Transferring HIV/AIDS Related Healthcare from Non‐governmental Organizations to the Public Healthcare System in South Africa: Opportunities and Challenges

Almost two decades after the transition to a post‐apartheid regime, South Africa is still high‐ranking in the incidence of chronic diseases like tuberculosis, HIV/AIDS, diabetes and hypertension. This article explores the transition from HIV/AIDS related healthcare offered by internationally supported non‐governmental organizations (NGOs) in rural areas to the inclusion of this healthcare into the public healthcare system. This transition is part of a wider process that represents the exact reverse of healthcare reforms in Western industrialized countries. Instead of a transition from public healthcare to privatized or marketized healthcare, the transition in South Africa is from partly private healthcare to a public healthcare system in which the private commercial health sector as well as all services provided by NGOs will be integrated. In that process, many obstacles obscure intended outcomes, such as equal access to healthcare. Some obstacles are evident in the case studies of two internationally supported NGOs in the field of HIV/AIDS healthcare. We will conclude that governance structures of public and private NGO‐based healthcare are often difficult to integrate; implementation timelines and priorities do not always coincide; and the public healthcare system is still too weak to deliver good quality healthcare in rural areas without continued NGO support.     

Statistical equality and cultural difference in Indigenous wellbeing frameworks: A new expression of an enduring debate

Recent years have seen a burgeoning interest in developing indicator frameworks for ‘Indigenous wellbeing’. Implicit in each of the frameworks are particular conceptions of what constitutes the ‘good life’ for Indigenous peoples and what ‘Indigenous development’ should entail. In developing these frameworks, then, certain judgements must be made about whether statistical equality should be prioritised as a ‘development’ goal. This issue has generated long‐standing debate and in this context must be broached anew. In this paper we briefly examine the growing interest in Indigenous wellbeing and outline three prominent indicator frameworks: the Productivity Commission's indicators for ‘Overcoming Indigenous Disadvantage’; the ‘capability indicators’ developed by the Cape York Institute for Policy and Leadership; and the indicators of wellbeing developed by the United Nations Permanent Forum on Indigenous Issues. The first prioritises statistical equality between Indigenous and non‐Indigenous Australians; the second adds a concern with ‘capabilities’; and the last emphasises the importance of distinct cultural preferences. We offer an assessment of these approaches, drawing in part on Amartya Sen's work. We argue that in seeking to improve the wellbeing of Indigenous Australians, policy‐makers should not only make their own normative assumptions clear, but also be aware of the implications of their decisions for constituents with different worldviews.     

Portuguese healthcare reforms in the context of crisis: External pressure or domestic choice?

As a result of the recent economic crisis, in 2011, Portugal signed a Memorandum of Understanding with the European Central Bank, the European Commission, and the International Monetary Fund (the “Troika”). In exchange for Troika's financial assistance, the Memorandum required the implementation of a specific set of reforms targeted at the healthcare sector. The literature on policy reforms in the context of crisis and conditionality argues that governments have restricted room to manoeuver in responding to external pressure. We challenge this view, finding that even in cases of conditionality and strong external pressures, crisis can be used as a window of opportunity for reforms substantially shaped by domestic policy choices. In the case of Portuguese health reforms, these choices were based on pre‐existing reform plans aimed on resolving country‐specific deficiencies of the healthcare system and were enabled by the two main political parties' strategies of tacit cooperation and blame avoidance. The article emphasizes the need for more fine‐grained analysis of welfare reforms in the crisis that pays equal attention to the institutional characteristics and the political context of the affected countries.     

Teaching and learning communication with children and young people: developing the qualifying social work curriculum in a changing policy context

Twenty years after survey evidence showed that UK social work students could complete their training without having learnt about or worked with children, new research suggests little has changed. There is still no guarantee that any student on qualification will have been taught about or assessed in communication skills with children and young people. This is despite the claim that the pre‐registration award provides teaching and assessment in core generic skills as a foundation for the development of specialist practice roles in agencies. In fact, as this paper shows, a common understanding of what counts as effective communication with children has yet to be consolidated in social work practice and research. This has impeded the process of curriculum development. Divergent expectations about what counts as social work communication with children in a changing policy context may be exacerbating long‐standing uncertainties about how genericism and specialism should be linked in professional education and training. In exploring these issues, this paper seeks to clear the way for the renewed effort that is now required if this aspect of curriculum development is to be effective.     

