Economic Reforms and Pro-Poor Growth: Lessons for Africa and other Developing Regions and Economies in Transition

The paper discusses the meaning and measurement of pro-poor growth and also reviews evidence of pro-poor growth (or the lack of it) in a large cross-section of countries and time periods. The emerging story is that many episodes of growth are not pro-poor and also that although economic reforms have had positive effects in those countries that have been steadfast in implementing market reforms, the overall impact on growth has been small for many countries and in most cases not pro-poor. I present a general theory of pro-poor growth that includes ten principles that should be incorporated in all economic reforms that seek to generate pro-poor growth. These principles highlight the importance of understanding the poor, their economic activities, capabilities, constraints that impede their participation in markets and also an appreciation of linkages within sectors and regions. It is argued that pro-poor reforms cannot have the intended impact unless there are significant changes in the institutions of governance. Finally, the principles presented underscore the fact that pro-poor growth policies cannot be sustained without workable partnerships between markets and states in the ever changing and complex processes of social and economic development.

Technical Efficiency of State Owned Enterprises in China (1980-1989): An Assessment of the Economic Reforms

This paper uses Data Envelopment Analysis to examine changes in levels of technical efficiency over time in China's state-owned enterprises (SOEs) during 1980-1989. Our paper adds to the growing body of literature in this area by obtaining measures of technical efficiency of individual SOEs over years and by identifying how different aspects of the reforms have affected efficiency. We estimate a Tobit regression model, using the technical efficiency score as the dependent variable and a set of reform variables and firm attributes as regressors. We find that specific aspects of the reforms were very effective in improving technical efficiency.

Federally regulated institutional review boards: The aspects of a "model" IRB---Is the current system in need of a tune up or complete overhaul?

Institutional Review Boards (IRBs) are the primary gatekeepers for the protection of ethical standards of federally regulated research on human subjects in this country. This paper focuses on what general, broad measures that may be instituted or enhanced to exemplify a "model IRB". This is done by examining the current regulatory standards of federally regulated IRBs, not private or commercial boards, and how many of those standards have been found either inadequate or not generally understood or followed. The analysis includes suggestions on how to bring about changes in order to make the IRB process more efficient, less subject to litigation, and create standardized educational protocols for members. The paper also considers how to include better oversight for multi-center research, increased centralization of IRBs, utilization of Data Safety Monitoring Boards when necessary, payment for research protocol review, voluntary accreditation, and the institution of evaluation/quality assurance programs. ^ This is a policy study utilizing secondary analysis of publicly available data. Therefore, the research for this paper focuses on scholarly medical/legal journals, web information from the Department of Health and Human Services, Federal Drug Administration, and the Office of the Inspector General, Accreditation Programs, law review articles, and current regulations applicable to the relevant portions of the paper. ^ Two issues are found to be consistently cited by the literature as major concerns. One is a need for basic, standardized educational requirements across all IRBs and its members, and secondly, much stricter and more informed management of continuing research. There is no federally regulated formal education system currently in place for IRB members, except for certain NIH-based trials. Also, IRBs are not keeping up with research once a study has begun, and although regulated to do so, it does not appear to be a great priority. This is the area most in danger of increased litigation. Other issues such as voluntary accreditation and outcomes evaluation are slowing gaining steam as the processes are becoming more available and more sought after, such as JCAHO accrediting of hospitals. ^ Adopting the principles discussed in this paper should promote better use of a local IRBs time, money, and expertise for protecting the vulnerable population in their care. Without further improvements to the system, there is concern that private and commercial IRBs will attempt to create a monopoly on much of the clinical research in the future as they are not as heavily regulated and can therefore offer companies quicker and more convenient reviews. IRBs need to consider the advantages of charging for their unique and important services as a cost of doing business. More importantly, there must be a minimum standard of education for all IRB members in the area of the ethical standards of human research and a greater emphasis placed on the follow-up of ongoing research as this is the most critical time for study participants and may soon lead to the largest area for litigation. Additionally, there should be a centralized IRB for multi-site trials or a study website with important information affecting the trial in real time. There needs to be development of standards and metrics to assess the performance of the IRBs for quality assurance and outcome evaluations. The boards should not be content to run the business of human subjects' research without determining how well that function is actually being carried out. It is important that federally regulated IRBs provide excellence in human research and promote those values most important to the public at large.^

