Partially because of the high cost of developing and maintaining cold chains, systems needed to keep heat-labile vaccines under adequate refrigeration from their points of manufacture to their administration in the field, the Joint WHO/FAO Expert Committee on Zoonoses (i.e., the approximately four fifths of all described human infections that people share with other vertebrate animals) recommended in 1982 operation of common cold chains by health and veterinary services in rural areas. Following this recommendation, a 1984 pilot level (...) initiative in medical-veterinary intersectoral cooperation should be regarded as a practical way to deliver human primary health care to currently neglected African pastoralists, and as a potential core program for development efforts overall within arid and semiarid areas of the African continent. (shrink)

This article proceeded from the assumption that the theme of service delivery in present-day South Africa could well be qualified by the notion of 'crisis', to the extent that this qualification, from a theological perspective and on the basis of comparative social analysis, well recalls the statements in such critical and profound theological documents as The Kairos Document and Evangelical Witness in South Africa on the 'crisis' in the latter years of apartheid. The further recognition that the (...) theme of service delivery constitutes an essentially new focus for practical-theological scholarship in South Africa led the author, who has a pertinent interest in the field of Christian diaconia, to thereupon go the full circle of practical-theological interpretation in developing such a focus. This was done by, firstly, attempting to develop a deeper contextual understanding of the problem of service delivery in the country on the basis of the prevailing debate on service delivery in South Africa, after which the ideas from conceptualisations of two different modes of diaconal practice within contexts of endemic poverty in the practical-theological literature were explored. The discussion concluded with a more pertinent consideration of the extent to which these two conceptualisations could be taken as providing direction in conceptualising a transformational diaconal response to the current service-delivery problem. (shrink)

Within a given culture – whether industrialized or more tradition oriented – essentially the same fundamental medical theories, practices, and pharmacopoeia tend to be applied to human and non-human sickness and patients. In modern industrialized societies, however, healthcare services are sharply divided between human and veterinary medicine. There is likewise a sharp division between practitioners in these two health sectors: medical doctors and veterinarians. Yet in non-Western, traditional or indigenous medical systems, the same practitioners often treat both humans (...) and animals. There is a growing body of literature that attests to the efficacy of traditional health practices and herbal medicines for the prevention and treatment of both human and livestock ailments.The authors argue for an intersectoral approach to human and veterinary health services in poor countries, especially those targeted to rural people with LIMITED access to modern health services. Extension of conventional medical and veterinary services is particularly difficult and costly in Third World countries where the necessary infrastructure (roads, clinics, labs, cold chains, etc.) is poorly developed and where much of the populace and their livestock reside in remote, rural areas, or where people may be nomadic or transhumant. Consideration should therefore be given to the joint delivery of human and livestock healthcare and related services, as well as to linking informal, ethnoveterinary practices and practitioners with more formalized systems of veterinary AND medical practice. Several advantages of such an approach are identified and explored. (shrink)

This practical-theological study aims to develop a contextual theology in the areas of business and government that will aid a successful intervention by the church in diminishing the corrupt practices prevalent in South Africa. It seeks to prove that corruption is a major factor in causing the delays experienced in the implementation of service delivery, and that this is causing much anger and increasing disillusionment with the present system of democratic government. At the moment the church has a (...) window of opportunity for this intervention to take place, since many of those responsible for supporting, organising and implementing service delivery, both in government and industry, worship regularly, as committed members, in local Christian congregations. A modified application of the Asset-Based Community Development (ABCD) approach using focus groups is suggested as both a tool for intervention and for further research. (shrink)

ABSTRACTAlthough dominant discourses of various kinds are frequently reproduced on talk radio, the fundamentally collaborative nature of the medium also means that it is able to serve as a channel...

Stakeholder management is an important method for reducing business risk. Recent decades have seen the growth of a new type of stakeholder: social protest stakeholders, individuals engaging in protest action which is directed at other unrelated parties, often the government. However, the actions of social protest stakeholders may negatively affect companies located nearby. This stakeholder category has not received any formal attention in the literature, and this article addresses the knowledge gap by exploring the effects of community-driven protest action in (...) South Africa and the strategies that firms adopt to mitigate the negative consequences of such protests. A multiple case study analysis was used to describe this type of stakeholder group and the management of the consequences of social protest action. Eight manufacturing companies in the Gauteng province participated in the study, the companies varied in size and industry. Among the key findings are that companies need to be highly adaptable if they are to mitigate the impact of protest action. We make practical suggestions about how companies may manage these risks, including the recommendation that companies engage more directly with social protestors to manage risks. The study makes an important contribution to the literature by identifying an additional key category of stakeholder and proposing a risk management approach to avert or minimize loss and damage. (shrink)

