Suchergebnisse

Abstract Background Egg donor agencies are increasingly being used as part of IVF in the US, but are essentially unregulated, posing critical ethical and policy questions concerning how providers view and use them, and what the implications might be. Methods Thirty-seven in-depth interviews of approximately 1 h were conducted – with 27 IVF providers and 10 patients. Results Clinicians vary in their views and interactions concerning egg donor agencies, ranging widely in whether and how often they use agencies. Agencies may offer egg recipients increased choices, but raise ethical and other concerns regarding respect for donors as individuals (e.g., adequacy of informed consent), potential harms, justice (e.g., concerns about possible eugenics – by encouraging and facilitating selection and marketing of facts for offspring), and donors constituting a vulnerable group. The quality of agencies appears to vary considerably, from acceptable to problematic. Agencies' medical and psychological screenings of donors can range, and be minimal. Not all agencies adequately track donors' prior numbers of donations, or share the relevant records with clinics. Clinics may find that potential donors have genetic mutations and medical problems about which they were unaware. Yet agencies and clinics do not provide care for such donors, generating stress. Dissemination of donors' personal data can potentially threaten confidentiality. Questions emerge of whether increased monitoring/oversight of agencies may be beneficial. Conclusions These data, the first to examine providers' views and interactions regarding egg donor agencies, suggest wide variations in quality and use of agencies, and have critical implications for practice, policy, education and research. Given the potential limitations of the current model of self-regulation of agencies, the present data suggest needs to consider stronger professional guidelines or possible governmental regulations to establish, require and enforce higher standards for agencies to follow, regarding advertising to potential donors and recipients, arranging for appropriate informed consent concerning risks and benefits involved, and for quality control. Appropriate informed consent should be obtained from potential egg donors, including the fact that they may learn about mutations or medical problems about which they were unaware, but for which they will not receive treatment as part of this process. Enhancing understanding among the public-at-large about what egg donation entails may also be helpful.

Background: This paper presents an in-depth international comparison of systems and procedures of aid evaluation, focusing on Country Program Evaluation among major donor agencies. The original client of this study is Ministry of Foreign Affairs, Japan (MOFAJ). Purpose: The purposes of this paper are set as follows: (1) to understand how aid agencies conduct Country Program Evaluation; and (2) to make recommendations for improvement of the current practice of Country Program Evaluation in the aid evaluation community. Setting: The examined donors include: the World Bank (WB), the Asian Development Bank (ADB), the Inter-American Development Bank (IADB), the United Nations Development Programme (UNDP), the U.S. (USAID), Canada (CIDA), the U.K. (DFID), the Netherlands (IOB), Germany (BMZ), France (Foreign Ministry), and Japan (Ministry of Foreign Affairs (MOFAJ)). In addition, aid agencies conducting respective project evaluation are also examined, and they are JICA (Japan), GTZ and KfW (Germany) and AFD (France). Intervention: This study presents the result of comparative analysis among those donor agencies in terms of the following viewpoints: (1) evaluation criteria employed; (2) approaches to evaluate "effectiveness" and "impact"; (3) attribution issue; (4) the use of a rating system; and (5) overall evaluative conclusion and integrating methods. All viewpoints are focusing on Country Program Evaluation. One conclusion is that most agencies have been struggling with how to judge the degree and value of their country programs. Data Collection and Analysis: Mixed methodologies were employed to collect data from the said donor agencies. The analysis was conducted by a systematic procedure consisting of: (i) summarizing information in a comparative table; (ii) trying to make groups/categories based on common characteristics if possible; and (iii) examining and concluding basic thoughts/philosophy which make their differences. Findings: This study made some new knowledge about how aid agencies conduct Country Program Evaluation and identified several issues remained. Varieties of their practices are observed and it is far from the unified methods agreed. Some remarkable points identified in this study are:(1) Most aid agencies invoke the DAC five evaluation criteria for Country Program Evaluation. (Major exception was USAID); (2) "Strategic relevance" and "coherence/complementarity" are the emerging new criteria; (3) Attribution is still the issue that aid agencies have struggled; and (4) The attitude for introduction of rating system is clearly divided among aid agencies.

