Main changes and differentiations in the health status of Poland's population with allowances for international mortality comparisons

The health status of the population of Poland is analyzed for the postwar period, with emphasis on the 1980s. Trends in mortality, and particularly in excess male mortality, are described and compared with other European countries.     

Problems and possibilities of development work among tribals: a participatory evaluation of a voluntary agency in India

Mandal, a church-related non-governmental voluntary agency operating in north-west India's Nasik district since 1966 was evaluated for performance in promoting self-sustaining economic growth and socio- political awareness in its beneficiaries. The research design incorporated 2 questions, the extent to which Mandal had used the integrated approach, and the extent to which it promoted structural change in the village. 2 levels of analysis were used: random samples of 315 individuals (163 beneficiaries and 152 non-beneficiaries) and data from the takatu's office for 20 involved villages and 8 control villages. Quantitative data were sought by examining files and doing closed interviews, and qualitative data were collected by observation and open-ended interviews. The variables used in the analysis were educational level, class category, caste, agricultural investment, family net income, individual consciousness and social participation. It was concluded that on the individual level some positive impact was discernible in terms of family income and agricultural investment. At the village level no quantitative improvement was measurable, but the effect of Mandal was symbolic in that it sets an example for social change. The Mandal has acquired a health, non-partisan secular image for social action.     

The Indonesian transmigration program in historical perspective

"The purpose of this paper is to look at what has been achieved by the transmigration program [in Indonesia], to examine the major problems that have arisen and to consider the present constraints which now cast some doubt upon the future of the program." A historical overview of government policies from 1905 to 1988 is provided, and problems of land supply, land use, and lack of funds are discussed. Data are from the 1961 and 1980 Indonesian censuses. (SUMMARY IN FRE AND SPA)     

Helping oneself by helping others: evaluation of a service credit banking demonstration

Between 1987 and 1990, the Robert Wood Johnson Foundation funded six service credit banking demonstration programs among the elderly in which participants delivered services in return for credits, entitling them to later service. This evaluation of the demonstrations found that these six sites successfully attracted elders for the delivery of household support services to a relatively old, frail population with potentially limited social networks. Evidence on the significance of the "credit" in attracting volunteers was mixed, but the programs have attracted new volunteers, and have not substituted for other volunteer activities. Program development has entailed considerable staff investment in volunteer support; programs are better understood as community membership organizations than as mechanical exchanges.     

Brief case: managing inputs

Jane Carmichael's views on Managing Inputs provide a further interesting contribution on a topic, strategic control, that we have covered on several occasions in this column. Carmichael's approach is to dig back behind the results being achieved to the 'inputs' on which they depend. But, while this may unearth causes of performance that can often be missed by a bottom-line orientation, results must ultimately remain vital; a business that is on track with all its input measures, but is missing its output goal is still in trouble. We continue to be interested in hearing from readers with views on strategic control processes, particularly those who have found productive ways of setting input and output targets.     

National Practitioner Data Bank--incomplete and future cloudy

Nearly six years after the National Practitioner Data Bank was authorized by Congress in the Health Care Quality Improvement Act of 1986, and more than a year after its actual creation, the device is still only partially operational. What is more, the success of even those limited efforts is being questioned, and the timetable for future developments remains to be firmed up. Also, the costs are much higher than estimated.     

The future of refugee flows and policies

"The number of forced migrants...is estimated today to exceed 40 million [worldwide]. The changed international climate of the 1990s...has shifted the focus from the asylum and resettlement countries to the countries of origin: there is today a greater willingness to intervene in other countries' affairs either to avert the creation of new flows of focused migrants or to assist internally displaced populations, and there is the expectation of large-scale voluntary returns of refugees in asylum. This article discusses these and other policy issues concerning forced migration in this new international environment."