South Asian immigrants' experience of child protection services: are we recognizing strengths and resilience?

Ethno‐racial minority families who come in contact with child protection services face unique challenges that include different ideas about appropriate child rearing practices, possibly different definitions of child maltreatment, the possibility of racial biases and service provision that does not address their particular needs. Ethno‐racial minority immigrants encounter additional barriers to services associated with the challenges of settlement in a new cultural environment. Although considerable research has explored these issues, knowledge of the experiences of ethno‐racial families who have been in contact with child protection is limited. The current paper provides insights from a qualitative study that explored the experiences of one ethno‐racial group (South Asians) in Canada. Findings suggest a variety of reasons that families come into contact with the child protection system, and the characteristics of the sample highlight their difficult financial and employment circumstances. Themes include participants' desire to be better informed about the reasons for child protection involvement and about what they can expect from the worker and the agency. They also identified a wish for services that not only recognize their cultural diversity but also respond to the needs of the whole family. In‐home services were especially appreciated. The findings reveal the resilience and personal agency among participants that can be enhanced through strength‐based approaches to practice. Helping others, establishing community networks and developing needed services were avenues of resilience identified.     

Back to Work after Incapacity Benefit: Differences between Ethnic Minority and Native Dutch Workers

Contemporary pleas for an activating welfare state and social security system emphasize that getting benefit claimants back to work is more important than providing income compensation for social risks connected with unemployment or illness. The Dutch system of incapacity benefits, however, is far removed from this normative ideal of a proactive social security system. Resumption of work after a spell of incapacity benefit is the exception rather than the rule. This article examines possible ethnic differences in resumption of work following incapacity benefit. We use a unique register data file from Statistics Netherlands that contains information about all incapacity benefit claimants in the Netherlands in 1999. In the analysis we follow these benefit claimants for three years and examine what their labour market position was in 2002. We find that resumption of work after incapacity benefit is even more the exception for migrant workers with a Turkish or Moroccan ethnic background. Contrary to our assumption, this difference from native Dutch workers cannot be explained by unfavourable personal characteristics of Turkish or Moroccan benefit claimants – their personal characteristics (gender, age, low educational level) appear to be rather favourable for resumption of work. In the current literature, these differences in outcomes between ethnic groups are often attributed to certain ‘ethnic‐specific’ or cultural factors. This article argues that we should be careful of explaining different outcomes between ethnic groups by (alleged) cultural phenomena. There are other explanations possible such as differences in work motivation, lack of ‘transition facilities’ in companies and differential treatment by employers or social security officials.     

What is Behaviour? And (when) is Language Behaviour? A Metatheoretical Definition

Behaviour is central to many fields, but metatheoretical definitions specifying the most basic assumptions about what is considered behaviour and what is not are largely lacking. This transdisciplinary research explores the challenges in defining behaviour, highlighting anthropocentric biases and a frequent lack of differentiation from physiological and psychical phenomena. To meet these challenges, the article elaborates a metatheoretical definition of behaviour that is applicable across disciplines and that allows behaviours to be differentiated from other kinds of phenomena. This definition is used to explore the phenomena of language and to scrutinise whether and under what conditions language can be considered behaviour and why. The metatheoretical concept of two different levels of meaning conveyed in human language is introduced, highlighting that language inherently relies on behaviours and that the content of what‐is‐being‐said, in and of itself, can constitute (interpersonal) behaviour under particular conditions. The analyses reveal the ways in which language meaningfully extends human's behavioural possibilities, pushing them far beyond anything enabled by non‐language behaviours. These novel metatheoretical concepts can complement and expand on existing theories about behaviour and language and contribute a novel piece of theoretical explanation regarding the crucial role that language has played in human evolution.     

