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The coverage of immunization against avoidable disease in the Republic of Benin as in other West African countries, is declining nowadays. To sustain the government effort, National Immunization Technical Advisory Groups (NITAG) were created technically and funded by the West African health organization (WAHO) and Preventive Medicine Agency in countries of the Economic Community of West African States (ECOWAS) including the Republic of Benin. The variation in experts’ methods of analyzing evidence sometimes results in risk error and lack of statistical power. This situation does not allow for the comparison of the scientific validity of certain recommendations made to policy makers, due to the lack of a rigorous framework. The aim of this paper is to design an improved framework to be used in the Republic of Benin in order to encourage a more harmonized approach based on evidence used by expert consultative committees. This framework shows four fundamental scientific steps including a Ministerial referral procedure, recommendation framework, evidence-based data collection, model analyses appropriate for expert advice on vaccines and child immunization, as well as three administrative steps including scientific discussion and work meetings without forgetting ethical aspects.

Copyright of Politique Africaine is the property of Karthala Editions Diffusion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Federal governments in Canada and the United States have followed similar timelines and events in their efforts to support Indigenous self-determination in health care. Since colonization, both settler colonies have aimed to assimilate Indigenous Peoples into settler society, in disregard of inherent Indigenous self-determining rights and titles. By the 1970s their policy agendas shifted towards Indigenous self-determination, including in matters of health service planning and delivery at the community-level. This paper analyzes this shift in policy from a comparative perspective with the aim of informing future reforms. We identify and examine the policy instruments used in the process, finding a greater use of regulatory instruments in the United States, compared to informative tools in Canada. We also discuss the associated impacts of the reform on the ability to practice self-determining activities within communities, highlighting some of the administrative enablers and barriers within and around health care settings. As little research has compared health policy reforms related to matters of Indigenous health in Canada and the United States, this paper provides new insights into the drivers and nature of the policy shift toward self-determination at the federal level and suggests grounds for further investigation.

This paper questions the signification of reinforcing the active role of elderly between societal injunction to feel responsible of the costs to the collectivity and the freedom to choose one's way of life and having the means to realize it. It describes two experiences in two Brussels communes of a model of co-construction with the elderly of a project to live in one's own home, to reinforce the active roles of persons. We want to illustrate the difficulty of such an approach in Belgium, separating the organization and the financing of medical and social care, that does not foster the accompanying and the active role of elderly. The conflict of interest between the different actors is not allowing the proper multidisciplinary approach to empower and allow the maintenance of elderly capability of choice and well being.

This paper deals with changes in code status policy in Ontario and endorses a new College of Physicians and Surgeons of Ontario (CPSO) policy. We argue that the recent policy changes in this area necessitate an active educational strategy around end-of-life care to prevent harm to dying patients.

Many people and financial institutions believe that the elderly are not a priority in sub-Saharan Africa, a region marked by serious economic, socio-political and health crises. The purpose of this paper is to describe and analyze the assumptions and arguments underlying this view and to demonstrate that the elderly are a vulnerable priority population ignored by all stakeholders and primarily by technical and financial partners. The premise is that development must be viewed as a whole. In addition to improving the living conditions of children, youth and women, efforts to promote development in Africa must also take into account the needs of the elderly. The paper argues that there are four main reasons for focusing on the elderly in sub-Saharan Africa: systemic reasons, ethical/humanitarian reasons, developmental reasons and/or the interests and future of youth and adults.

Background: Nutrition education is one of the main lines of the French nutrition policy that has been undertaken for several years. The underlying hypothesis of this approach is that knowledge improvement is one of the ways likely to contribute to health-enhancing diet and physical activity. The objective of this paper, based on the 2008 Health and nutrition Barometer, is to examine the associations observed between knowledge and behavior with regard to diet and physical activity., Methods: The 2008 Health and nutrition Barometer is a nationally representative telephone survey conducted on 4714 individuals aged 12-75 years. For six recommendations of the National Nutrition and Health Program (Programme national nutrition santé [PNNS]), multiple logistic models were used to identify associations between knowledge of these recommendations and behavior, among adults aged 18-75 years. For food consumed on the day before the interview, odds ratios were adjusted for sex, age, education level, agglomeration size and region. As bivariate analysis showed that income level was significant for recommended consumption of fish, this variable was introduced among adjustment variables. Similarly, the variable occupation was introduced for physical activity., Results: A positive association between knowledge of recommendations and nutritional behavior on the day before interview was observed for fruit and vegetables (OR=1.7), dairy products (OR=1.6), and starchy food (OR=1.6). The same was observed for consumption of fish during the 15 days before the interview (OR=5.0) and for physical activity during a usual week (OR=1.5) but not for the "meat, seafood and eggs" food group., Conclusion: Eating habits and physical activity are positively associated with knowledge of nutritional recommendations, mainly acquired via nutritional information and educational actions. Nevertheless, the important differences observed for certain dietary groups between knowledge of recommendations and dietary intake emphasizes the need to further support individual-focused initiatives with health-enhancing environmental strategies., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

