and difficult to find. This article is essentially a mapping exercise, describing the history and current use Of government contracting as a tool of social regulation, what the author calls the issue of 'linkage'. The article considers the popularity of linkage in the I 9,h century in Europe and North America, particularly in dealing with issues of labour standards and unemployment. The use of linkage expanded during the 20(th) century, initially to include the provision of employment opportunities to disabled workers. During and after World War 11, the use of linkage became particularly important in the United States in addressing racial equality, in the requirements for non-discrimination in contracts, and in affirmative action and set-asides for minority businesses. Subsequently, the role of procurement spread both in its geographical coverage and in the subject areas of social policy that it was used to promote. The article considers examples of the use of procurement to promote equality on the basis of ethnicity and gender drawn from Malaysia, South Africa, Canada, and the European Community. More recently, procurement has been used as an instrument to promote human rights transnationally, also by international organizations such as the International Labour Organisation. The article includes some reflections on the relationship between 'green' procurement, 'social' procurement, and sustainable development, and recent attempts to develop the concept of 'sustainable procurement.

Religion, Human Rights, Equality and the Public Sphere

This article distinguishes three different conceptions of the relationship between religion and the public sphere. The reconciliation of these different aspects of freedom of religion can be seen to give rise to considerable difficulties in practice, and the legal and political systems of several Western European countries are struggling to cope. Four recurring issues that arise in this context are identified and considered: what is a 'religion' and what are 'religious' beliefs and practices for the purposes of the protection of 'freedom of religion', together with the closely related issue of who decides these questions; what justification there is for a provision guaranteeing freedom of religion at all; which manifestations of religious association are so unacceptable as to take the association outside the protection of freedom of religion altogether; and what weight should be given to freedom of religion when this freedom stands opposed to other values. It is argued that the scope and meaning of human rights in this context is anything but settled and that this gives an opportunity to those who support a role for religion in public life to intervene.

Inclusive development? State-led land development model in New Town, Kolkata

Urban land development in India is changing under the auspices of economic liberalisation. Kolkata has been in the forefront of this transformation through development of new townships in the urban peripheries based on a distinctive state-led land development model. Within this context New Town, Kolkata (also known as Rajarhat) provides a highly illuminative case to articulate the ways in which the state is implementing its neoliberal agenda in land development. It rides on political and ideological high ground by seeking to create a ‘model development’ of state–market partnership for dual goals of fostering capitalist interest while fulfilling welfarist principles. Interesting insights have emerged that point to a policy paradox. On one hand, the process follows market principles of efficacy and efficiency; on the other hand, state’s keenness to extend control persists, thereby creating a highly uneven terrain for state–market interaction. New Town reflects a typical quasi-market condition shaped by the monopolistic state, the poorly structured role of the private sector, an absence of civic bodies, and minimal land and housing provision for the poor. In India, as internationally, the economic liberalisation market ideology is increasingly construed as good governance. In this context New Town is a step in the right direction, but the progress is patchy, uneven, and still evolving.

Towards Charity Accountability: Narrowing the gap between provision and needs?

Although charities currently play a rich and varied role in modern society, their continued success is dependent upon the public's trust. With respect to charity accountability, two key questions emerge: to whom is a charity accountable; and what form should that account take? Despite the widespread acceptance that charities should discharge accountability, there is limited knowledge of the relative importance of different stakeholder groups and whether the information currently being disclosed meets their needs. Using extensive document analysis and a survey of stakeholders, this research explores these issues in the context of the top 100 UK fundraising charities. Furthermore, it compares the results with much earlier research to identify changes over time.