The impact of 1995--1996 health sector reforms in the effectiveness of malaria control program in the state of Orissa, India

Malaria poses a significant public health problem worldwide. The World Health Organization indicates that approximately 40% of the world's population and almost 85% of the population from the South–East Asian region is at risk of contracting malaria. India being the most populous country in the region, contributes the highest number of malaria cases and deaths attributed to malaria. Orissa is the state that has the highest number of malaria cases and deaths attributable to malaria. A secondary data analysis was carried out to evaluate the effectiveness of the World bank-assisted Malaria Action Program in the state of Orissa under the health sector reforms of 1995-96. The secondary analysis utilized the government of India's National Anti Malaria Management Information System's (NAMMIS) surveillance data and the National Family Health Survey (NFHS–I and NFHS–II) datasets to compare the malaria mortality and morbidity in the state between 1992-93 and 1998-99. Results revealed no effect of the intervention and indicated an increase of 2.18 times in malaria mortality between 1992-1999 and an increase of 1.53 times in malaria morbidity between 1992-93 and 1998-99 in the state. The difference in the age-adjusted malaria morbidity in the state between the time periods of 1992-93 and 1998-99 proved to be highly significant (t = 4.29 df=16, p<. 0005) whereas the difference between the increase of age-adjusted malaria morbidity during 1992-93 and 1998-99 between Orissa (with intervention) and Bihar (no intervention) proved to be non significant (t=.0471 df=16, p<.50). Factors such as underutilization of World Bank funds for the malaria control program, inadequate health care infrastructure, structural adjustment problems, poor management, poor financial management, parasite resistance to anti-malarial drugs, inadequate supply of drugs and staff shortages may have contributed to the failure of the program in the state.^

A study to determine the association between medical decision-making and the performance of an institutional ethics committee

This study developed proxy measures to test the independent effects of medical specialty, institutional ethics committee (IEC) and the interaction between the two, upon a proxy for the dependent variable of the medical decision to withhold/withdraw care for the dying--the resuscitation index (R-index). Five clinical vignettes were constructed and validated to convey the realism and contextual factors implicit in the decision to withhold/withdraw care. A scale was developed to determine the range of contact by an IEC in terms of physician knowledge and use of IEC policy.^ This study was composed of a sample of 215 physicians in a teaching hospital in the Southwest where proxy measures were tested for two competing influences, medical specialty and IEC, which alternately oppose and support the decision to withhold/withdraw care for the dying. A sub-sample of surgeons supported the hypothesis that an IEC is influential in opposing the medical training imperative to prolong life.^ Those surgeons with a low IEC score were 326 percent more likely to continue care than were surgeons with a high IEC score when compared to all other specialties. IEC alone was also found to significantly predict the decision to withhold/withdraw care. Interaction of IEC with the specialty of surgery was found to be the best predictor for a decision to withhold/withdraw care for the dying. ^

Perceptions of institutional support of community -based participatory research within prevention research centers