In 2006, the Senegalese government introduced the "Plan Sésame", an unprecedented policy in West Africa aimed at reducing social vulnerability among the elderly (i.e. people aged over 60 years). This paper examines the process of implementation of the "Plan Sdsame': Using a qualitative approach, the study was based on a unique case study authorized by the Senegalese Ministry of Health. Three methods were used: i) individual interviews (n = 19), ii) discussion groups (n = 24), and iii) documentary study. Despite its social objective, the "Plan Sésame" was ultimately limited to free health care. However, even the health component of the plan has suffered from under funding. Political obstacles, inadequate accompanying measures and short staffing have resulted in late reimbursements at a local level, thus limiting the implementation of the plan. While both health professionals and elderly people are in favor of free healthcare, they are also critical of the implementation issues surrounding the "Plan Sésame": Although it appears to be a viable solution, these issues may spell the end of the plan. The task of designing solid technical foundations and developing appropriate accompanying measures should not be overlooked because of the limited interest of international partners in the "Plan Sésame" the national dimension of the plan and its electoral importance.

The creation in 2010 of a national ethical area on Alzheimer disease illustrates the evolution in the French context towards an institutionalization of ethical approach concerning chronic diseases and long term care. This paper presents the background of such a national area, how it works, its objectives and two concrete outputs: the charter "Alzheimer Ethics & Society 2011" and the advice "Alzheimer, ethics and society", published in September 2012.

In recent decades, both public health professionals and the populations targeted by prevention and health promotion programs have shown an increasing interest in ethical issues since some interventions have been seen as impinging on fundamental rights and values. Insofar as bioethics is not adapted to population interventions and community health issues, a specific expertise in public health ethics is now required. However, ethical expertise in this area faces many challenges. The purpose of this paper is to examine four of these challenges. The first three challenges concern professional or specialist expertise. The paper suggests that expertise in public health ethics should go beyond the search for greater sophistication in defining ethical principles. Experts in public health ethics also need to identify appropriate strategies to include public health professionals in ethical analysis and to adopt a critical and reflexive approach to the status of moral experts and moral expertise. However, the main challenge is to identify appropriate ways of reconciling lay and specialist ethical expertise. The paper argues that secular morality and common morality represent two key sources of lay ethics expertise and that the fundamental values that inform discourse ethics should be derived from both forms of expertise.

Rates of child and youth obesity and associated chronic diseases are rising worldwide, in part as a result of inadequate physical activity (PA) levels. Environmental change is needed in multiple settings to encourage the adoption of healthy lifestyle behaviours at an early age. Schools are an ideal setting in which to incorporate a variety of interventions in order to improve student PA levels and healthy eating environments. This paper reviews effective and promising policies for increasing PA levels in the school setting and introduces other untested interventions that could become the basis of future well-designed studies. Policies outlined in this review should be considered by a range of stakeholders and be carefully monitored and evaluated. These policies should include daily, quality, safe physical education and physical activity; extracurricular physical activity; training of physical activity leaders; active transportation to and from school; adequate facilities; and community outreach. Successful school initiatives and stakeholders should also be recognized formally for their contribution.

The aim of this paper is to draw the reader's attention to the problem of dissemination of costly innovations, particularly in the field of oncology, in a context of scarce resources.Comparison of five economic aggregates related to health and the gross domestic product captures the weight of this sector in the national economy but also its cost to the community. A focus on oncology shows that during the year 2004, the cost of cancer in France, all sites being taken into account, amounted to 10.9 billion euros and the societal cost to 32 billion euros (2% of gross domestic product). The cost of breast cancer (36% of all female cancers) reached 1.5 billion euros for treatment and 3.5 billion euros for societal expenses (0.2% of gross domestic product). Due to the significant, rapid expansion of these costs (+19.2% in 2006 and 18.5% in 2007 for diagnosis-related group outliers) but also to the scarcity of resources, the development of costly innovations remains problematic. This article, based on concrete examples of breast cancer treatment, provides information on the contribution of health technology assessment (particularly cost-utility and budget impact analyses) to public decision. Economic evaluation, in particular, cost-utility assessment, allows comparison of costs and consequences (generic result usually expressed in quality-adjusted life years) in order to prioritize diagnostic and/or therapeutic strategies and to make choices based on social acceptability. Budget impact analysis, without consideration of efficacy, makes it possible to balance the financing needs arising from the adoption of a costly innovation with the paying capabilities of a given institution.

Achieving effective health informatics interoperability in a fragmented and uncoordinated health system is by definition not possible. Interoperability requires the simultaneous integration of health care processes and information across different types and levels of care (systems thinking). The fundamental argument of this paper is that information system interoperability will remain an unfulfilled hope until health reforms effectively address the governance (accountability), structural and process barriers to interoperability of health care delivery. The ascendency of Web 2.0 and 3.0, although still unproven, signals the opportunity to accelerate patients' access to health information and their health record. Policy suggestions for simultaneously advancing health system delivery and information system interoperability are posited.

