An economic evaluation of the Safe Motherhood programme in Guangxi, China

Maternal and infant mortality is a global health issue with a significant social and economic impact. Each year, over half a million women worldwide die due to complications related to pregnancy or childbirth, four million infants die in the first 28 days of life, and eight million infants die in the first year. Ninety-nine percent of maternal and infant deaths are in developing countries. Reducing maternal and infant mortality is among the key international development goals. In China, the national maternal mortality ratio and infant mortality rate were reduced greatly in the past two decades, yet a large discrepancy remains between urban and rural areas. To address this problem, a large-scale Safe Motherhood Programme was initiated in 2000. The programme was implemented in Guangxi in 2003. Interventions in the programme included both demand-side and supply side-interventions focusing on increasing health service use and improving birth outcomes. Little is known about the effects and economic outcomes of the Safe Motherhood Programme in Guangxi, although it has been implemented for seven years. The aim of this research is to estimate the effectiveness and cost-effectiveness of the interventions in the Safe Motherhood Programme in Guangxi, China. The objectives of this research include: 1. To evaluate whether the changes of health service use and birth outcomes are associated with the interventions in the Safe Motherhood Programme. 2. To estimate the cost-effectiveness of the interventions in the Safe Motherhood Programme and quantify the uncertainty surrounding the decision. 3. To assess the expected value of perfect information associated with both the whole decision and individual parameters, and interpret the findings to inform priority setting in further research and policy making in this area. A quasi-experimental study design was used in this research to assess the effectiveness of the programme in increasing health service use and improving birth outcomes. The study subjects were 51 intervention counties and 30 control counties. Data on the health service use, birth outcomes and socio-economic factors from 2001 to 2007 were collected from the programme database and statistical yearbooks. Based on the profile plots of the data, general linear mixed models were used to evaluate the effectiveness of the programme while controlling for the effects of baseline levels of the response variables, change of socio-economic factors over time and correlations among repeated measurements from the same county. Redundant multicollinear variables were deleted from the mixed model using the results of the multicollinearity diagnoses. For each response variable, the best covariance structure was selected from 15 alternatives according to the fit statistics including Akaike information criterion, Finite-population corrected Akaike information criterion, and Schwarz.s Bayesian information criterion. Residual diagnostics were used to validate the model assumptions. Statistical inferences were made to show the effect of the programme on health service use and birth outcomes. A decision analytic model was developed to evaluate the cost-effectiveness of the programme, quantify the decision uncertainty, and estimate the expected value of perfect information associated with the decision. The model was used to describe the transitions between health states for women and infants and reflect the change of both costs and health benefits associated with implementing the programme. Result gained from the mixed models and other relevant evidence identified were synthesised appropriately to inform the input parameters of the model. Incremental cost-effectiveness ratios of the programme were calculated for the two groups of intervention counties over time. Uncertainty surrounding the parameters was dealt with using probabilistic sensitivity analysis, and uncertainty relating to model assumptions was handled using scenario analysis. Finally the expected value of perfect information for both the whole model and individual parameters in the model were estimated to inform priority setting in further research in this area.The annual change rates of the antenatal care rate and the institutionalised delivery rate were improved significantly in the intervention counties after the programme was implemented. Significant improvements were also found in the annual change rates of the maternal mortality ratio, the infant mortality rate, the incidence rate of neonatal tetanus and the mortality rate of neonatal tetanus in the intervention counties after the implementation of the programme. The annual change rate of the neonatal mortality rate was also improved, although the improvement was only close to statistical significance. The influences of the socio-economic factors on the health service use indicators and birth outcomes were identified. The rural income per capita had a significant positive impact on the health service use indicators, and a significant negative impact on the birth outcomes. The number of beds in healthcare institutions per 1,000 population and the number of rural telephone subscribers per 1,000 were found to be positively significantly related to the institutionalised delivery rate. The length of highway per square kilometre negatively influenced the maternal mortality ratio. The percentage of employed persons in the primary industry had a significant negative impact on the institutionalised delivery rate, and a significant positive impact on the infant mortality rate and neonatal mortality rate. The incremental costs of implementing the programme over the existing practice were US $11.1 million from the societal perspective, and US $13.8 million from the perspective of the Ministry of Health. Overall, 28,711 life years were generated by the programme, producing an overall incremental cost-effectiveness ratio of US $386 from the societal perspective, and US $480 from the perspective of the Ministry of Health, both of which were below the threshold willingness-to-pay ratio of US $675. The expected net monetary benefit generated by the programme was US $8.3 million from the societal perspective, and US $5.5 million from the perspective of the Ministry of Health. The overall probability that the programme was cost-effective was 0.93 and 0.89 from the two perspectives, respectively. The incremental cost-effectiveness ratio of the programme was insensitive to the different estimates of the three parameters relating to the model assumptions. Further research could be conducted to reduce the uncertainty surrounding the decision, in which the upper limit of investment was US $0.6 million from the societal perspective, and US $1.3 million from the perspective of the Ministry of Health. It is also worthwhile to get a more precise estimate of the improvement of infant mortality rate. The population expected value of perfect information for individual parameters associated with this parameter was US $0.99 million from the societal perspective, and US $1.14 million from the perspective of the Ministry of Health. The findings from this study have shown that the interventions in the Safe Motherhood Programme were both effective and cost-effective in increasing health service use and improving birth outcomes in rural areas of Guangxi, China. Therefore, the programme represents a good public health investment and should be adopted and further expanded to an even broader area if possible. This research provides economic evidence to inform efficient decision making in improving maternal and infant health in developing countries.