A rising number of patients require continuing or palliative services and this means that they will need to transition from one model of healthcare delivery to another. If it is generally recognised that patient vulnerability to inadequate services increases when the setting in which patient receives care changes, it is usually taken to be the result of poor coordination of services or personnel. Recognising that an integrated system is essential to adequate access, the point that I (...) put forward in this paper is that the centrality of acute care services affects the way in which chronic and palliative services are structured and, consequently, their availability. I argue that the problem originates in the manner in which some of the foundational concepts of the acute care model are imported into the other models of care delivery. In order to make this case, I review the three main models of healthcare service delivery by focusing my analysis along three axes: the goal of the care model; the predominant understanding of autonomy implicit in the model; and, the main actors in the care relationship. By examining how the various concepts translate from one model to the next, I discuss what I identify to be one of the main conceptual obstacles to less problematic transitioning, the notion of autonomy and the corresponding view of the patient as an isolated agent. (shrink)

This research addresses equity in geographic access to financial services. As financial products and services continue to become more accessible and affordable, many low‐ to moderate‐income Americans remain unbanked and underbanked, relying instead upon informal, alternative financial service providers, including check cashing outlets and payday lenders. While geographic access to affordable financial products and services assists in the successful asset building strategies of economically vulnerable households, concerns that access to financial services is uneven persist. This article (...) uses geographic information systems and spatial binary logistic regression analysis to test the hypothesis that sociodemographic characteristics and mortgage lending variables have a predictive relationship on the presence of financial deserts—census tracts where check cashing outlets are more prevalent than banks—in southeastern Pennsylvania. Results of comparison of means and regression analysis reveal that these tracts are associated with higher than average population density, lower levels of median household income, a higher proportion of Black and Latinx residents, and higher levels of mortgage application denial. This article contributes to the ongoing debate over the emergence of a two‐tiered or dual financial service delivery system, whereby financial products and services are bifurcated based on socioeconomic status and geography. (shrink)

With an upsurge of interest and investment in new legal technologies comes consideration of who is making them and whether these individuals or entities should be subject to regulation. This article looks at how such regulation might function in light of the existing regulatory regimes governing lawyers and the capacities of legal regulators. It considers the ramifications both of maintaining the existing system, or in extending some form of regulation to these new entrants to the legal services market.

Climate change, energy price spikes, and concerns about energy security have reignited interest in state and local efforts to promote end-use energy efficiency, customer-sited renewable energy, and energy conservation. Government agencies and utilities have historically designed and administered such demand-side measures, but innovative third-party administrative models present new options to finance, market, and deliver sustainable energy services to energy end-users. This study outlines the concept of a new third-party administrative model, a sustainable energy utility (SEU), with the potential to (...) achieve deep energy efficiency savings and a high penetration of customer-sited renewable energy. An SEU is characterized by central coordination, comprehensive programs, flexible incentives, financial self-sufficiency, competitive procurement, and a focus on delivering energy services rather than commodity energy. (shrink)

In this article, I will argue that the delivery of healthcare could be an act of resistance, that is, day‐to‐day, routine and perhaps mundane acts, undertaken in the course of the delivery of health services, which for many could also be considered otherwise routine care. I first consider how resistance has been conceptualised. How we understand resistance will determine if we believe healthcare could be conceptualised this way. I will show how resistance has been applied to day‐to‐day (...) struggles elsewhere and argue that it can clearly encompass open, collective dissent and more subtle, day‐to‐day action that does not necessarily make clear political demands. I go on to introduce some examples, where the delivery of health services could be conceptualised as resistance. While I advocate for a broad understanding of resistance, clearly not every act could be considered resistance; I will consider some points of tension and contention in utilising resistance to describe the delivery of health services, in particular discussing the issue of intent and opposition as they relate to resistance. Finally, while I hope that I make a convincing case, one final issue remains, namely, why turn to resistance at all, when many of the examples that I provide could be labelled using concepts that are more widely utilised. I will offer some general reflections on this point, speaking to the benefits and potential of resistance. (shrink)