Background: Egg donor agencies are increasingly being used as part of IVF in the US, but are essentially unregulated, posing critical ethical and policy questions concerning how providers view and use them, and what the implications might be. Methods: Thirty-seven in-depth interviews of approximately 1 h were conducted – with 27 IVF providers and 10 patients. Results: Clinicians vary in their views and interactions concerning egg donor agencies, ranging widely in whether and how often they use agencies. Agencies may offer egg recipients increased choices, but raise ethical and other concerns regarding respect for donors as individuals (e.g., adequacy of informed consent), potential harms, justice (e.g., concerns about possible eugenics – by encouraging and facilitating selection and marketing of facts for offspring), and donors constituting a vulnerable group. The quality of agencies appears to vary considerably, from acceptable to problematic. Agencies' medical and psychological screenings of donors can range, and be minimal. Not all agencies adequately track donors' prior numbers of donations, or share the relevant records with clinics. Clinics may find that potential donors have genetic mutations and medical problems about which they were unaware. Yet agencies and clinics do not provide care for such donors, generating stress. Dissemination of donors' personal data can potentially threaten confidentiality. Questions emerge of whether increased monitoring/oversight of agencies may be beneficial. Conclusions: These data, the first to examine providers' views and interactions regarding egg donor agencies, suggest wide variations in quality and use of agencies, and have critical implications for practice, policy, education and research. Given the potential limitations of the current model of self-regulation of agencies, the present data suggest needs to consider stronger professional guidelines or possible governmental regulations to establish, require and enforce higher standards for agencies to follow, regarding advertising to potential donors and recipients, arranging for appropriate informed consent concerning risks and benefits involved, and for quality control. Appropriate informed consent should be obtained from potential egg donors, including the fact that they may learn about mutations or medical problems about which they were unaware, but for which they will not receive treatment as part of this process. Enhancing understanding among the public-at-large about what egg donation entails may also be helpful.

In fragile and conflict-affected settings (FCAS), largescale infrastructure projects often connect areas under various forms of rule. Donor agencies and development banks should demand from contractors conducting feasibility studies to include conflictsensitive employment (CSE) strategies for those parts of the infrastructure project that are affected by violent conflict.
In addition to available international procurement guidelines, donor agencies and development banks should require bidders to outline a CSE strategy. They should demand from bidders a convincing calculation of the costs of CSE, especially in comparison to the costs of anticipated security measures for the duration of the project, its maintenance and protection for a specified period (at least five years) after completion. The CSE framework (Grawert et al., 2017) should be attached to the tender as a guideline.
As changes in control over areas and settings of armed conflict are common in FCAS, conditions for company operations in large-scale infrastructure building will change, too. While bidders' contingency plans should include such potential changes, donor agencies or development banks should allow for budget adjustments if these changes exceed the anticipated volume of the project.
Local companies often are familiar with local power relations and able to assess project risks in local areas realistically. Donor agencies and development banks should require from bidders an initial outline of units that will have to be constructed by local companies, and bidders should detail the envisaged CSE strategies.
Donor-funded skills upgrading measures could enable local companies to carry out part of the operations required for the large-scale infrastructure project. Such projects will thus become development corridors that enhance mobility and communication as well as professional qualification of the local inhabitants.

AbstractAfter a decade of rapid growth in average incomes, many countries have attained middle income country (MIC) status. At the same time, poverty has not fallen as much as one might expect and as a result most of the world's poor now live in MICs. In fact, there are up to a billion poor people or a 'new bottom billion' living not in the world's poorest countries but in MICs. Not only has the global distribution of poverty shifted to MICs, so has the global disease burden. This article examines the implications of this 'new bottom billion'– the fact that up to a billion of the world's poorest people now live in MICs – for global health efforts, and recommends a tailored middle income strategy for the Global Fund and GAVI. The article describes trends in the global distribution of poverty, preventable infectious diseases, and health aid response to date; revisits the rationale for health aid through agencies like GAVI and the Global Fund; and proposes a new MICs strategy and components, concluding with recommendations.Policy Implications


 Eliminating the country income threshold as an across‐the‐board criterion for allocating global health funding.

 Setting up regional pooled procurement or pricing mechanisms.

 Building evidence based, priority setting institutions in MICs.

 Establishing increased accountability mechanisms and providing technical support for MICs.

 Increasing the allocative efficiency of health aid while ensuring equity.

The paper builds on recent empirical evidence on the importance of strategic donor behaviour in aid allocation in order to develop a theoretical model where donor pressure on a recipient for influencing the aid disbursement of a multilateral institution is endogenously determined. Our game-theoretic, multi-agent model with one aid recipient, two bilateral donors and one multilateral institution illustrates the advantage of putting pressure on the recipient as an instrument for foreign policy, as seen from the mighty donor's point of view. The model shows how this strategic donor behaviour is damaging to the aid-recipient; we also show that other donors not sharing foreign policy goals similar to the strategic, influential donors will, in fact, reduce their aid contributions to the multilateral organizations. This may obviously have profound implications for the volume of total aid flows and may crucially undermine current efforts to substantially increase ODA to meet the Millennium Development Goals by 2015. Our paper also contributes to the common debate on foreign aid by presenting a rigorous model that explains the coexistence of both multilateral aid organizations and bilateral aid programmes.