Delivery care in Quang Ninh province, Northern Vietnam : resources and access to safe care.

Every mother and child has the right to survive childbirth which requires skilled birth attendants together with referral and available emergency obstetric care (EmOC). The objective of the study was to describe delivery care routines at different levels in the health care system in Quang Ninh province, Northern Vietnam. The design was cross sectional using a structured questionnaire. Two districts in Quang Ninh province with 40 Community Health Centres (CHC), three district hospitals and one region hospital was included in the study, in total 138 (CHC n=105 and hospitals n=33) health care providers participated. In our study 20% (CHC) of the health care providers assisting deliveries at CHC were midwives and health care provider’s in our study further report to have assisted at less then 10 deliveries/year (81% of respondents at CHC). Findings show that the health care provider’s routines and care for women during labour and delivery vary and that there is a need for re-training and that women in labour should be cared for by health care providers with adequate training like midwifery. In our study CHC had poor resources to provide basic or comprehensive EmOC. Our findings indicate that there is a need for re-training in delivery care among health care providers and since the number of deliveries at CHC is few they should be handled by someone who is a skilled birth attendant. Our findings also show a variation in care routines during labour and delivery among health care providers at CHC and hospital levels and this also show the need for re-training and support from proper authorities in order to improve maternal and newborn health.

The Evolution of a Responsibility to Protect in Africa : The African Unions Emerging Peace and Security Regime

The thesis focuses on, and tries to evaluate, the role that the African Union (AU) plays in protecting the peace and security on the African continent. The thesis takes an interdisciplinary approach to the topic by both utilizing international relations and international law theories. The two disciplines are combined in an attempt to understand the evolution of the AU’s commitment to the pragmatist doctrine: responsibility to protect (R2P). The AU charter is considered to be the first international law document to cover R2P as it allows the AU to interfere in the internal affairs of its member states. The R2P doctrine was evolved around the notion of a need to arrive at a consensus in regard to the right to intervene in the face of humanitarian emergencies. A part of the post-Cold War shift in UN behaviour has been to support local solutions to local problems. Hereby the UN acts in collaboration with regional organizations, such as the AU, to achieve the shared aspirations to maintain international peace and security without getting directly involved on the ground. The R2P takes a more holistic and long-term approach to interventions by including an awareness of the need to address the root causes of the crisis in order to prevent future resurrections of conflicts. The doctrine also acknowledges the responsibility of the international community and the intervening parties to actively participate in the rebuilding of the post-conflict state. This requires sustained and well planned support to ensure the development of a stable society.While the AU is committed to implementing R2P, many of the AU’s members are struggling, both ideologically and practically, to uphold the foundations on which legitimate intervention rests, such as the protection of human rights and good governance. The fact that many members are also among the poorest countries in the world adds to the challenges facing the AU. A lack of human and material resources leads to a situation where few countries are willing, or able, to support a long-term commitment to humanitarian interventions. Bad planning and unclear mandates also limit the effectiveness of the interventions. This leaves the AU strongly dependent on regional powerbrokers such as Nigeria and South Africa, which in itself creates new problems in regard to the motivations behind interventions. The current AU charter does not provide sufficient checks and balances to ensure that national interests are not furthered through humanitarian interventions. The lack of resources within the AU also generates worries over what pressure foreign nations and other international actors apply through donor funding. It is impossible for the principle of “local solutions for local problems? to gain ground while this donor conditionality exists.The future of the AU peace and security regime is not established since it still is a work in progress. The direction that these developments will take depends on a wide verity of factors, many of which are beyond the immediate control of the AU.