Cochran has argued that Catholic health care occupies a “unique place on the border of public and private life”. Catholic health care is accountable to both its religious and sacramental traditions and its public responsibilities. It is inevitable that “border skirmishes” will arise. Yet there is no single formula for suggesting what public-private collaboration should comprise or how conflicts between values ought to be resolved. It may be, as Cochran suggests, that increasingly bitter conflicts over widely valued services such (...) as sterilization, combined with market pressures to conform to for-profit trends in health care, will make divestiture of faith-based hospitals in favor of other types of church-community partnerships the best course for the future. (shrink)

Bioethics is gradually becoming an important part of the drive to increase quality healthcare delivery in sub‐Saharan African countries. Yet many healthcare service‐users in Africa are familiar with incidences of questionable health policies and poor healthcare delivery, leading to severe consequences for patients. We argue that the overarching rights‐based ethical administrative framework recently employed by healthcare authorities contributes to the poor uptake and enforcement of current normative tools. Taking Ghana as a case study, we focus on the (...) cultural ethical context and we tease out the concepts of the good and the ethical among the Akan and Bulsa ethnic groups. We point out three tenets towards building a normative framework that can resonate with service‐users and practitioners: ontological communitarianism; empathic humanism; and virtuous character. Finally, we indicate how these core tenets can be dovetailed into building an effective normative framework and into the training of healthcare providers. (shrink)

Medical-legal partnership (MLP) embeds attorneys and paralegals into care delivery to help clinicians address root causes of health inequities. Notwithstanding decades of favorable outcomes, MLP is not as well-known as might be expected. In this essay, the authors explore ways in which strategic alignment of legal services with healthcare services in terms of professionalism, information collection and sharing, and financing might help the MLP movement become a more widespread, sustainable model for holistic care delivery.

For the last thirty years, the nation's mental health and social service systems have been under relentless assault, with dramatically rising costs and the fragmentation of service delivery rendering them incapable of ensuring the safety, security, and recovery of their clients. The resulting organizational trauma both mirrors and magnifies the trauma-related problems their clients seek relief from. Just as the lives of people exposed to chronic trauma and abuse become organized around the traumatic experience, so too have our social (...) service systems become organized around the recurrent stress of trying to do more under greater pressure: they become crisis-oriented, authoritarian, disempowered, and demoralized, often living in the present moment, haunted by the past, and unable to plan for the future.Complex interactions among traumatized clients, stressed staff, pressured organizations, and a social and economic climate that is often hostile to recovery efforts recreate the very experiences that have proven so toxic to clients in the first place. Healing is possible for these clients if they enter helping, protective environments, yet toxic stress has destroyed the sanctuary that our systems are designed to provide.This thoughtful, impassioned critique of business as usual begins to outline a vision for transforming our mental health and social service systems. Linking trauma theory to organizational function, Destroying Sanctuary provides a framework for creating truly trauma-informed services. The organizational change method that has become known as the Sanctuary Model lays the groundwork for establishing safe havens for individual and organizational recovery. The goals are practical: improve clinical outcomes, increase staff satisfaction and health, increase leadership competence, and develop a technology for creating and sustaining healthier systems. Only in this way can our mental health and social service systems become empowered to make a more effective contribution to the overall health of the nation.Destroying Sanctuary is a stirring call for reform and recovery, required reading for anyone concerned with removing the formidable barriers to mental health and social services, from clinicians and administrators to consumer advocates. (shrink)

In the discipline of practical theology, one finds a long history of linking the name of the field to diaconiology, in which you find the Greek word diaconia, directly translated as 'service'. For good and scientific reasons, the field changed its name to practical theology in some Faculties of Theology but that does not take away the fact that this field of research is still very much engaged in the broad area of 'service of all kinds'. The purpose of this (...) article was to do a descriptive investigation into the problems and challenges of service delivery in the suburb of Belhar (Cape Town), specifically looking at the role of leadership during a (new) time of struggle. As part of the normative task, the researcher took a closer look at the Belhar Confession as a prophetic stance in this regard. In an ironic twist, we see in these events the struggle between the real and the ideal that is typical of many places in the country facing problems with service delivery. The Church often thinks it knows what the world wants from it - inspiration, 'leadership,' clear teaching. But surely what the world is most hungry for is the simple knowledge that healing is possible - not by forgetting or minimizing outrages and sufferings but by sheer, obstinate, costly commitment to work with the grain of grace. (Rowan Williams, Archbishop of Canterbury, in Lapsley 2012:i). (shrink)

