Setting health priorities: a review of concepts and approaches

The setting of health priorities is primarily concerned with the equitable distribution of resources and is now more than ever an important part of strategic planning within the National Health Service (NHS). The basic information which can be used to assist in such decision-making and the process by which different agencies become involved are important aspects of priority-setting; this article is based on a major review of the research literature on these aspects and provides a discussion and an analysis of experience within health and other fields. From this material a number of possible approaches to priority-setting are identified and discussed. The article concludes that, before it can be decided how priorities should be set in the future, outstanding questions about how far rational approaches are feasible, about who is to be involved and what role they should play, and about how far such decisions are to be taken nationally or locally will need further consideration.     

Four criteria to evaluate providers' service-delivery response to new contraceptive introduction

This article presents an evaluation framework developed to assess the first-level effects of introducing the Standard Days Method (SDM) in Peru Ministry of Health clinics. Four questions are asked: 1) To what extent do providers routinely achieve SDM service delivery standards? 2) Is the time invested in SDM delivery consistent with program norms? 3) How does SDM delivery compare with delivery of established methods? and 4) How does SDM introduction affect delivery of established methods? A study at 62 clinics demonstrated the framework's usefulness. The Standard Days Method introduction had positive overall effects on the quality of care but provider training needed adjustments.     

The sacred and the profane in life science work: The case of assisted reproduction laboratories

Reproductive medicine and assisted reproduction therapies have been developed over the last decades resulting in over five million babies. The handling of human reproductive materials and patients is based on the ability to combine health care work and techno-scientific expertise in both the clinic and the laboratory setting. This study of Swedish assisted reproductive technology clinics demonstrates that the active day-to-day manipulation of human reproductive materials enact both the ‘profane’, through treating the embryos as raw materials in standardized procedures enabling economies of scale, and the ‘sacred’ through enacting a separation, the potential to human life, the patients ordeals, and seriousness. The enactment of the profane and the sacred is mostly balanced but at certain points in the work procedures, their intersecting becomes particularly salient. Such points provide opportunities for the study of the sense making of professionals in organizational grey zones, during techno-scientific activities.     

Abuse of disabled children in Ghana

Even though disabled children are targets of various forms of abuse, such issues remain mostly undocumented open secrets in many countries including Ghana. The article is based on a qualitative data provided by three key informants. Six stories emerged from the data and are discussed in terms of four main forms of abuse. Labelling theories are employed to strengthen the discussions. The article is aimed at increasing awareness on the various forms of abuse experienced by disabled children in Ghana. The study is also meant to capture the attentions of stakeholders that have the responsibility to end abusive practices against disabled children in Ghana.     

Cost-effectiveness analysis of the New South Wales adult drug court program

In New South Wales, Australia, a cost-effectiveness evaluation was conducted of an adult drug court (ADC) program as an alternative to jail for criminal offenders addicted to illicit drugs. This article describes the program, the cost-effectiveness analysis, and the results. The results of this study reveal that, for the 23-month period of the evaluation, the ADC was as cost-effective as were conventional sanctions in delaying the time to the first offense and more cost-effective in reducing the frequency of offending for those outcome measures selected. Although the evaluation was conducted using the traditional steps of a cost-effectiveness analysis, because of the complexity of the program and data limitations it was not always possible to adhere to textbook procedures. As such, each step involved in undertaking the cost-effectiveness analysis is discussed, highlighting the key issues faced in the evaluation.     

There's more to the picture than meets the eye: Measuring tangible and intangible capital in two marginal communities in rural Denmark

A missing link in economics has been what Veblen in 1908 termed intangible capital. This includes common norms, trust and high levels of cooperative performance. Intangibles are invisible to the eye and not easily measured in quantitative terms. They nevertheless involve visible, socioeconomic outcomes and should therefore rightly be seen as productive, like tangibles. Thus, uneven levels of intangible capital would explain Differential Economic Performance (DEP) between, say, two firms containing exactly the same stock of physical, economic and human capital. Despite this common sense observation, most economists have failed to see that ‘there's more to the picture than meets the eye’, as Neil Young once sang. We use statistical, historical and fieldwork data from two Danish, marginal rural communities both rich on intangible capital. This to show how intangible capital in the form of social, organisational and cultural capital is accumulated and utilised in situ, at the microlevel. We suggest that the difference between these two, very similar communities should be explained in their varying ability to utilise local stocks of tangible and intangible capital. Drawing on seminal ideas from Bourdieu [The forms of capital. In: Richardson, J.G. (Ed.) Handbook of Theory and Research for the Sociology of Education. Greenwood Press, New York, Westport, CT and London, 1986, pp. 241–58] and the DORA project [Bryden, Differential economic performance in rural areas. In: International Conference on Rural Communities and Identities in the Global Millennium. Malpasino University College, Nainamo, BC, Canada, 2000], we want to develop a ‘total capital’ assessment tool for mapping and measuring socioeconomic development in marginal rural communities. In this way, we hope to count in ‘all’ capital as Schultz [Investment in human capital. In: Kiker, B.F. (Ed.) Investment in Human Capital. Columbia, 1971, pp. 3–21] prophesised. This in order to explain what we term Differential Local Development (DLD), where ‘good’, sustainable development is associated with high economic performance and increase in population.     

EXCHANGE PROCESSES IN HISTORY: INTEGRATING THE MICRO AND MACRO LEVELS OF ANALYSIS

The existing form of social exchange theory has serious flaws. Yet, this article argues that exchange theory should and can be a powerful tool for analysis at both the micro and macro levels. A model of exchange is developed that: (1) includes temporality; (2) includes both positive and negative sanctions; (3) defines rationality and voluntariness in such a way as to account for long-term, stable systems of unequal exchange; and (4) links the micro and macro levels of analysis. Selective historical materials are introduced to analyze the problem of routine, peaceful, unequal exchange between Romans and barbarians inside the Roman Empire. In interpersonal exchange, it shows, all the terms of exchange are not negotiated by the partners to exchange. Governing rules have been established by collective actors at the macro level for social exchange at the micro level. Traditional exchange theory has failed to identify the historically distant conflict of macro level actors over governing rules.     

Objective Inequality Indexes Joining Income with Life Expectancy Through the Life Quality Index of Sub-populations

Social Indicators Research - Two indexes are developed to compare inequality: one within, the other between countries. The indexes are objective, more transparent and comprehensive. They integrate...     

Confiding About Problems in Marriage and Long‐Term Committed Relationships: A National Study

This study examined confiding patterns in a national sample of 1000 U.S. adults aged 25–70 to inform the development of an educational program for confidants, called Marital First Responders. Results showed that 73% of U.S. adults have been a confidant to someone with a problem in a marriage or long‐term committed relationship. The most common confiding relationship was between friends, followed by siblings. Confidants reported a wide range of problems brought to them, ranging from everyday complaints to serious issues such as infidelity and divorce. Confiders identified the most and least helpful responses. Findings suggest that naturally occurring confiding relationships have considerable potential to be the first level of help for troubled couple relationships.