Vård i livets slut av personer med demens. Personal och anhörigas upplevelse av given vård : En metasyntes

Palliativt förhållningssätt kännetecknas av helhetssyn av människan och uppnås genom stöttning av individen att leva med värdighet och största möjliga välbefinnande till livets slut oavsett diagnos eller ålder. Demens är en sjukdom som är svårt handikappande för den som drabbas och för de anhöriga är sjukdomen förödande. Den palliativa vården av personer med demens är inte optimerad. Studier visar att det dels beror på demenssjukdomen som är svår att vårda och dels för att stöd till de personer som vårdar sina anhöriga och det sociala kommunala nätverket har brister. Syfte: Att analysera upplevelsen av given vård i livets slutskede hos personer med demensdiagnos ur personalens och anhörigas perspektiv. Metod: Metasyntes utförd med Howell Major och Savin-Badins analysmodell, Qualitative Research Synthesis. Resultat: Kunskap och personcentrering var de två begrepp som blev produkten av syntesen. Begreppen fungerar som motsatser, om det finns kunskap och personcentrering så finns en bra upplevelse av given vård hos personal och anhöriga och om det brister i kunskap och personcentrering blir upplevelsen sämre. Diskussion: Kunskap om demens bland personal har i syntesen visats vara en indikator för god vård vid livets slut. Utbildning i demenssjukdom bör ske kontinuerligt och på olika nivåer beroende på vilken personalkategori som utbildas. Konklusion: Palliativ vård och demens måste få utrymme i utbildningarna av all personal, från undersköterska till specialistläkare.

The effects of longevity and distortions on education and retirement

This article studies the impact of longevity and taxation on life-cycle decisions and long-run income. Individuals allocate optimally their total lifetime between education, working and retirement. They also decide at each moment how much to save or consume out of their income, and after entering the labor market how to divide their time between labor and leisure. The model incorporates experience-earnings profiles and the return-to-education function that follows evidence from the labor literature. In this setup, increases in longevity raises the investment in education - time in school - and retirement. The model is calibrated to the U.S. and is able to reproduce observed schooling levels and the increase in retirement, as the evidence shows. Simulations show that a country equal to the U.S. but with 20% smaller longevity will be 25% poorer. In this economy, labor taxes have a strong impact on the per capita income, as it decreases labor effort, time at school and retirement age, in addition to the general equilibrium impact on physical capital. We conclude that life-cycle effects are relevant in analyzing the aggregate outcome of taxation.

Equity and Efficiency in Education: motivations and targets

The recently released "Educational PAC" attempts to place basic education at the center of the social debate. We have subsidized this debate, offering a diagnosis of how different education levels can impact individuals' lives through broad and easily interpreted indicators. Initially, we analyze how much each educational level reaches the poorest population. For example, how are those in the bottom strata of income distribution benefited by childcare centers, private secondary education, public university or adult education. The next step is to quantify the return of educational actions, such as their effects on employability and an individual's wages, and even health as perceived by the individual, be that individual poor, middle class or elite. The next part of the research presents evidence of how the main characters in education, aka mothers, fathers and children, regard education. The site available with the research presents a broad, user-friendly database, which will allow interested parties to answer their own questions relative to why people do not attend school, the time spent in the educational system and returns to education, which can all be cross-sectioned with a wide array of socio-demographic attributes (gender, income, etc.) and school characteristics (is it public, are school meals offered, etc.) to find answers to: why do young adults of a certain age not attend school? Why do they miss classes? How long is the school day? Aside from the whys and hows of teaching, the research calculates the amount of time spent in school, resulting from a combination between absence rates, evasion raters and length of the school day. The study presents ranks of indicators referring to objective and subjective aspects of education, such as the discussion of the advantages and care in establishing performance based incentives that aim at guiding the states in the race for better educational indicators.

The brazilian education quality index (Ideb): measurement and incentives upgrades

The increasing availability of social statistics in Latin America opens new possibilities in terms of accountability and incentive mechanisms for policy makers. This paper addresses these issues within the institutional context of the Brazilian educational system. We build a theoretical model based on the theory of incentives to analyze the role of the recently launched Basic Education Development Index (Ideb) in the provision of incentives at the sub-national level. The first result is to demonstrate that an education target system has the potential to improve the allocation of resources to education through conditional transfers to municipalities and schools. Second, we analyze the local government’s decision about how to allocate its education budget when seeking to accomplish the different objectives contemplated by the index, which involves the interaction between its two components, average proficiency and the passing rate. We discuss as well policy issues concerning the implementation of the synthetic education index in the light of this model arguing that there is room for improving the Ideb’s methodology itself. In addition, we analyze the desirable properties of an ideal education index and we argue in favor of an ex-post relative learning evaluation system for different municipalities (schools) based on the value added across different grades