This paper explores the wartime creation of veterinary expertise in cattle breeding, and its contribution to the transition between two very different types of agriculture. During the interwar period, falling prices and steep competition from imports caused farmers to adopt a ‘low input, low output’ approach. To cut costs, they usually butchered, marketed or doctored diseased cows in preference to seeking veterinary aid. World War II forced a greater dependence on domestic food production, and inspired wide-ranging state-directed attempts (...) to increase agricultural output. However, the weak connection between veterinary services and livestock productivity meant that the drive for greater milk yields did not automatically translate into a demand for improved veterinary health care. Rather veterinary expertise had to be actively created and made relevant to the new context. Leaders of the profession secured this goal through establishing a government-backed ‘scheme for the control of certain diseases of dairy cows’. Drawing on pre-existing but rarely applied reproductive technologies, the scheme provided the opportunities and education necessary for more extensive veterinary interventions in cattle breeding. I show how its operation transformed understandings of fertility, raised veterinarians to the status of experts, won them the patronage of farmers and the state, and facilitated the shift to a productivity-oriented agriculture. (shrink)

This work serves as an introduction to both the theoretical and practical aspects of using computers to improve the delivery of social services. Though many practitioners believe that computerization dehumanizes clients and should be avoided, John Murphy and John Pardeck demonstrate how, through a holistic approach to computer use, this problem, and others like it, can be averted. By providing practitioners the opportunity to sharpen their conceptual skills in computer technology, this book promotes a rational understanding of the (...) possible uses and limitations of computers in social service agencies. Unlike other, technically-oriented works in this field, Murphy and Pardeck's work focuses on the philosophical justification of computer use, along with the conceptual or symbolic nature of computerization. They fully illustrate how to create the organizational conditions necessary for computers to improve social-service delivery, and they do so in a manner that is easily accessible for both general classroom and professional use. Among the topics addressed are the technological world-view, Western philosophy, and knowledge; computer mediated therapy; ethical issues related to computerized service delivery; and construction of a socially responsible technology. This work will be a unique and important resource for courses in computer applications, policy analysis, and social service administration, as well as a useful reference source for human service agencies and practitioners. Public and academic libraries will also find it to be a valuable addition to their collections. (shrink)

This book is an essential guide for veterinarians, veterinary faculty and policymakers for understanding the core competencies of a fresh veterinarian. The book briefly covers competencies in preclinical, paraclinical, and clinical subjects including anatomy, physiology, biochemistry, veterinary jurisprudence, animal management & welfare including nutrition and breeding, infectious and non-infectious diseases, disease epidemiology, diagnosis, and treatment, prevention, control and zoonoses, surgical and other clinical interventions. The book further includes other competencies, including biologicals, anti-mortem, and post-mortem inspection, certifications, applied one (...) health aspects, review and analysis of scientific evidence, international trade and regulations, and organization of veterinary services. It also highlights the importance of effective communication, interpersonal skills, record keeping and management of a small veterinary hospital, health informatics, etc. The book breakdowns the must-have competencies of a global veterinarian into different topics and subtopics for easy comprehension and further learning. It enables the professional standard-setting & regulatory bodies and academicians in improved curricula designing and implementation and more importantly tries to bring uniformity in day one veterinary graduates’ competencies globally, enhancing the movement and employability of veterinarians across the world. (shrink)

In Europe, a well-known problem is the coordination of interagency service delivery to independently living older persons, disabled persons or persons suffering from chronic illness. Coordination is necessary in order for the users to receive services at the appropriate time and place. Based on historical institutionalism, which focuses on the path dependency of the development of government policy and organizational and professional rules, it can be stated that coordination requires organizational models or other solutions that fit the characteristics (...) of the context (‘configuration’) for which the solution is intended. The western European countries have different configurations. Remarkably, across these countries, we see the emergence of multidisciplinary teams as a solution to the problem of coordination. Consequently, if we take the above statement to mean that a solution should fit all the configuration’s characteristics, we must reject the statement. However, when we assume that a solution should fit particular configurational characteristics, we must not. We take the second position and we argue that multidisciplinary teams have emerged because they fit one particular feature that is similar in the countries: professionalism and professional fragmentation. (shrink)

This article provides an account of rent-seeking in relation both to economic policies and political practices in South Africa. The article draws attention to continuities and similarities in this regard between the two distinct periods of nationalist rule from 1948 to 1994 and from 1994 to 2012. The economic dimensions that are specifically addressed are industrial policy, the labour market, state administration and tenders and service delivery and welfare. The more specifically political dimensions addressed include the electoral system, (...) the relationship between constitutionalism and the judiciary, and the rule of law. The article highlights the dangers posed by excessive rent-seeking and especially its negative implications for redistribution, economic growth and the consolidation of democracy in a highly unequal society. (shrink)

