A new group of Western development donors has emerged as increasingly influential actors in globa... more A new group of Western development donors has emerged as increasingly influential actors in global social policy. Big philanthropies have begun implementing social protection projects on a vast scale across the Global South and have become integrated within global governance structures. It is essential to examine whether their approach to social policy in the South is effective, legitimate and desirable for the substantive agendas and programmes in these countries and for analysis of social policy in a development context. This study investigates contemporary big philanthropies through a qualitative case-study of the Bill and Melinda Gates Foundation and its role in the health sector in Tanzania. It examines the ways in which big philanthropies engage and seek to influence policy on the ground, directly exploring the views and experiences of local stakeholders. The study finds that big philanthropies have distinctive features and mechanisms as global social policy entrepreneurs. In ...
Health research policy and systems / BioMed Central, Jan 19, 2016
Global investment in biomedical research has grown significantly over the last decades, reaching ... more Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, mak...
Abstract Despite the absence of an unemployment grant in South Africa, there is growing concern t... more Abstract Despite the absence of an unemployment grant in South Africa, there is growing concern that other social assistance provision might nevertheless weaken work motivation and create a 'dependency culture'. This study explores attitudes about the relationship between grant ...
To address problems of inadequate public health services, escalating private healthcare costs and... more To address problems of inadequate public health services, escalating private healthcare costs and widening health inequalities, the South Africa (SA) Government has launched a bold new proposal to introduce a universal, comprehensive and integrated system for all SAs; National Health Insurance. Though attention has been devoted to the economics of universal coverage less attention has been paid to other potential challenges, in particular the important role played by the clinicians tasked with implementing the reforms. However, historical and comparative analysis reveals that whenever health systems undergo radical reform, the medical profession is instrumental in determining its nature and outcomes. Moreover, early indications suggest many SA private general practitioners (GPs) are opposed to the measures-and it is not yet known whether they will comply with the proposals. This study therefore analyses the dynamics and potential success of the reforms by directly examining the perceptions of the SA medical profession, in particular private-sector GPs. It draws on a conceptual framework which argues that understanding human motivation and behaviour is essential for the successful design of social policy. Seventy-six interviews were conducted with clinicians in the Eastern Cape Province in 2012. The findings suggest that the SA government will face significant challenges in garnering the support of private GPs. Concerns revolved around remuneration, state control, increased workload, clinical autonomy and diminished quality of care and working conditions. Although there were as yet few signs of mobilization or agency by private clinicians in the policy process, the findings suggests that it will be important for the government to directly address their concerns in order to ensure a stable transition and successful implementation of the reforms.
Pressure to utilize research evidence in decisions about patient care and pop - ulation health, s... more Pressure to utilize research evidence in decisions about patient care and pop - ulation health, so-called evidence-based medicine, has swept the health care systems of most industrial coun - tries. In the UK, the attention of policy makers has recently turned from the ...
Abstract Despite the absence of an unemployment grant in South Africa, there is growing concern t... more Abstract Despite the absence of an unemployment grant in South Africa, there is growing concern that other social assistance provision might nevertheless weaken work motivation and create a 'dependency culture'. This study explores attitudes about the relationship between grant ...
We report the results of a survey of patients' awareness, attitudes and satisfact... more We report the results of a survey of patients' awareness, attitudes and satisfaction regarding fundholding and related developments in primary care, and compare the responses of patients in fundholding and non-fundholding practices. (Six total fundholding general practices and two non-fundholding general practices in West Berkshire were included.) An anonymous postal questionnaire was sent to 1150 patients with joint pain aged 17-80, of whom 715 (63%) returned completed questionnaires. Few (17%) fundholding respondents had received information from their practice about fundholding or (36%) were aware of new or different services being offered but the majority had heard of fundholding and were able to describe it accurately. Satisfaction with GP services was high in both types of practice, but fundholding patients reported higher levels of satisfaction with getting a referral to a hospital specialist (FH: 81% vs. NFH: 63%), and with the length of time between referral and treatment (FH: 81% vs. NFH: 59%). A majority of patients in both types of practice wanted to be involved in decisions about the services available to them but only a third of patients thought that fundholding would make this easier. Fundholding patients were more likely to report being given enough choice about treatments available to them (51%) than their non-fundholding counterparts (35%). Fundholding patients had not perceived a reduction in quality of care as a result of budgetary pressures and were more satisfied with the process of referral to secondary care than their counterparts in non-fundholding practices. Patients in both types of practice felt that it was important to be involved in decisions about the services available to them, but few thought that this would be more likely as a result of fundholding. Provision of information to patients is a prerequisite for their involvement, but judging by the number of patients receiving any information about fundholding from their practices this aspect of the reforms does not seem to have been implemented.