Three essays on education from the perspective of the economics of public setor

This work consists of three essays organized into chapters that seek to answer questions at first sight unrelated, but with one common denominator, which is the scarcity of public resources devoted to education, overall, especially in lower education. . The first chapter deals with the scarcity of resources devoted to education in a context of population aging. Two hypotheses were tested for Brazilian municipalities on the relationship between the aging of the population and educational expenditure. The first, already proven in the literature, is that there is an intergenerational conflict for resources and the increase of the share of elderly in the population reduces the educational expenditure. The second, proposed here for the first time, is that there should be reduction of competition for resources if there is a relationship of co-residence between young and old. The results indicated that an increase in the share of elderly reduces the educational expenditure per youth. But the results also illustrate that an increase in the share of elderly co-residing with youth (family arrangement more common in Latin American countries) raises the educational expenditure, which reflects a reduction of competition for resources between generations. The second chapter assesses the allocative efficiency of investments in Higher Education. Using the difference between first-year and last-year students’ scores from Enade aggregated by HEI as a product in the Stochastic Production Function, is possible to contribute with a new element in the literature aimed at estimating the production function of education. The results show that characteristics of institutions are the variables that best explain the performance of students, and that public institutions are more inefficient than the private ones. Finally, the third chapter presents evidence that the allocation of public resources in early childhood education is important for a better future school performance. In this chapter was calculated the effects of early childhood education on literacy scores of children attending the 2nd grade of elementary school. The results using OLS and propensity score matching show that students who started school at the ages to 5, 4, and 3 years had literacy scores between 12.22 and 19.54 points higher than the scores of those who began school at the ages 6 years or late. The results also suggest that the returns in terms of literacy scores diminish in relation to the number of years of early childhood education.

A eficácia das ações de educação previdenciária como ferramenta para melhorar o entendimento do produto previdência privada

A presente Dissertação procura demonstrar a efetividade das ações de Educação Previdenciária como fator positivo para as empresas de Previdência Privada.

O direito fundamental à liberdade de consciência em discussão: ética e experimentação didático-científica em animais nas universidades

O reconhecimento pela Ciência de que os animais são seres sencientes e conscientes propiciou o surgimento das teorias morais que chamamos de direito animal, bem como o desenvolvimento de alternativas técnicas ao uso de animais, sobretudo na educação. Neste cenário, estudantes de biomédicas se recusam à realização de experimentação animal, baseados no direito à objeção de consciência protegido pela Constituição da República Federativa Brasileira de 1988, que, contudo, tem sido negado pelos tribunais. Este trabalho tem por objetivo, através do estudo de casos, apresentar que as premissas e os fundamentos em que se apoiam os tribunais para negar a objeção de consciência são questionáveis do ponto de vista jurídico, tendo em vista o sentido da objeção de consciência e hermenêutico, pela aplicação do princípio da força normativa da constituição e do princípio da proporcionalidade.

Courts as healthcare policy-makers: the problem, the responses to the problem and problems in the responses

This article starts by analysing healthcare litigation in Brazil by means of a literature review of articles that contribute with empirical findings on this phenomenon. Based on this review, I argue that health care litigation in Brazil makes the public health system less fair and rational. In the second part of this article, I discuss the three most overarching responses to control the level of litigation and its impact on the public health system: (i) the public hearing held by the Supreme Federal Court and the criteria the court established thereafter; (ii) the recommendations by the National Council of Justice aimed at building courts’ institutional capacity; and (iii) the enactment of the Federal Law 12.401/11, which created a new health technology assessment system. I argue that latter is the best response because it keeps the substantive decisions on the allocation of healthcare resources in the institution that is in the best position to make them. Moreover, this legislation will make the decisions about provision of health treatments more explicit, making easier for courts to control the procedure and the reasons for these decisions.