The paper examines three factors that are driving and constraining the development of rural legal services delivery in China: geographic limitation, professional interest and political intervention. Firstly, geography matters and rurality creates natural barriers for rural residents in limiting the access to legal services. There is an inherent spatial inequality for rural population when it comes to the distribution of legal service and the geographic isolation and remoteness nurture a particular type of legal culture among rural residents. (...) Secondly, professionalism matters. There are strong ideological and economic forces which pull the rural legal service providers away from their grass-roots. The calling of an emerging legal professionalism (and the related financial incentives) demands a certain degree of legal knowledge and qualification, rules of procedures, code of conduct and regularity in legal practice. In order to survive in an increasingly competitive legal market, rural legal service providers have to run legal practices as a business, considering the "bottom line" and following the logic of a legal market. Finally, politics matters. To overcome geographic barriers and correct market failure, the government would need to steps-in to provide or supplement legal service in rural areas by introducing a public dimension of legal services. Politics may ameliorate where the legal service market fails. (shrink)

Since the advent of democracy in South Africa, there has been a concerted effort at reviving the notion of ubuntu. Variously conceived, it is seen as the authentic African ethical concept, a way of life, an authentic mode of being African, an individual ideal, the appropriate public spirit, a definition of life itself and the preferred manner of conducting public and private business. Thus, among other public displays of the spirit of ubuntu, the government of the day has deliberately (...) chosen its service delivery mantra and its public slogan as Batho Pele to animate, or perhaps pay obeisance to, ubuntu. In this paper we seek to advance arguments that question such a public, widespread, and concerted ‘ubuntu-isation’ of the intellectual, business, public and private lives. Our project follows two main lines of reasoning. We seek to show that the aggressive promotion of ubuntu in post-apartheid South Africa is an elitist project so conceived by the new black elite. It is conceived both as a restorative move that is aimed at securing the dignity of the black masses as well as an attempt at forging a so-called black identity. This line of reasoning will rely on similar historical cases on the continent that sought to aggressively promote an African mode of being, which coincided with both the end of colonialism and the rise of black elitism. We note that such attempts always ended in very public social and political failure. We seek to question the desirability of ubuntu as a mark/guide of the spirit of the nation. Here our critique shall be concentrated on the disjunct that exists between the metaphysical conditions necessary for the attainment of ubuntu and the stark ontological and ethical crisis facing the new elite and ‘our people’. (shrink)

Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? (...) The lack of consensus on answers to these questions highlights the need for ethical guidance. Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research. (shrink)

Development is concerned with the transformation of people to foster their health, wholeness and growth. The link between health and development points to religion as potential social capital for development. There is an ongoing debate about the role of pastoral care as a religious resource in global healthcare contexts. This is unfortunately not the case in Africa, as pastoral care has not received sufficient attention for its role in healthcare and development in development discourses. The limited research on pastoral (...) care in healthcare contexts in Africa has implications for African healthcare systems, pastoral care and the delivery of an effective, holistic and quality healthcare service. Taking as its point of departure a thesis about the potential of religion as a social capital resource for development, the article argues for pastoral care as a viable religious resource for healthcare and development. Osmer’s theological task of good practice is employed as an interdisciplinary engagement in dialogue with selective perspectives in the disciplines of development and health and social sciences for appropriate analysis. (shrink)

A significant number of inmates with mental illness reside within the New York State Department of Corrections (NYSDOCS). New York State has taken the initiative to provide mentally ill inmates with necessary services through a collaboration of the New York State Department of Correctional Services and the New York State Office of Mental Health (NYSOMH). The collaboration results in a mental health delivery system that provides many essential services to mentally ill inmates. This paper focuses on (...) the organization of mental health services within NYSDOCS, best practices, past and current litigation, and staff responsibilities. As the population of mentally ill inmates continues to grow, implications for the Human Services professions of OMH and DOCS needs to continue to address and provide adequate mental health care and resources for this special population. (shrink)

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize (...) person-centered care as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