Improving decision‐making in care order proceedings: A multijurisdictional study of court decision‐makers' viewpoints

Child welfare removals of children are among the most invasive decisions a state can make toward its citizens, and typically it is the courts that make these decisions. These interventions are regularly exposed to criticism. In this paper, we examine if and how care order proceedings could be improved in England, Finland, Norway, and California, USA. We have asked the judiciary decision‐makers about their view on what should be improved. Our findings show that the organization of the proceedings, including time and staff, are identified as issues in all four systems. Furthermore, the preparations by the child welfare agency are also mentioned as an issue, for English, Finnish, and Californian decision‐makers. Very few decision‐makers indicate features related to the individual, situational, and contextual dimensions, which is interesting since this would be expected from organization theory. The strong call for change in the way proceedings are organized indicates a need for modernization as well as better use of available competency from child development experts. The respondents focus on the elements that a decision‐maker has direct experience with and knowledge about, and this is indeed worth noting for policymakers in the four systems.     

Understandings of environmental injustice and sustainability in marginalized communities: A qualitative inquiry in Nevada

As eco‐social work practice and scholarship continues to grow, multiple frameworks are emerging to help guide the work. In this study, we interviewed 59 people affected by environmental injustice. Participants identified components within both environmental injustice and sustainability, as well as gaps that these models individually do not support. Therefore, we suggest that merging environmental justice with sustainability through centering justice (a component within environmental justice), and also finding solutions through technological advances (a component within sustainability), may best support these communities. In addition, the participants discussed the need for support, which social workers can provide.     

Poverty alleviation,coverage and fiscal sustainability: Investigating the effect of a new social pension in Hong Kong

This article synthesises the characteristics of social pensions across Asia and evaluates the effect of a new social pension in the Hong Kong SAR, the Old Age Living Allowance (OALA), on poverty alleviation, coverage rates and fiscal sustainability. We found that the effectiveness of the OALA in reducing old‐age poverty was limited, although it has led to an increase of retirement pension coverage by 6%. The OALA is projected to face substantial cost increases in the medium and longer term. Increasing the level of OALA benefits would be a direct means to enhance its poverty alleviation effect but may potentially be hampered by concerns about the fiscal sustainability of such changes. More obfuscated alternatives for Hong Kong policy makers to affect old‐age poverty alleviation include adjusting the indexing rules of benefit level payments and the eligibility criteria to reduce the stigma attached to the current policy choices.     

Changing Healthcare System Types

This article classifies 32 Organisation for Economic Co‐operation and Development (OECD) healthcare systems based on data from 2001 and 2007. It shows that European countries are clustered in different types of healthcare systems and that traditional typologies are only partially represented in the four types of healthcare systems identified in this study. Type 1 represents countries with low total health expenditure (THE), high public financing, and low out‐of‐pocket payment (OOP). In‐patient healthcare is higher and out‐patient healthcare lower than the OECD average. General practitioners (GPs) are paid by capitation, and patients' access to healthcare is strictly regulated. Type 2 represents countries with an average level of THE, high public financing, above‐average OOP, and high in‐patient and out‐patient healthcare. GPs receive a salary, and access regulation is strict. Type 3 is characterized by very low THE, low public financing, and very high OOP. Both in‐patient and out‐patient healthcare is well below average, and GPs are paid a salary. Type 4 includes systems with the highest THE, the highest public financing, and the lowest direct payments by patients. In‐patient healthcare is below the OECD mean and out‐patient healthcare is well above it. GPs are paid by fee‐for‐service, and most countries offer free choice of medical doctors. The clusters for the years 2001 and 2007 are quite robust. During this time period, THE increased, and patients' access to medical doctors has since become more regulated.     