Escola de desenvolvimento social do estado de São Paulo - EDESP – oportunidades e desafios para tornar-se referência como escola de governo da assistência social

Entre os desafios para a implementação da política de desenvolvimento social do Brasil, muito tem sido discutido acerca das dificuldades de capacitação dos profissionais que diariamente executam ações que traduzem esta política. Parte da dificuldade é decorrente das transformações ocorridas nas últimas décadas nas Políticas Públicas de Assistência Social no país e no entendimento destas novas demandas. O Brasil está transformando a sua antiga política assistencialista na do direito social. A capacitação e a garantia da educação continuada e da educação permanente são elementos fundamentais e estruturantes para a consolidação deste novo projeto de política social. Neste sentido, a criação de uma escola de governo no Estado de São Paulo, com a perspectiva de capacitação e educação continuada dos profissionais envolvidos na prestação de serviços socioassistenciais, vem colaborar com a formação dos atores sociais (servidores e prestadores de serviço), capazes de executar e aprimorar as políticas sociais regionais e do SUAS, de forma transversal e multidisciplinar, visando garantir o direito e o acesso a bens e serviços aos cidadãos e grupos em situação de vulnerabilidade e risco social e pessoal. Este trabalho busca resgatar o contexto e as motivações que levaram à criação da Escola de Desenvolvimento Social do Estado de São Paulo (EDESP), sua história e as expectativas em torno dela, permitindo, a partir de experiências em outras escolas de governo e referenciais de boas práticas, elencar alguns pontos para reflexão.

Projeto café do trabalhador como promotor de segurança alimentar e nutricional: avaliação da eficácia da unidade Natal-RN

The evaluation of public policies that promote Food Security and Nutrition (FSN) it s a multidisciplinary activity extremely relevant to the effectiveness of actions to legitimize the Human Right to Adequate Food (HRAF). This study aimed at assessing the effectiveness of the unit project Natal-RN Café do Trabalhador in promoting SAN to its users. The theoretical framework is based on the public and political and on the dimensions of the concept of FSN (quantity and quality-regularity). Through a qualitative approach, methodologically this was the work of an evaluation of efficiency of the unit Natal-RN of Café do Trabalhador project in light of the assumptions of the concept of SAN. Data collection was conducted through retrospective archival research in official documents of the project, semi-structured interviews with managers involved in its implementation (representative of the Secretary of State for Employment, Housing and Care of RN SETHAS and third party), socioeconomic questionnaire applied to the users of the unit, check the amount, regularity and quality of meals offered for 15 days (menu routine) using the descriptive form menu and form filling type checklist for verification of compliance with good practices . Methods of analysis, we used content analysis, descriptive statistics and compared to previously established parameters for the project. As categories of analysis were defined organizational arrangement, access, user, food quantity-regularity and food quality. The results show that, it was found in the category arrangement that will implement the project dismissed technical criteria for choosing the districts and the quantitative distribution of meals for each location. It was found that the valuation of the shares of the company outsources technical SETHA has not been performed. We observed in the access category, the unit has a strategic location, but lack of space in the refectory. The main obstacle to economic access for users is the lack of a register for the beneficiaries. In the category of users, it was identified that the clientele of the project it is predominantly men, with more than 51 years, low education, earning wages less 1 obtained through informal employment, which they move up through the unit transport collective, go to all days of operation due primarily to price. About the meals category quantity-regularity of food showed that the menu serves 95% of the desired needs, and that holidays and weekends are periods of disrupting the regularity of supply of meals. Regarding the category of food quality, it was found that the nutritional aspect on the menu are food sources rich in sodium, nitrates and low in fiber. In the aspect of hygiene and sanitation are the main limitations related to waste management, lack of exposure controls of food prepared and inadequacies of the physical structure. The results showed that in general and the institutional arrangement of the organs attached to the project should establish a systematic evaluation project is to establish as a promoter of and FSN overcome these obstacles

O princípio constitucional do desenvolvimento sustentável: análise da sua concretização no Estado do Rio Grande do Norte