Task shifting is increasingly used to address human resource shortages impacting HIV service delivery in low- and middle-income countries. By shifting basic tasks from higher- to lower-trained cadres, such as Community Health Workers, task shifting can reduce overhead costs, improve community outreach, and provide efficient scale-up of essential treatments like antiretroviral therapies. Although there is rich evidence outlining positive outcomes that CHWs bring into HIV programs, important questions remain over their place in service delivery. These challenges often reflect (...) concerns over whether CHWs can mitigate HIV through a means that does not overlook the ethical and practical constraints that undergird their work. Ethical and practical guidance thus needs to become the cornerstone of CHW deployment. This paper analyzes such challenges through the lens of Ethical Principlism. We examined papers identifying substantive and ethical challenges impacting CHWs as they provide HIV services in low- and middle-income contexts. To do this, we analyzed papers written in English and published from year 2000 or later. These articles were identified using MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar databases. In total, 465 articles were identified, 78 of which met our inclusion criteria. Article reference lists and grey literature were also examined. CHWs experience specific challenges while carrying out their duties, such as conducting emotionally- and physically-demanding tasks with often inadequate training, supervision and compensation. CHWs have also been poorly integrated into health systems, which not only impacts quality of care, but can hinder their prospects for promotion and lead to CHW disempowerment. As we argue, these challenges can be addressed if a set of ethical principles is prioritized, which specifically entail the principles of respect for persons, justice, beneficence, proportionality and cultural humility. CHWs play a crucial role in HIV service delivery, yet the ethical challenges that can accompany their work cannot be overlooked. By prioritizing ethical principles, policymakers and program implementers can better ensure that CHWs are combatting HIV through a means that does not exploit or take their critical role within service delivery for granted. (shrink)

Our aim in this article is to define the difficulties that clinical ethics services encounter when they are asked to demonstrate the value a clinical ethics service (CES) could and should have for an institution and those it serves. The topic emerged out of numerous related presentations at the Un- Conference hosted by the Cleveland Clinic in August 2018 that identified challenges of articulating the value of clinical ethics work for hospital administrators. After a review these talks, it was (...) apparent that the field of clinical ethics may be at a crisis of sorts due to increased pressure to provide explicit measures to healthcare institutions to concretely demonstrate that CESs make a valuable difference in healthcare delivery. In this article, we grapple with how to satisfy the need for demonstrable value in a field in which metrics alone may not capture the scope of clinical ethics practice. We suggest that capturing the value of a CES has been difficult because the benefits of ethics consultation may be overt or attributable to the CES, but are often hidden due to the systems-level and process-oriented nature of clinical ethics work. Part of the difficulty in demonstrating the value of CESs is capturing and conveying all of the ways the integration of a CES throughout an institution positively affects patients, families, visitors, healthcare professionals, administrators, and the institution itself. Our aim is to (1) elucidate the multifaceted value added by a CES, including value that tends to be hidden and (2) suggest how to demonstrate value to others in a way that is not simplistic or reductionistic. (shrink)

The migration of nursing professionals from developing countries such as Zimbabwe to industrialised countries is taking place at an alarming rate, with little signs of slowing down. In Africa, nurses form the backbone of the healthcare delivery system and their migration has a huge negative impact on health service provision. Drawing on evidence from selected health institutions, the paper shows the magnitude of migration of nurses from Zimbabwe. The paper also shows that public to private health sector migration (...) of nurses is occurring at a significant rate. The effects of such movements are examined in detail. For instance, at the health institution level, nurse migration has led to staff shortages, and health institutions located in the disadvantaged areas have been the worst affected. The paper calls for the adoption of an integrated approach in managing and addressing the concerns of the nursing professionals. (shrink)

The principles of equality and equity, respectively in the Bill of Rights and the white paper on health, provide the moral and legal foundations for future health care for children in South Africa. However, given extreme health care need and scarce resources, the government faces formidable obstacles if it hopes to achieve a just allocation of public health care resources, especially among children in need of highly specialised health care. In this regard, there is a dearth of moral analysis (...) which is practically useful in the South African situation. We offer a set of moral considerations to guide the macro-allocation of highly specialised public health care services among South Africa's children. We also mention moral considerations which should inform micro-allocation. (shrink)