The Institute of Medicine (IOM) report on the future of health care states that the focus on health needs to shift to the management and prevention of chronic illnesses and that academic health centers (AHCs) should play an active role in this process through community partnerships (IOM, 2002). Grant funding from the National Institutes of Health and the creation of the Centers for Disease Control and Prevention (CDC) Prevention Research Centers (PRC) across the county represent a transition toward more proactively seeking out community partnerships to better design and disseminate health promotion programs (Green, 2001). ^ The focus of the PRCs is to conduct rigorous, community-based, prevention research, to seek outcomes applicable to public health programs and policies. The PRCs work is to create and foster partnerships among public health and community organizations, to address health promotion and disease prevention issues (CDC, 2003). ^ The W.K. Kellogg Foundation defines CBPR as "a collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health." ^ In 1995, CDC asked the IOM to review the PRC program to examine the extent to which the program is providing the public health community with strategies to address public health problems in disease prevention and health promotion (IOM, 1997). No comprehensive evaluation n of the individual PRCs had ever been done (IOM, 1997). ^ The CDC was interested in understanding how it could better support the PRC program through improved management and oversight to influence the program's success. The CDC only represents one of the entities that influence the success of a PRC. Another key entity to consider is the support of and influence of the Schools of Public Health in which the PRCs reside. Using evaluation criteria similar to those that were developed by the IOM, this study examined how aspects of structural capacity of the Schools of Public Health in which the PRCs reside are perceived to influence PRC community-based research activities. ^

Hacia una escuela inclusiva : un aporte desde las estrategias de la gestión

Ante un contexto signado por reformas educativas, demandas de pluralismo y atención a la diversidad, nos enfrentamos al cambio paradigmático de lo organizacional, lo que implica una revisión profunda del modo de gestión de las instituciones en los distintos niveles educativos. La escuela, inmersa en un contexto de cambios acelerados tanto científicos como tecnológicos, y continuamente demandada por una sociedad cada vez más heterogénea y pluralista, debe adaptarse a estos cambios y dar una respuesta efectiva. La escuela inclusiva es una alternativa válida tanto desde sus principios como en sus procedimientos, hacia la apertura a la diversidad de la población en edad escolar. En tal sentido, el desarrollo de una gestión educativa basada en la descentralización; la sustitución de la programación de detalle por la orientación estratégica; el “achatamiento" de la jerarquía; la desburocratización; el trabajo en equipo y la democratización en la toma de decisiones. Desde tal perspectiva, en este trabajo se plantean una serie de consideraciones a tener en cuenta en todo proyecto de inclusión escolar desde la gestión, que podrían contribuir al análisis de la capacidad de inclusión de la escuela actual, en sus diversas dimensiones: pedagógica, administrativa, organizativa y comunitaria, y para la puesta en práctica de un modelo Curricular, desde una gestión participativa.

Combatir al “enemigo interno" : el caso de la provincia de Mendoza (1973-1976)

Hacia mediados de la década del 70, la crisis institucional, la conflictividad social y el fracaso del intento redistribucionista del tercer gobierno peronista, llevaron a que se produjera una generalización de distintos procedimientos autoritarios que incluyeron el accionar represivo paraestatal y otras estrategias tales como reformas legales de corte represivo, un operativo de “limpieza" de militantes de izquierda al interior del peronismo, y modificaciones doctrinarias de reglamentos militares. En este trabajo, desde el campo de la historia reciente, y a partir del uso de fuentes escritas y orales, analizaremos en la trama local, de qué manera dichos factores se inscribieron y articularon en el proceso de represión paraestatal previo a la dictadura, en pos de profundizar en el estudio de las redes de relaciones implicadas en la prácticas coercitivas llevadas a cabo durante el tercer gobierno peronista.

Making Abortion Services Accessible in the Wake of Legal Reforms: A Framework and Six Case Studies

Contiene Informe completo y resumen.