The Article 225 of Constitution of the Federative Republic of Brazil in its main body, stipulates that everyone is entitled to ecologically balanced environment and the use of common people and essential to the healthy quality of life, should be imposed on public authorities and the community the duty to defend it and preserve it for present and future generations. Following a universal trend, the letter raised the Brazilian environment the category of one of those values ideals of social order, dedicating it, along with a constitution of rules sparse, a chapter, itself, which definitely, institutionalized the right to healthy environment as a fundamental right of the individual. The national public policies and state should be in line with modern theories of Sustainable Development, outlined within the international society, and certainly instruments that should be made effective through the mobilization of civil society as a whole. The implementation of Human Rights, in fact, depends on a strong political action and not just a legal problem. Thus, this work of theoretical-descriptive nature we will address various dimensions of sustainable development, such as environmental education, water, sanitation, health and sustainable development plans, evaluating its current stage in our state

Direito à moradia em cidades sustentáveis: parâmetros de políticas públicas habitacionais Natal 2013

The right to housing is included in several international human rights instruments and in Brazilian legal system integrates the constitutional catalog of fundamental social rights (art. 6) and urban development policy (art. 182 and 183). Besides, it is for all federative governments its effectiveness by building programs and improvement of housing conditions and sanitation (art. 23, IX), which justifies the investment in urban planning and public policy of housing affordability because they are tools for achieving this right. Newer strategies in this area have been based on tax incentives, combined with the mortgage as a way to induce the construction of new housing units or reform those in a precarious situation. However, there is still a deficit households and environmental soundness, compounded with the formation of informal settlements. Consequently, we need constant reflections on the issue, in order to identify parameters that actually guide their housing policies in order to meet the constitutional social functions of the city and ensure well-begins of its citizens (art. 182). On the other hand, the intervention of the government in this segment can not only see the availability of the home itself, but also the quality of your extension or surroundings, observing aspects related to environmental sanitation, urban mobility, leisure and services essential health, education and social assistance. It appears that the smoothness and efficiency of a housing policy condition to the concept of adequate housing, in other words, structurally safe, comfortable and environmentally legally legitimate, viable from the extensive coordination with other public policies. Only to compliance with this guideline, it is possible to realize the right to housing in sustainable cities

As relações entre o público e o privado no processo de expansão do ensino superior no Brasil: democratização ou mercantilização?

The present study analyzes the expansion of Brazilian superior education, investigating how the public and the private sectors are inserted in this process, taking as analysis dimensions the philanthropic actions, the democratization and the mercantilism. The study had for general objective to analyze the dynamics of the expansion of superior education in Brazil, investigating how it configures the overlap between the public and the private in this process. More specifically was tried: a) to understand the process of participation of the non-state public, state and private sectors with lucrative goals in the expansion of superior education; b) to analyze the limits between the democratization and mercantilism in the process of expansion of superior education; c) to analyze the mechanisms that express the privatization in the process of expansion of superior education; d) to investigate, in a program of the government, how is materialized the overlap between the public and the private, in the expansion of superior education. In the development of the study, was adopted as theoretician and methodological way a historical and critical perspective, because is considered it allows to understand the mediations between the inquiry subject and the historical context in which it is developed, allowing, this way, the true explanation of the studied object. About the technician procedures, it was adopted documentary and bibliographical research. Also, secondary data were searched on the main governmental web sites (INEP, SISPROUNI, INEP, PNUD; IBGE) which produce statistics on superior education and sponsors of private institutions of superior education, as example ABMES and the Court of Accounts of the Union, amongst others. The study results had delineated a picture that allows to evidence that has been occurring, in the country, a process of expansion of superior education, marked for the articulated participation of the public state, private with lucrative ends and private without lucrative ends sectors, but it is distinguished in recent years the prevalence of the private sector with lucrative ends. In result, it is concluded that this process of expansion cannot be considered as dimension of the democratization because it occurs by means that move it away from the education as a right to be placed in the scope of the market, changing the right into a service that is appropriated by mercantile relations