What is a person‐centred approach? Familiarity and understanding of individualised funding amongst carers in New South Wales

Person‐centred approaches place individuals with a disability at the centre of decision making, with their carers and family invited to be partners in the process. Rather than being required to fit within existing service programs, person‐centred approaches enable individuals to choose the support options that best meet their needs. In order to facilitate this, person‐centred approaches will be accompanied by the introduction of individualised funding. This means the individual will be provided with funding to purchase services of their choosing. Given these significant changes occurring in the disability sector, Carers NSW surveyed informal carers of people with a disability to identify what they knew about person‐centred approaches and how they felt about their introduction. Survey results indicate that there is a need to increase the capacity and willingness of carers significantly in order to engage with person‐centred approaches and individualised funding. Carers require targeted and comprehensive information about these concepts in order to understand fully the changes occurring within the disability sector. These findings also indicate specific areas that need to be addressed in order to increase carers' awareness of these concepts and also to address existing negativity and confusion.     

Family participation in child protection practice: an observational study of family group meetings

Over the past two decades, child protection authorities internationally have begun to implement models of family participation in child protection decision‐making. Debate exists about the extent to which these models promote family involvement in decision‐making. While a significant body of research on family and professional experience and perceptions of models of family participation in decision‐making has emerged, there has been little observational research of these approaches. In this paper, we report on observational data from 11 family group meetings (FGMs) in a child protection context in Queensland, Australia. Under Queensland child protection law, these meetings are referred to as an inclusive process for child protection decision‐making and planning. We draw on observational data to analyse how family inclusion in child protection decision‐making is facilitated, or limited, by the FGM process. We consider tensions in the realization of a participatory ethos in child protection services systems and discuss what practitioners can practically do to enhance family participation in child protection decision‐making.     

Healthcare in India: Changing the Financing Strategy

The way in which healthcare is financed is critical for equity in access to healthcare. At present the proportion of public resources committed to healthcare in India is one of the lowest in the world, with less than one‐fifth of health expenditure being publicly financed. India has large‐scale poverty and yet the main source of financing healthcare is out‐of‐pocket expenditure. This is a cause of the huge inequities we see in access to healthcare. The article argues for strengthening public investment and expenditure in the health sector and suggests possible options for doing this. It also calls for a reform of the existing healthcare system by restructuring it to create a universal access mechanism which also factors in the private health sector. The article concludes that it is important to over‐emphasize the fact that health is a public or social good and so cannot be left to the vagaries of the market.     

Implementing Consumer Choice in Long‐term Care: The Impact of Individual Budgets on Social Care Providers in England

In common with many advanced welfare states, England has increasingly relied on consumerist principles to deliver both greater quality and improved efficiency in the long‐term care system. The Individual Budget (IB) pilots marked the next step in this process, through a new system of funding whereby greater control of resources is given to service users, in lieu of direct in‐kind care provision. IBs have the potential to transform the market for care services as well as the relationships between key stakeholders within it. Purchasing will increasingly be shaped by the demands of IB holders, with providers expected to deliver a wider range of personalized services. What will this mean for providers, and what can they do to prepare for these changes? These questions are relevant not just in England but in many other countries adopting similar mechanisms for devolving control over the design, delivery and funding of care to the end‐user. The article explores the early impact of IBs on providers' services, on their workforces, and on the administrative implications for providers of managing IBs. The study finds that providers were positive about the opportunities for better‐quality services that IBs can bring about. However, participants highlighted a number of obstacles to their effectiveness, and reported a range of potentially adverse administrative and workforce consequences which have the potential to jeopardize the consumerist policy objectives of increased choice and efficiency.     

Benefit ‘Myths’? The Accuracy and Inaccuracy of Public Beliefs about the Benefits System

There is a widespread assumption by academics and commentators that negative public attitudes to the benefits system are due to ‘myths’ held by the British public. However, there is little research on whether the public believe these ‘myths’, nor critical scrutiny of benefit ‘truths’. This article therefore investigates what British people believe about the benefits system, and the extent to which these beliefs can be regarded as correct. To do this, we use 46 measures from 18 datasets (including British Social Attitudes, the European Social Survey, Eurobarometer, and surveys by YouGov and Ipsos MORI made available for academic study for the first time), and compare these perceptions to true figures obtained from a variety of sources. We find that – against expectations – there are some areas where the public are (on average) relatively accurate (e.g. the share of the population who currently claim out‐of‐work benefits). Yet overall, our evidence shows that the British public have low levels of understanding of the benefits system, primarily in ways that seem likely to undermine public support. People wildly overestimate unemployment benefits compared to pensions, the value of unemployment benefits, and misperceive trends in claims. While it is difficult to know the true level of benefit fraud exactly, the public overestimate fraud compared to any reasonable figure. We conclude by discussing the implications for both understanding and changing attitudes towards benefits.     