Gênese, desenvolvimento, crise e reformas nos serviços públicos de extensão rural durante a década de 1990

This article presents an historical overview of the processes of genesis, development, crisis and reforms in public agricultural extension throughout the 1990s, offering an overview of its main determinants, based on the literature on the subject. In this way, we analyzed the process of constitution of institutional apparatuses for the offering of extension services and linking policies technical modernization of agriculture worldwide during the postwar period, weaving considerations on the Brazilian case. The article also examines the aspects that determined the emergence of a crisis of public extension occurred during the 1980s, amid intensifying criticism of the Green Revolution model of agriculture. Finally, the article seeks to highlight the connections between the crisis and the reforms of privatization of public extension occurred in several countries during the 1990s guided the redesign of its institutional forms, forms of financing, its goals, its target audience, the working methodologies and technological matrix advocated

Reformas liberales, sociedad rural y derechos de propiedad territorial en la frontera sur bonaerense (2da mitad del siglo XIX) : Las "donaciones condicionadas" de Azul

El objetivo del trabajo es examinar la revisión oficial de las "donaciones condicionadas" implementadas en el partido de Azul y la respuesta de la sociedad rural durante la segunda mitad del siglo XIX. Mediante un análisis principalmente cualitativo de la legislación, prensa, correspondencia, expedientes de tierras y otras fuentes coetáneas, se aborda el marco legal y el accionar social, considerando los argumentos esgrimidos para la puesta en valor de los derechos y el acceso a la propiedad formal. Así como los rasgos centrales del proceso, caracterizado por una gran interacción, complejidad, disputas y resistencias durante esta etapa de reestructuración hasta el cierre de la frontera. Se plantea que las "reformas liberales" no supusieron un cambio radical en las prácticas sociales y en el acceso al recurso, de raigambre institucional y social anterior

Gênese, desenvolvimento, crise e reformas nos serviços públicos de extensão rural durante a década de 1990

This article presents an historical overview of the processes of genesis, development, crisis and reforms in public agricultural extension throughout the 1990s, offering an overview of its main determinants, based on the literature on the subject. In this way, we analyzed the process of constitution of institutional apparatuses for the offering of extension services and linking policies technical modernization of agriculture worldwide during the postwar period, weaving considerations on the Brazilian case. The article also examines the aspects that determined the emergence of a crisis of public extension occurred during the 1980s, amid intensifying criticism of the Green Revolution model of agriculture. Finally, the article seeks to highlight the connections between the crisis and the reforms of privatization of public extension occurred in several countries during the 1990s guided the redesign of its institutional forms, forms of financing, its goals, its target audience, the working methodologies and technological matrix advocated

Reformas liberales, sociedad rural y derechos de propiedad territorial en la frontera sur bonaerense (2da mitad del siglo XIX) : Las "donaciones condicionadas" de Azul

El objetivo del trabajo es examinar la revisión oficial de las "donaciones condicionadas" implementadas en el partido de Azul y la respuesta de la sociedad rural durante la segunda mitad del siglo XIX. Mediante un análisis principalmente cualitativo de la legislación, prensa, correspondencia, expedientes de tierras y otras fuentes coetáneas, se aborda el marco legal y el accionar social, considerando los argumentos esgrimidos para la puesta en valor de los derechos y el acceso a la propiedad formal. Así como los rasgos centrales del proceso, caracterizado por una gran interacción, complejidad, disputas y resistencias durante esta etapa de reestructuración hasta el cierre de la frontera. Se plantea que las "reformas liberales" no supusieron un cambio radical en las prácticas sociales y en el acceso al recurso, de raigambre institucional y social anterior

Gênese, desenvolvimento, crise e reformas nos serviços públicos de extensão rural durante a década de 1990

This article presents an historical overview of the processes of genesis, development, crisis and reforms in public agricultural extension throughout the 1990s, offering an overview of its main determinants, based on the literature on the subject. In this way, we analyzed the process of constitution of institutional apparatuses for the offering of extension services and linking policies technical modernization of agriculture worldwide during the postwar period, weaving considerations on the Brazilian case. The article also examines the aspects that determined the emergence of a crisis of public extension occurred during the 1980s, amid intensifying criticism of the Green Revolution model of agriculture. Finally, the article seeks to highlight the connections between the crisis and the reforms of privatization of public extension occurred in several countries during the 1990s guided the redesign of its institutional forms, forms of financing, its goals, its target audience, the working methodologies and technological matrix advocated