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Small fish in a big pond? External aid and the health sector in South Africa

HEALTH POLICY AND PLANNING 1999年第3期14卷 264-272页

作者： Schneider, H Gilson, L Univ Witwatersrand Ctr Hlth Policy Johannesburg South Africa Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England

Since a new government was elected in 1994, South Africa has become a favoured nation for the many bilateral and multi-lateral agencies providing aid to developing countries. Despite several relatively large pledges of 'transition support', however, external resources constitute less than 2% of the annual government budget. This non-dependence has established a degree of equilibrium in a relationship normally regarded as highly unequal in other African countries. Although international donors funded the anti-apartheid movement in South Africa prior to 1994, the new government inherited a chaotic administration that had little institutional experience of conventional development aid. Many of the new cadres entering government had not been exposed to the workings of government, let alone donor, bureaucratic processes. It is not surprising, therefore, that in the first few years after 1994, the aid relationship was characterized by low disbursements, unrealistic expectations and a degree of conflict. Since 1997, however, aid supported projects have started to become more visible. Within the broad objective of supporting transformation of the health system, one of the key areas of donor support is managerial capacity development, particularly of district, hospital and provincial health structures. These initiatives tend to be poorly coordinated, a problem compounded by a quasi-federal system in which provinces have large amounts of autonomy. The contribution of donor aid to strengthening the health system could be enhanced by the establishment of a clear national framework to guide the many externally supported projects building managerial skills and systems.

关键词：筹资组织/组织和管理卫生保健公平提供/组织和管理卫生保健部门卫生政策国际机构政治南非

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Keeping a tight grip on the reins: donor control over aid coordination and management in Bangladesh

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HEALTH POLICY AND PLANNING 1999年第3期14卷 219-228页

作者： Buse, K Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England

A long-standing consensus that aid coordination should be owned by recipient authorities has been eclipsed by accord on the desirability of recipient management of aid along-side domestic resources, Nonetheless, in many low and lower-middle income countries, donors remain remarkably uncoordinated;where attempts at coordination are made, they are often donor-driven, and only a small proportion of aid is directly managed by recipients. This paper draws on evidence from an in-depth review of aid to the health sector in Bangladesh to analyze the systems by which external resources are managed. Based on interviews with key stakeholders, a questionnaire survey and analysis of documentary sources, the factors constraining the government from assuming a more active role in aid management are explored. The results suggest that donor perceptions of weak government capacity, inadequate accountability and compromised integrity only partially account for the propensity for donor leadership. Equally important is the consideration that aid coordination has a markedly political dimension. Stakeholders are well aware of the power, influence and leverage which aid coordination confers, an awareness which colours the desire of some stakeholders to lead aid coordination processes, and conditions the extent and manner by which others wish to be involved. It is argued that recipient management of external aid is dependent on major changes in the attitudes and behaviours of recipients and donors alike.

关键词：孟加拉国数据收集发展中国家效率组织筹资组织/组织和管理政府卫生保健公平提供/组织和管理卫生保健部门卫生经费支出卫生政策卫生服务需求国际机构社会责任

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Rehabilitating health services in Cambodia: the challenge of coordination in chronic political emergencies

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HEALTH POLICY AND PLANNING 1999年第3期14卷 229-242页

作者： Lanjouw, S Macrae, J Zwi, AB Overseas Dev Inst Humanitarian Policy Grp London SW1E 5DP England Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England

The end of the Cold War brought with it opportunities to resolve a number of conflicts around the world, including those in Angola, Cambodia, El Salvador and Mozambique. International political efforts to negotiate peace in these countries were accompanied by significant aid programmes ostensibly designed to redress the worst effects of conflict and to contribute to the consolidation of peace. Such periods of political transition, and associated aid inflows, constitute an opportunity to improve health services in countries whose health indicators have been among the worst in the world and where access to basic health services is significantly diminished by war. This paper analyzes the particular constraints to effective coordination of health sector aid in situations of 'post'-conflict transition. These include: the uncertain legitimacy and competence of state structures;donor choice of implementing channels;and actions by national and international political actors which served to undermine coordination mechanisms in order to further their respective agendas. These obstacles hindered efforts by health professionals to establish an effective coordination regime, for example, through NGO mapping and the establishment of aid coordinating committees at national and provincial levels. These technical measures were unable to address the basic constitutional question of who had the authority to determine the distribution of scarce resources during a period of transition in political authority. The peculiar difficulties of establishing effective coordination mechanisms are important to address if the long-term effectiveness of rehabilitation aid is to be enhanced.