This work resulted from a conference held in 2003 that was jointly sponsored by the Rockefeller Archive Center and Quinnipiac University. Drawing upon perspectives from history, philosophy, and the social sciences, as well as public health and medicine, the authors in this volume examine and critique the role of Foundations, most prominently the Rockefeller Foundation, in promoting and expanding the development of Western medicine around the world during the 20th century. The first half of the book examines the historical involvement (...) of philanthropic foundations in public heath, basic medical research, and related social and political issues. These studies range from an examination of the Rockefeller's Foundation's anti-malaria campaigns to the involvement of Foundations in promoting eugenic ideology and population control. The second half of the book considers current situations in which philanthropic foundations are active in promoting public health and westernized medicine, including consideration of the fight against AIDS in Africa, the resurgence of tuberculosis as a major public health threat, and the ongoing war against malaria. Finally, the book concludes with thoughts on the future of health, disease, and public health by Peter C. Goldmark, Jr., a former president of the Rockefeller Foundation. By considering issues of public health and health policy from a wide range of perspectives, this book seeks to contribute both to our understanding of the past successes and failures of growing dominance of Westernized medicine over global health, and to consider present and future possibilities for improving the delivery of health services to the population of the world. (shrink)

Presently, most studies focus on the minimization of the costs and negative social effects of the location of construction waste recycling centers; however, the influence of the location on future operation is usually ignored. Aiming at solving these problems, a location model for the maximization of service reliability was devised. Service reliability includes the recycling reliability of the construction waste and the delivery reliability of the recycled product. Through maximizing service reliability, the location deviation as a result of arrival (...) delay is expected to be reduced and the service reliability improved. Then, two important parameters in our model were solved on the basis of correlative mathematical theories. Finally, an example was implemented to verify our location optimization model. A genetic algorithm was used to obtain optimal solutions, and the solutions were analyzed. Through establishing a location optimization model, a possible better solution to location problems may be obtained to help in implementing location selection for recycling centers. (shrink)

IntroductionMaking appropriate plans for the provision of hospice care is considered a perceived need in the Iranian health system. The current study aimed to develop a model for establishing hospice care delivery system for the adult patients with cancer.Materials and MethodsThis study is part of a larger study that has been done in four phases. This Health System Policy Research utilized a mixed qualitative-quantitative approach. At the first phase, a qualitative study was conducted which explained the care needs and (...) the requirements for establishing this system from the stakeholders’ perspective. The second phase aimed to examine the current situation of hospice care delivery in Iran and identify and determine the similarities and differences among them in the selected countries. At the third phase, the main areas of the model and the related indicators were extracted and prioritized by consulting with experts. Then the model was formulated. At the fourth phase, the proposed model was validated and finalized in terms of importance, scientific acceptability, and feasibility.ResultsBased on the developed model the first and the most important step in establishing the hospice care delivery system is laying the groundwork in the health system which requires focusing on policymaking. It is necessary to establish hospice centers and implement public awareness raising programs, train, and supply expert manpower, strengthen family physician and referral process, formulate clinical guidelines, encourage the private sector and NGOs.) to invest, develop end-of-life and hospice care service packages, and create quality care indicators. The proposed model had moderate feasibility.ConclusionThis model was developed based on the current Iranian healthcare structure and the needs of terminally ill cancer patients. It can be used as a model tailored to the current state of the health system and community in Iran. It is suggested to use this model as a pilot at the regional level. (shrink)

International service learning programs are growing more popular with students looking to advance their skills and knowledge to become global citizens. While the benefits of these programs among students are well documented, little is known about the implications they have on host communities themselves. This volume explores the impact of ISL programs on members of host communities who are increasingly influenced by the presence of international students in their lives. Drawing upon post-colonial, feminist and other critical and decolonizing theories, it (...) examines the complicated power relations between North American ISL students and host communities in East and West Africa, the Caribbean and Central America. It stresses the importance of developing trusting relations between ISL students, faculty and individuals in the host communities to create mutually engaging learning experiences. (shrink)

The criticality of ethical practices in B2B service delivery is increasingly recognised for its substantial impact on firm performance. However, there remains a gap in understanding how ethicality at managerial and staff levels translates into tangible business outcomes in B2B contexts. This study aims to bridge this gap, focusing on the impact of ethicality on perceived service delivery performance and firm performance, mainly through ethical leadership and climate lenses. The research objectives include unravelling the dynamics between staff-level ethical (...) perceptions and managerial-level ethical practices and their collective impact on service delivery and firm performance. Employing a multilevel data collection and analytical framework, the study collected data from 5500 employees and 110 managers, providing a comprehensive view of ethical influences across different organisational strata. This approach facilitated a nuanced examination of how ethical perceptions and behaviours permeate through the organisational hierarchy. Major findings reveal that individual-level ethical perceptions enhance service delivery through positive citizenship behaviour of the employees and reduced opportunism. A culture of shared ethical values, reinforced by robust ethical leadership and a supportive climate, significantly bolstered firm performance at the organisational level. These insights contribute significantly to B2B theory by elucidating the mechanisms through which ethicality at various levels influences firm outcomes. The study underscores the importance of fostering an ethical culture at the individual level and holistically across the organisation to enhance service delivery and achieve superior firm performance. (shrink)

