Suchergebnisse

In the past decade, the problems of primary health care delivery have encompassed the problems of poverty, illness, fertility, mortality, & preventive medicine. Basic medicine-oriented at the village level by various medical groups, government strategies, & international health programs-or decentralization & expansion of Ur medicine to Ru areas have been the diverse experimental approaches. Many of the programs have not been sustained or successful over the long term. It is necessary to question whether primary health care is then the best form of medicine, or merely the one we are most habituated to & comfortable with. Primary health care, in & of itself, may not be nearly as effective as multidisciplinary approaches integrating SE planning, social sciences, epidemiologists, medical administrators, etc. Trial & error over time & endurance are the best indicators of what will & will not constitute the best approach & delivery of medical service. Present systems of primary health care should not be scrapped, but neither so firmly entrenched as to be unmodifiable. 1 Table. A. Rothman.

Reporting of performance information on public sector services has increased substantially in recent years. The audit of such information, however, is still relatively uncommon. In 1989 the Audit Office in New Zealand was confronted with a legislative requirement to audit Statements of Service Performance (SSPs). This paper backgrounds New Zealand's shift in emphasis from program effectiveness audits to the audit of non‐financial performance information, describes the development of audit methodology in this area and identifies lessons learned.

How should local service delivery of public goods and services be improved for desirable development outcomes? This paper attempts at answering this question by providing a framework for improving local service delivery. It argues that improving local service delivery is a function of triangulating delivery of any public goods and services through their policy, institutional, and financial characteristics; zeroing in on their interdependence and normative dimensions; the effectiveness of institutions and capabilities and productivity of their actors; and the role of governance against the backdrop of development constraints and supported by opportunities for reforms. It further argues that institutions and their actors take the primordial role in improving local service delivery especially in cases of policy gaps and financial inadequacies. Corollary argument is that governance - both institutional and democratic - is the key in helping catalyze institutional change and improving service provision to achieve such goals as quality of life, empowered citizenry, and responsive leadership based on normative entitlements. The values (rights, equity, quality, and sustainability) and elements/principles of governance (efficiency, participation, transparency, accountability, and predictability) both lay the groundwork for delivering goods and services, as well as serve as indicators in assessing local service delivery. In other words, improving local service delivery is a function of the triangulation of policy, institutions, and finance within value-based and principle-oriented governance framework.