Measuring and monitoring soil organic carbon stocks in agricultural lands for climate mitigation

Policies that encourage greenhouse-gas emitters to mitigate emissions through terrestrial carbon (C) offsets – C sequestration in soils or biomass – will promote practices that reduce erosion and build soil fertility, while fostering adaptation to climate change, agricultural development, and rehabilitation of degraded soils. However none of these benefits will be possible until changes in C stocks can be documented accurately and cost-effectively. This is particularly challenging when dealing with changes in soil organic C (SOC) stocks. Precise methods for measuring C in soil samples are well established, but spatial variability in the factors that determine SOC stocks makes it difficult to document change. Widespread interest in the benefits of SOC sequestration has brought this issue to the fore in the development of US and international climate policy. Here, we review the challenges to documenting changes in SOC stocks, how policy decisions influence offset documentation requirements, and the benefits and drawbacks of different sampling strategies and extrapolation methods.

Responding to rapid change in higher education : enabling university departments responsible for work related programs through boundary spanning

Boundary spanning links organisations to one another in order to create mutually beneficial relationships; it is a concept developed and used in organisational theory but rarely used to understand organisational structures in higher education (Pruitt & Schwartz, 1999). Yet understanding boundary spanning activity has the capacity to help universities respond to demands for continuous quality improvement, and to increase capacity to react to environmental uncertainty. At a time of rapid change characterised by a fluctuating economic environment, globalisation, increased mobility, and ecological issues, boundary spanning could be viewed as a key element in assisting institutions in effectively understanding and responding to such change. The literature suggests that effective boundary spanning could help universities improve organisational performance, use of infrastructure and resources, intergroup relations, leadership styles, performance and levels of job satisfaction, technology transfer, knowledge creation, and feedback processes, amongst other things. Our research aims to put a face on boundary spanning (Miller, 2008) by contextualising it within organisational systems and structures in university departments responsible for work related programs i.e. Work Integrated Learning (WIL) and Co-operative Education (Co-op). In this paper these approaches are referred to collectively as work related programs. The authors formed a research team in Victoria, British Columbia in 2009 at a sponsored international research forum, Two Days in June. The purpose of the invitation-only forum was to investigate commonalities and differences across programs and to formulate an international research agenda for work related programs over the next five to ten years. Researchers from Queensland University of Technology, University of Cincinnati, Baden-Wuerttemberg Cooperative State University, University of Ottawa,and Dublin City University agreed that further research was needed into the impact stakeholders, organisational systems, structures, policies, and practices have on departments delivering work related programs. This paper illustrates how policy and practice across the five institutions can be better understood through the lens of boundary spanning. It is argued that boundary spanning is an area of theory and practice with great applicability to a better understanding of the activity of these departments. The paper concludes by proposing topics for future research to examine how boundary spanning can be used to better understand practice and change in work related programs.

