A spatial–temporal analysis of the impact of access restrictions on forest landscapes and household welfare in Tanzania

This paper explores the impact of the re-introduction of access restrictions to forests in Tanzania, through participatory forest management (PFM), that have excluded villagers from forests to which they have traditionally, albeit illegally, had access to collect non-timber forest products (NTFPs). Motivated by our fieldwork, and using a spatial–temporal model, we focus on the paths of forest degradation and regeneration and villagers' utility before and after an access restriction is introduced. Our paper illustrates a number of key points for policy makers. First, the benefits of forest conservation tend to be greatest in the first few periods after an access restriction is introduced, after which the overall forest quality often declines. Second, villagers may displace their NTFP collection into more distant forests that may have been completely protected by distance alone before access to a closer forest was restricted. Third, permitting villagers to collect limited amounts of NTFPs for a fee, or alternatively fining villagers caught collecting illegally from the protected forest, and returning the fee or fine revenue to the villagers, can improve both forest quality and villagers' livelihoods.

Promoting mother–infant book sharing and infant attention and language development in an impoverished South African population: a pilot study

The low rates of child literacy in South Africa are cause for considerable concern. Research from the developed world shows that parental sharing of picture books with infants and young children is beneficial for child language and cognitive development, as well as literacy skills. We conducted a pilot study to examine whether such benefits might extend to an impoverished community in South Africa, by evaluating the impact of training mothers in book sharing with their 14–18 month old infants. Seventeen mothers received book sharing training; and 13 mothers did not, but instead received a comparison training in toy play. We assessed the mothers’ behavior during both book sharing and toy play before and after training, and we also assessed infant attention and language. Mothers receiving book sharing training engaged well with it, and they also benefited from it; thus, compared to the comparison group mothers, they became more sensitive, more facilitating, and more elaborative with their infants during book sharing, and they also became more sensitive to their infants during toy play. In addition, infants whose mothers received the book sharing training showed greater benefits than the comparison group infants in both their attention and language. Training in book sharing for families living in conditions of marked socio-economic adversity in South Africa has the potential to be of considerable benefit to child developmental progress. A large scale controlled trial is required to confirm this.

Health surveys and use of maternal and child health care services in three municipalities within the Sao Paulo metropolitan area

Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the Sao Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes. Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the Sao Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions. Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of Sao Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance. Conclusions. The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.

Effect of facilitation of local maternal-and-newborn stakeholder groups on neonatal mortality : cluster-randomized controlled trial

BACKGROUND: Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. METHODS AND FINDINGS: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]). CONCLUSIONS: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44599712. Please see later in the article for the Editors' Summary.

Pharmaceutical benefits in Australia and Sweden: welfare policy and the cost of prescription drugs

Pharmaceutical benefits provide a stable framework within which consumers, prescribers, suppliers, pharmacists and other actors undertake transactions. The state in effect delivers a good that enhances individual autonomy. A major reason for the legitimacy enjoyed by pharmaceutical benefits in both Australia and Sweden is that these programs have strong attributes of universalism (rather than targeting). Sweden's predominantly public health system allows greater scope for pharmaceutical policy innovation. Australia's Pharmaceutical Benefits Scheme (PBS), while historically resilient and effective, is now wedged precariously between traditional considerations of equity and public health on the one hand, and constant pressure for increased marketisation on the other.