关键词：柬埔寨发展中国家效率组织筹资组织/组织和管理卫生保健部门/组织和管理卫生政策国际机构国际合作战争

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Zambia: the role of aid management in sustaining visionary reform

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HEALTH POLICY AND PLANNING 1999年第3期14卷 254-263页

作者： Lake, S Musumali, C Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England

As part of its ongoing reform of the health sector, Zambia has developed a number of systems and structures to coordinate and manage external resources. With increasing attention being given to the potential for sector-wide approaches (SWAps) to enhance the efficiency and effectiveness of health systems in low-income countries, Zambia provides an interesting case study of how this is emerging in practice over time. The paper outlines the different coordination mechanisms and assesses them in terms of selected criteria of effectiveness, finding that the potential to meet reform objectives is currently not being met. Factors influencing the effectiveness of these mechanisms are identified as falling into categories around personalities and human interaction, the nature of reform processes, and the impact of broader context. The need to maintain dialogue in the face of external constraints and uncertainties is stressed.

关键词：发展中国家效率组织筹资组织/组织和管理卫生保健公平提供/组织和管理卫生保健改革/组织和管理卫生政策卫生服务易得程度组织目标政治社会正义社会责任赞比亚

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Managing external resources in Mozambique: building new aid relationships on shifting sands?

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HEALTH POLICY AND PLANNING 1999年第3期14卷 243-253页

作者： Pavignani, E Durao, JR Minist Hlth Maputo Mozambique

The Mozambican health sector is recovering from war and general disruption. This massive endeavour is supported by several donor agencies, which con tribute a substantial proportion of national health expenditure. The final years of the war and the transition period have seen an extreme fragmentation of the health sector. To correct it, serious efforts to coordinate the plethora of aid agencies and related external inputs have taken place. This paper reviews the actors present on the Mozambican health scene and their interactions. The existing aid management mechanisms are described a nd their effectiveness appraised. The factors affecting both the process and its outcomes are analyzed. Given the prevailing complexity, this research presents a number of tentative conclusions. First, the evidence suggests that coordination efforts have paid off. However, progress has required intense and sustained work. Incremental approaches, where donor demands are progressively raised as the system is strengthened, have been crucial. The initiative has come mainly from donors, with the Ministry of Health receptive and reactive. When the recipient administration has been able to take advantage of donor initiatives, success has ensued. Individual people have been crucial in shaping the process. Critical factors contributing to positive developments on both sides of the donor-recipient relationship have been frankness, risk-taking and a long-term perspective.

关键词：预算发展中国家效率组织财务审计筹资组织/组织和管理卫生保健公平提供/组织和管理卫生保健部门卫生政策国际机构领导莫桑比克

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Watching the bottom line: Enhancing the role and impact of infection control in a managed care environment

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第1期28卷 25-29页

作者： Rhinehart, E AIG Consultants Inc Healthcare Management Div Qual Management Serv Atlanta GA 30328 USA

Health care expenditures exceeded $1 trillion in 1997, with projections for $2.2 trillion in expenditures by 2008. Decreasing organizational revenues and efforts to reduce operating costs have had a direct impact on infection control programs. Senior managers in hospitals and other provider organizations are focusing on achieving and maintaining revenues while controlling costs. Infection control professionals must align themselves and their programs with these organizational goals by (1) identifying areas in which the infection control program can support and enhances revenues, (2) facilitating the avoidance of excess costs for care, especially those related to nosocomial infection, (3) identifying opportunities for cost reduction through value analysis, and (4) participating in efforts to measure and prevent other adverse outcomes of care.

关键词：费用控制筹资组织/组织和管理卫生经费支出/统计学和数值数据卫生经费支出/发展趋势感染控制/组织和管理管理医疗规划/组织和管理模型经济计量学结果评价(卫生保健)/组织和管理风险分担财政/组织和管理美国利用情况审核/组织和管理人类

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Frustration grows over EU grant application procedures

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NATURE 2000年第6779期404卷 695-695页

作者： Abbott, A Weydt, P

Scientists across Europe are complaining that application procedures for EU research grants are too complicated and time-consuming.

关键词：生物科学欧盟筹资组织/组织和管理

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