A new group of Western development donors has emerged as increasingly influential actors in globa... more A new group of Western development donors has emerged as increasingly influential actors in global social policy. Big philanthropies have begun implementing social protection projects on a vast scale across the Global South and have become integrated within global governance structures. It is essential to examine whether their approach to social policy in the South is effective, legitimate and desirable for the substantive agendas and programmes in these countries and for analysis of social policy in a development context. This study investigates contemporary big philanthropies through a qualitative case-study of the Bill and Melinda Gates Foundation and its role in the health sector in Tanzania. It examines the ways in which big philanthropies engage and seek to influence policy on the ground, directly exploring the views and experiences of local stakeholders. The study finds that big philanthropies have distinctive features and mechanisms as global social policy entrepreneurs. In ...
Health research policy and systems / BioMed Central, Jan 19, 2016
Global investment in biomedical research has grown significantly over the last decades, reaching ... more Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, mak...
Abstract Despite the absence of an unemployment grant in South Africa, there is growing concern t... more Abstract Despite the absence of an unemployment grant in South Africa, there is growing concern that other social assistance provision might nevertheless weaken work motivation and create a 'dependency culture'. This study explores attitudes about the relationship between grant ...
To address problems of inadequate public health services, escalating private healthcare costs and... more To address problems of inadequate public health services, escalating private healthcare costs and widening health inequalities, the South Africa (SA) Government has launched a bold new proposal to introduce a universal, comprehensive and integrated system for all SAs; National Health Insurance. Though attention has been devoted to the economics of universal coverage less attention has been paid to other potential challenges, in particular the important role played by the clinicians tasked with implementing the reforms. However, historical and comparative analysis reveals that whenever health systems undergo radical reform, the medical profession is instrumental in determining its nature and outcomes. Moreover, early indications suggest many SA private general practitioners (GPs) are opposed to the measures-and it is not yet known whether they will comply with the proposals. This study therefore analyses the dynamics and potential success of the reforms by directly examining the perceptions of the SA medical profession, in particular private-sector GPs. It draws on a conceptual framework which argues that understanding human motivation and behaviour is essential for the successful design of social policy. Seventy-six interviews were conducted with clinicians in the Eastern Cape Province in 2012. The findings suggest that the SA government will face significant challenges in garnering the support of private GPs. Concerns revolved around remuneration, state control, increased workload, clinical autonomy and diminished quality of care and working conditions. Although there were as yet few signs of mobilization or agency by private clinicians in the policy process, the findings suggests that it will be important for the government to directly address their concerns in order to ensure a stable transition and successful implementation of the reforms.
Pressure to utilize research evidence in decisions about patient care and pop - ulation health, s... more Pressure to utilize research evidence in decisions about patient care and pop - ulation health, so-called evidence-based medicine, has swept the health care systems of most industrial coun - tries. In the UK, the attention of policy makers has recently turned from the ...
Abstract Despite the absence of an unemployment grant in South Africa, there is growing concern t... more Abstract Despite the absence of an unemployment grant in South Africa, there is growing concern that other social assistance provision might nevertheless weaken work motivation and create a 'dependency culture'. This study explores attitudes about the relationship between grant ...
We report the results of a survey of patients' awareness, attitudes and satisfact... more We report the results of a survey of patients' awareness, attitudes and satisfaction regarding fundholding and related developments in primary care, and compare the responses of patients in fundholding and non-fundholding practices. (Six total fundholding general practices and two non-fundholding general practices in West Berkshire were included.) An anonymous postal questionnaire was sent to 1150 patients with joint pain aged 17-80, of whom 715 (63%) returned completed questionnaires. Few (17%) fundholding respondents had received information from their practice about fundholding or (36%) were aware of new or different services being offered but the majority had heard of fundholding and were able to describe it accurately. Satisfaction with GP services was high in both types of practice, but fundholding patients reported higher levels of satisfaction with getting a referral to a hospital specialist (FH: 81% vs. NFH: 63%), and with the length of time between referral and treatment (FH: 81% vs. NFH: 59%). A majority of patients in both types of practice wanted to be involved in decisions about the services available to them but only a third of patients thought that fundholding would make this easier. Fundholding patients were more likely to report being given enough choice about treatments available to them (51%) than their non-fundholding counterparts (35%). Fundholding patients had not perceived a reduction in quality of care as a result of budgetary pressures and were more satisfied with the process of referral to secondary care than their counterparts in non-fundholding practices. Patients in both types of practice felt that it was important to be involved in decisions about the services available to them, but few thought that this would be more likely as a result of fundholding. Provision of information to patients is a prerequisite for their involvement, but judging by the number of patients receiving any information about fundholding from their practices this aspect of the reforms does not seem to have been implemented.
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