Population dynamics and animal welfare issues raised by the culling of kangaroos in Puckapunyal

The culling of kangaroos at the Puckapunyal Army base (Australia) raises some intriguing ethical issues around animal welfare. After discussing the costs and benefits of the cull, this paper addresses the more general animal welfare issues related to population dynamics. Natural selection favours the maximization of the number of surviving offspring. This need not result in the maximization of the welfare of individuals in the species. The contrast between growth maximization and welfare maximization is first illustrated for a single population and then discussed in terms of competing populations. In the Lotka-Volterra model of competing species and its generalizations, the choice of different birthrates does not affect the population sizes at equilibrium. Welfare could be much higher at lower birthrates without even reducing numbers (at equilibrium)

Diminishing and negative welfare returns of economic growth : an index of sustainable economic welfare (ISEW) for Thailand

Thailand has achieved remarkable levels of economic growth over the last three decades. This sustained economic growth has played a major role in reducing absolute poverty levels from nearly one third of the population in 1975 to presently less than 10%, thus increasing the welfare of many Thais. This performance ranks Thailand as one of the world's most successful economies during this period. However, an increasing number of studies have begun to find that at a certain point achieving economic growth stops improving welfare and actually begins to diminish it due to the hidden and traditionally unreported costs of associated with this growth. With one exception, these new studies have focussed on high-income countries. This study will estimate an index of sustainable economic welfare (ISEW) for a developing country, Thailand, over a 25-year period, 1975–1999. This paper concludes that even low–middle income countries are beginning to approach the point in which economic growth produces both diminishing and, at times, negative welfare returns as the costs of achieving economic growth begin to outweigh the benefits. These results are important for policy makers and highlight the importance of implementing alternative welfare enhancing interventions that must be considered in place of simply achieving economic growth. The emphasis of this paper is not on the methodology of estimating the ISEW for Thailand, but rather on the policy implications for developing countries of diminishing and negative welfare returns brought about through the achievement of economic growth.

Parental decision-making surrounding complicated births: the impact on parent-infant and infant-marital relationships

This paper reviews current research regarding the impact of birth complications on parental decisionmaking, and the resulting effects on parent-infant and infant-marital relationships. It discusses the importance of informed decision-making on parental satisfaction of the birthing experience, and the benefits of certain strategies, such as kangaroo care, in the facilitation of greater levels of attachment and improved relationships. The paper concludes with suggestions for future research areas to focus on finding better ways to prepare and support parents in these situations, thus improving the quality of relationships between parents and with their child.

Tourism, trade and domestic welfare

Tourism has been regarded as a major source of economic growth and a source of foreign exchange. It has also been viewed as an activity that imposes costs on the host country. Such costs include increased pollution, congestion and despoliation of fragile environments, and intra-generational inequity aggravation. One aspect that has been ignored is the general equilibrium effects of tourism on other sectors in the economy. This paper presents a model that captures the interdependence between tourism and the rest of the economy, in particular agriculture and manufacturing. An important result obtained is that the tourist boom may 'immiserize' the residents.

Tourism, globalization, social externalities, and domestic welfare

One of the impacts of globalisation has been the growth in tourism and mobility of capital. This paper examines the welfare effect of tourism on the host economy with imperfect competition. Three channels that affects domestic welfare by tourism are: social externalities accompanied with tourists, the terms of trade effect via rises in the non-tradable prices, and the resource movement effect to the manufacturing sector. Owing to the positive terms-of-trade effect and/or the beneficial resource movement effect, the optimal levels of tourism occur at the situations that tourists bring negative social externalities to the economy.

Managing professionals : the emerging leadership role of Victorian Maternal and Child Health coordinators

Drawing on research into cultural and organizational change in the Victorian Maternal and Child Health Service during the 1990s, this paper examines implications for the nursing leadership provided by service coordinators. The project included a quantitative survey of nurses and semistructured interviews with managers and coordinators. Under a strongly neoliberal state government in Victoria, Australia, services were fundamentally restructured through tendering processes. A competitive, productivist culture was introduced that challenged the professional ethos of nurses and a primary health orientation to the care of mothers and infants. This paper focuses on the pressures that the entrepreneurial environment presented to maternal and child health nurses' identity and collegial relations and to the coordination role. It argues that coordinators emerged as a Significant nursing management group at the interface of administrative change and the management of professional practice. Although many nurses skilfully negotiated tensions with peers and management, their leadership role needs further clarification and support.