Ethnographic insights into competing forms of co‐production: A case study of the politics of street trees in a northern English city

The aim of this article is to explore the link between different notions of co‐production. It seeks to emphasise the underlying politics of co‐production in the sense of who defines co‐production, especially in relation to initial decisions concerning which specific policy areas are deemed suitable for codesigning, cocreating, or codelivering with services users or local communities. We argue that the rejection of co‐production by government may inflame political resentment and reconfirm negative pre‐existing attitudes about “the establishment.” This is particularly problematic when politicians have promoted the rhetoric of “inclusive governance,” “sharing power,” or “delegating power” but then reject the co‐productive claims emerging from such statements. The study contributes to existing work by analysing what happens when co‐productive structures are terminated or when public protests demand the reinstitutionalisation of those relationships. We make this contribution by presenting findings from an ethnographic case study involving street trees in a large English city. We suggest these specific findings have a broader relevance.     

The impact of international migration on the public pension system: The case of Portugal

This article analyses the impact of replacement migration on the financial sustainability of the old‐age pension system in Portugal, a country with one of the largest ageing populations in Europe. We do this using demographic forecasts and prospective exercises for the evolution of the Portuguese economy. During the 2015–2060 period, our results evidence the positive impacts of international migration on old‐age pension system financial balances, reaching over 3 per cent of GDP after 2045. Moreover, even when taking into considering the low dynamics for the Portuguese economy, replacement migration is an important input to improve pension system financial sustainability.     

Risk and Public Protection: Responding to Involuntary and ‘Taboo’ Risk

Growing media, political and public concern with high‐risk offenders in the community has focused policy attention on the concept of ‘public protection’. A notion that the public has the right to be protected, particularly from ‘monstrous’ offenders such as predatory paedophiles, has infiltrated much recent legislation and penal policy. This article will explore the critical factors in the ‘public protection’ trend and the framing of risk and risky offenders that has ensued. In particular, attention will be given to the new surveillance and intervention mechanisms under the Multi‐Agency Public Protection Arrangements (MAPPA) and whether these arrangements manage risk or displace it. To what extent are they driven by the ‘precautionary principle’ and defensive responses to risks that are over‐inflated? To what extent does this result in ‘perverse incentives’ to over‐manage certain risks and to over‐concentrate on restrictive risk management techniques such as electronic tagging, satellite surveillance and curfews rather than treatment? Does the system represent effective risk management or a system for dealing with risk anxiety – both of the public(s) and of politicians?     

Harmful care. To what extent is terminology from medicine and clinical psychology applicable to out‐of‐home care?

Research concerning outcomes for children who have been placed in out‐of‐home care has indicated that the care may have unwanted consequences. However, there has been no coherent terminology for differentiating between different types of such unwanted consequences. In this article therefore, we attempt to disentangle different aspects of potentially harmful care for looked after children, as well as to discuss potential pathways to more systematically approach and report adverse events for this group. In this endeavour, we turn to two adjacent disciplines, medicine and psychology, where these issues have received more interest. The applicability of the concepts used in these fields is discussed, and it is concluded that although they provide some help in categorizing different aspects of harmful care, the complexity of out‐of‐home care makes existing models difficult to adopt without adjustments. This has consequences for the possibility of evaluating care in research, as well as for monitoring adverse events in practice. Importantly, the causality will often be unknown. We therefore suggest that it is essential to shed more light on how decisions should be made about when to intervene or not in out‐of‐home care, despite limited information.