Purpose This study investigates the impact of open-source software (OSS) on the sustainability of academic library services in Bangladesh. It aims to understand how OSS can address budget constraints, technological demands and the need for enhanced service delivery in these libraries. Design/methodology/approach An in-depth qualitative research approach was used, involving semi-structured interviews with library administrators, IT staff and librarians from various academic institutions across Bangladesh. Findings The study reveals that OSS adoption is primarily driven by financial imperatives and (...) the need for flexible, customizable solutions tailored to specific institutional needs. Key benefits identified include significant cost savings, improved customization and flexibility of services and enhanced community support and collaboration. However, challenges such as a lack of in-house technical expertise, resistance to change among staff and stakeholders and inadequate IT infrastructure impede successful OSS implementation. Practical implications To harness the full potential of OSS, academic libraries must invest in capacity building through targeted training programs, improve IT infrastructure and foster a culture of collaboration and knowledge-sharing within the library community. These strategies are essential to overcoming existing barriers and ensuring long-term sustainability. Originality/value This research contributes to the understanding of OSS’s role in enhancing the sustainability of academic library services. It provides practical recommendations for academic libraries seeking to leverage OSS for improved service delivery and operational efficiency. (shrink)

This article presents an ethical analysis and critique of personalized service in the tradition of Catholic social teaching (CST) that is both Catholic and Personalist. It tackles the ethical issues involved when service delivery is personalized, issues that affect both the consumers and the service providers. It focuses on nonprofessional services that are offered by low-skilled blue-collar workers through corporations that are organized to produce efficient service to a high volume of consumers. Customer service involves intersubjectivity, that is, (...) interaction between two persons as subjects. Ethics in the service context is not only about treating consumers in a just manner; the threats to the personhood of the service providers are also significant, for their work cannot be separated from their very being. By focusing on the ethical issues of emotional labor and consumerism of human service, the study will argue that the human interaction in personalized service runs the risk of alienating us from our authentic selves and from each other. If the objective of personalized service is to create authentic human relationship in the service encounter, the latter can arise even in a nonpersonalized service. We do not have to personalize our actions in order to create genuine human interaction. Instead, what we must do is to treat each other as persons. (shrink)

Animal health is key to successful livestock production in developing countries. The development and delivery of vaccines against major epidemic diseases is one component of improving animal health. This paper presents a case study from Kenya on the production and delivery of a vaccine against Contagious Caprine Pleuropneumonia (CCPP), a major disease of goats. The vaccine, while technically a viable preventative measure against CCPP, has not been well integrated into Kenya's animal health care system. From February through November, (...) 1992, the authors explored the organizational and policy constraints to vaccine production and distribution. Data were obtained through interviews, field visits, and available documents. Results suggest an animal health system that 1) does not have a well developed infrastructure to track, identify, and control animal diseases; 2) tends to place greater emphasis on cattle, rather than small ruminant health care; and 3) is not well linked in terms of research, development, and extension services. (shrink)

Human services planning for crews who go to Mars is in its earliest phase, but the modalities for service delivery are well worth anticipating because they could involve some of the first innovations that merge physical, biological, and digital capacities on the new planet. This chapter examines the constraints of the planet Mars, itself, on all humans. It anticipates how “exogenous stressors” might affect the psychological, social, and cultural capacities and conflicts of the earliest crews. Several types of (...) service modalities are explored: hibernation; medication management; traditional psychotherapy; long-distance modalities to approximate the “talking cure”; digitized, keyed psychology workbooks; robotics, or service delivery without verbal feedback; AI technologies, or service delivery with verbal feedback; problem-solving at the cultural level; digital bulletin boards to substitute for journaling; and a special section on the issue of privacy. The chapter rounds out with a section, on types of spiritual services that may be beneficial even for those who profess no faith. We focus on “sacred space,” and on death and burial ritual on Mars. Factors explored here reflect the backgrounds of the two authors: one, a cultural anthropologist and biologist, and the other, an astronomer who is also a Catholic priest. (shrink)