Make-buy decisions in the face of technological change: does industry clockspeed matter?

Some evidence in the area of make-buy decisions for new technologies suggests that it is a good idea for a company to pursue a fairly rigorous ''make'' policy in the early days of a potentially disruptive innovation. Other studies prescribe exactly the opposite, promoting instead a ''buy'' strategy. This paper seeks to bridge the gap between these perspectives by suggesting that both strategies are valid, but that they are most successfully applied in different market environments. The ''make'' prescription may be more suited to either extremely fast or extremely slow rates of technological change, while a ''buy'' strategy might be more appropriate in market sectors where technologies evolve at a medium pace. This paper highlights the importance of industry clockspeed and supplier relationships in make-buy decisions for new technologies, and puts forward two new hypotheses that require empirical testing.

Conceptualising climate change in rural Australia : community perceptions, attitudes and (in) actions

Public engagement and support is essential for ensuring adaptation to climate change. The first step in achieving engagement is documenting how the general public currently perceive and understand climate change issues, specifically the importance they place on this global problem and identifying any unique challenges for individual communities. For rural communities, which rely heavily on local agriculture industries, climate change brings both potential impacts and opportunities. Yet, to date, our knowledge about how rural residents conceptualise climate change is limited. Thus, this research explores how the broader rural community – not only farmers – conceptualise climate change and responsive activities, focussing on documenting the understandings and risk perceptions of local residents from two small Australian rural communities. Twenty-three semi-structured interviews were conducted in communities in the Eden/Gippsland region on the border of New South Wales and Victoria, and the North-East of Tasmania. There are conflicting views on how climate change is conceptualised, the degree of concern and need for action, the role of local industry, who will 'win' and 'lose', and the willingness of rural communities to adapt. In particular, residents who believed in anthropogenic or human-induced factors described the changing climate as evidence of 'climate change', whereas those who were more sceptical termed it 'weather variability', suggesting that there is a divide in rural Australia that, unless urgently addressed, will hinder local and national policy responses to this global issue. Engaging these communities in the 21st century climate change debate will require a significant change in terminology and communication strategies.

Stability and change in prosocial and antisocial behavior across the transition to school : Teacher and peer perspectives

Research Findings: The transition to school is a major developmental milestone, and behavior tendencies already evident at the point of school entry can impact upon a child's subsequent social and academic adjustment. The current study aimed to investigate stability and change in the social behavior of girls and boys across the transition from day care to 1st grade. Teacher ratings and peer nominations for prosocial and antisocial behavior were obtained for 248 children belonging to 2 cohorts: school transitioning (n = 118) and day care remaining (n = 130). Data were gathered again from all children 1 year later, following the older group's entry into school. Teacher ratings of prosocial and antisocial behavior significantly predicted teacher ratings of the same behavior at Time 2 for both cohorts. Peer reports of antisocial behavior also showed significant stability, whereas stability of peer-reported prosocial behavior varied as a function of behavior type. Practice or Policy: The results contribute to understanding of trends in early childhood social behavior that potentially influence long-term developmental trajectories. Identification of some behaviors as more stable in early childhood than others, regardless of school entry, provides useful information for both the type and timing of early interventions. © 2010 Taylor & Francis Group, LLC.

Demanding a change : time to act on statutory demands

The statutory demand procedure has been a part of our corporate law from its earliest modern formulations and it has been suggested, albeit anecdotally, that under the current regime, it gives rise to more litigation than any other part of the Corporations Act. Despite this there has been a lack of consideration of the underlying policy behind the procedure in both the case law and literature; both of which are largely centred on the technical aspects of the process. The purpose of this article is to examine briefly the process of the statutory demand in the context of the current insolvency law in Australia. This paper argues that robust analysis of the statutory demand regime is overdue. The paper first sets out to discover if there is a policy justification for the process and to articulate what that may be. Second, it will briefly examine the current legislation and argue that the structure actually encourages litigation which is arguably undesirable in the context of insolvency. In particular we will ask if the current rigid legal regime is appropriate for dealing efficiently with the highly charged atmosphere of contested insolvency. Third, it will examine suggested reforms in this area as to whether they might be a way forward.

Infrastructure charges and increases to new house prices : a preliminary analysis of the US empirical models

Sourcing appropriate funding for the provision of new urban infrastructure has been a policy dilemma for governments around the world for decades. This is particularly relevant in high growth areas where new services are required to support swelling populations. The Australian infrastructure funding policy dilemmas are reflective of similar matters in many countries, particularly the United States of America, where infrastructure cost recovery policies have been in place since the 1970’s. There is an extensive body of both theoretical and empirical literature from these countries that discusses the passing on (to home buyers) of these infrastructure charges, and the corresponding impact on housing prices. The theoretical evidence is consistent in its findings that infrastructure charges are passed on to home buyers by way of higher house prices. The empirical evidence is also consistent in its findings, with “overshifting” of these charges evident in all models since the 1980’s, i.e. $1 infrastructure charge results in greater than $1 increase in house prices. However, despite over a dozen separate studies over two decades in the US on this topic, no empirical works have been carried out in Australia to test if similar shifting or overshifting occurs here. The purpose of this research is to conduct a preliminary analysis of the more recent models used in these US empirical studies in order to identify the key study area selection criteria and success factors. The paper concludes that many of the study area selection criteria are implicit rather than explicit. By collecting data across the models, some implicit criteria become apparent, whilst others remain elusive. This data will inform future research on whether an existing model can be adopted or adapted for use in Australia.

The role of law in responding to climate change : emerging regulatory, liability and market approaches

Climate change presents as the archetypal environmental problem with short-term economic self-interest operating to the detriment of the long-term sustainability of our society. The scientific reports of the Intergovernmental Panel on Climate Change strongly assert that the stabilisation of emissions in the atmosphere, to avoid the adverse impacts of climate change, requires significant and rapid reductions in ‘business as usual’ global greenhouse gas emissions. The sheer magnitude of emissions reductions required, within this urgent timeframe, will necessitate an unprecedented level of international, multi-national and intra-national cooperation and will challenge conventional approaches to the creation and implementation of international and domestic legal regimes. To meet this challenge, existing international, national and local legal systems must harmoniously implement a strong international climate change regime through a portfolio of traditional and innovative legal mechanisms that swiftly transform current behavioural practices in emitting greenhouse gases. These include the imposition of strict duties to reduce emissions through the establishment of strong command and control regulation (the regulatory approach); mechanisms for the creation and distribution of liabilities for greenhouse gas emissions and climaterelated harm (the liability approach) and the use of innovative regulatory tools in the form of the carbon trading scheme (the market approach). The legal relations between these various regulatory, liability and market approaches must be managed to achieve a consistent, compatible and optimally effective legal regime to respond to the threat of climate change. The purpose of this thesis is to analyse and evaluate the emerging legal rules and frameworks, both international and Australian, required for the effective regulation of greenhouse gas emissions to address climate change in the context of the urgent and deep emissions reductions required to minimise the adverse impacts of climate change. In doing so, this thesis will examine critically the existing and potential role of law in effectively responding to climate change and will provide recommendations on the necessary reforms to achieve a more effective legal response to this global phenomenon in the future.

US Federal Government entrepreneurship : new enterprise structures

Purpose: The purpose of this paper is to guide the formation and to determine the structure of new governmental entrepreneurial ventures based on the nature of the public goods and the need for an entrepreneurial orientation. Design/methodology/research: This paper is conceptual and is based on reviews of appropriate organizational structure and entrepreneurship, cases studies, and the authors' experiences. Findings: Public or quasi-public entities may need to change their organizational structure in order to act more entrepreneurially and to be more effective in accomplishing their missions. Propositions are raised to guide the development of new public or private enterprises and provide the basis for future research. Research limitations/implications: This paper is conceptual and needs to be tested empirically. Though other levels of government and countries were included, a major focus is on the US federal government. Originality/value: This is the first published research on the topic of new enterprise government structures based on the nature of the goods and the requisite entrepreneurial orientation. It will help governmental and quasi-governmental organizations in developing efficient and effective organizational structures.

Status of current research on the implication of climate change on built environment

The cycling interaction between climate change and building performance is of dynamic nature and both are essentially the cause and the effect of each other. On one hand, buildings contribute significantly to the global warming process. On the other hand, climate change is also expected to impact on many aspects of building performance. In this paper, the status of current research on the implication of climate change on built environment is reviewed. It is found that although the present research has covered broad areas of research, they are generally only limited to the qualitative analyses. It is also highlighted that although it is widely realized that reducing greenhouse gas emissions from the building sector is very important, the adoption of complementary adaptation strategy to prepare the building for a range of climate change scenarios is also necessary. Due to the lack of holistic approach to generate future hourly weather data, various approaches have been used to generate different key weather variables. This ad hoc situation has seriously hindered the application of building simulation technique to the climate change impact study, in particular, to provide quantitative information for policy and design development.

Development priority zoning (DPZ)-led scenario simulation for regional land use change : the case of Suichang County, China

China has experienced an extraordinary level of economic development since the 1990s, following excessive competition between different regions. This has resulted in many resource and environmental problems. Land resources, for example, are either abused or wasted in many regions. The strategy of development priority zoning (DPZ), proposed by the Chinese National 11th Five-Year Plan, provides an opportunity to solve these problems by coordinating regional development and protection. In line with the rational utilization of land, it is proposed that the DPZ strategy should be integrated with regional land use policy. As there has been little research to date on this issue, this paper introduces a system dynamic (SD) model for assessing land use change in China led by the DPZ strategy. Land use is characterized by the prioritization of land development, land utilization, land harness and land protection (D-U-H-P). By using the Delphi method, a corresponding suitable prioritization of D-U-H-P for the four types of DPZ, including optimized development zones (ODZ), key development zones (KDZ), restricted development zones (RDZ), and forbidden development zones (FDZ) are identified. Suichang County is used as a case study in which to conduct the simulation of land use change under the RDZ strategy. The findings enable a conceptualization to be made of DPZ-led land use change and the identification of further implications for land use planning generally. The SD model also provides a potential tool for local government to combine DPZ strategy at the national level with land use planning at the local level.

Productivity, technical and efficiency change in Singapore’s services sector, 2005 to 2008

The current study was motivated by statements made by the Economic Strategies Committee that Singapore’s recent productivity levels in services were well below countries such as the US, Japan and Hong Kong. Massive employment of foreign workers was cited as the reason for poor productivity levels. To shed more light on Singapore’s falling productivity, a nonparametric Malmquist productivity index was employed which provides measures of productivity change, technical change and efficiency change. The findings reveal that growth in Total Factor Productivity (TFP) was attributed to technical change with no improvement in efficiency change. Such results suggest that gains from TFP were input-driven rather than from a ‘best-practice’ approach such as improvements in operations or better resource allocation.

Regulating assisted reproductive technologies in Victoria : the impact of changing policy concerning the accessibility of in vitro fertilisation for preimplantation tissue-typing

On 1 January 2010, the Assisted Reproductive Treatment Act 2008 (Vic) came into force. The legislation was the outcome of a detailed review and consultation process undertaken by the Victorian Law Reform Commission. Arguably, the change to the regulatory framework represents a significant shift in policy compared to previous regulatory approaches on this topic in Victoria. This article considers the impact of the new legislation on eligibility for reproductive treatments, focusing on the accessibility of such services for the purpose of creating a “saviour sibling”. It also highlights the impact of the Victorian regulatory body’s decision to abolish its regulatory policies on preimplantation genetic diagnosis and preimplantation tissue-typing, concluding that the regulatory approach in relation to these latter issues is similar to other Australian jurisdictions where such practices are not addressed by a statutory framework.

Dealing with unfinished business : preparing pre-service social education teachers for curriculum change

Pre-service teacher education is unfinished business. New social education teachers face the challenge of fluid policy environments in which curriculum content and pedagogy are continually changing. The evolving Australian curriculum is the most recent example of such fluidity with its emphasis on shifting the educational agenda to a focus on discipline-based approaches. This paper addresses the concerns of final year pre-service and early career social education teachers, in terms of their professional development needs, by drawing on the findings of a pilot study with students and recent graduates from a university in south-east Queensland. It concludes that social education curriculum units which embed links to professional practice and professional development in teaching, learning and assessment may provide the way forward for enhancing the transition to practice for beginning teachers and assist them in navigating constant change.