Without any proof, a governmental agency has decreed that Corticotulle was not enough efficient to be reimbursed by National Health Security. Dealing with treatment of basal cell carcinoma, another governmental agency has published recommendations which even do not follow basic rules of logic. This paper points out that economical and political methods are not scientific or medical ones.

Conflicts of interest between the food industry and public decision makers have increasingly multiplied over the last few years, especially within the context of implementing the French National Nutrition Programme. This paper describes the rhetoric and the strategies developed by the private sector in order to counter the law's implementation and enforcement based on a concrete example, namely, the removal of vending machines from schools. After having evoked possibilities of developing new partnerships as suggested by national and international health authorities, it reaffirms the right and the duty of the State to regulate within the framework of a health promotion policy, an approach which integrates the necessary open democratic public debate between the different sectors.

This paper analyses the main results and prospects concerning research and studies about social inequalities in health in France. Research orientations, which may contribute usefully to defining health and social policies in this field and favour their development are then proposed. Health policy content and implementation placing high priority on the problem of social inequalities in health are discussed.

Initially introduced by Juppé in 1996, the legislative reforms of January 2nd and March 4th 2002 legally enacted new forms of consumer representation and participation in the development of the health system. However, it appears that while this new role which was created to ensure legitimate participation has been recognised by law in theory, it has not necessarily received the same recognition and incorporation in practice at the grass roots level. As a result, it is now essential to think about practical methods of representation in order to sustain local legitimacy of consumers and patients on the ground and construct it from the bottom-up. The goal of this work was to understand how and under what conditions local legitimacy for health care system consumers, as a particular group of actors, can be effectively built, independently and irrespective of the specific question of elective democratic processes. The foundation of this work is based on material which resides in the collection of data from various local participation experiments that we or other researchers have contributed to establishing in a select group of health care settings. The results of this analysis serve to update a list of principle factors through which the legitimacy of the health care system's users is constructed. Such factors include the following: the promoting agents' expectations vis-à-vis the system's users and the a priori status which is given to them; the identification and selection methods used for choosing users, and the link to the types of users in terms of representation; the nature of the "generalisation" process for decision-making, understood as the process which transforms individuals' words and perspectives into collective ones; and the conditions for and modes of interaction between laypersons and professional experts. Finally, the paper presents the potential conflictive relationship or tension which may exist between representation and legitimacy with regard to the process for building legitimacy. The authors discuss the links between local, direct and elective democracy. The paper describes how effective democratic conditions can be built on the ground (from self-administered legitimacy to externally acknowledged legitimacy). In conclusion the paper succinctly distinguishes the articulation between representative democracy and participatory democracy, and how local processes relying upon direct democracy may be properly linked to the more "classical representative model of democracy".

HIV/AIDS infection has spread like wildfire in the countries of sub-saharan Africa. In order to fight that pandemic, Cameroon has organised itself by setting up, with the assistance of bilateral and multilateral partners, a national structure with the aim to reduce the spread of the disease. Two years after the launch of the National Plan for the Fight Against HIV/AIDS, an advocacy campaign targetting social leaders made it possible to assess the difficulties encountered by such an entity in a social and cultural environment as complex as that of Cameroon. The paper presents the initiatives taken by the government and analyses the major specific obstacles which are met on the ground. They include beliefs, social structures, gender issues, the status of women and the social representations of sexuality. If consensus and compromise are the usual ways of solving the problems raised at the national level, the analysis stresses the need for a more courageous political will adapted to the urgency of the prevailing situation.

Child mortality continues to be a public health priority world-wide. Even though under-five mortality rates have declined from an estimated 84 per 1000 in 1985-89 to 67 per 1000 in 1999, wide geographical differences persist. During the 1990 World Summit on Children in New York, the world's policy-makers and researchers made improving children's lives by ensuring that each child receives the best care and attention possible their main goal. The strategies identified to achieve this goal have guided and benefited from the progress in child health research throughout the last decade. Indeed, research into the causes of ill-health informs and guides public health programmes to improve the burden of preventable deaths, but it requires sustained and renewed investments for the developing world. In this review paper we have aimed to describe the magnitude of current child morbidity and mortality in the developing world; to review the main advances in child health research since the 1990 World Summit on Children and evaluate the implication of different institutions involved in international child health; to measure the adequacy between priority research setting and public health needs for child health in developing countries; to identify constraints in the application of the research results; and to define key strategies and research challenges that are required in the next decade to respond to child heath needs in developing countries. This assessment is based on a ten-year literature review through Medline and a survey to key international informants in the field of child health in developing countries, using a trilingual open-ended questionnaire. The literature published from January 1990 to June 2001, covering more than 4,700 references, enabled us to review more than 130 articles. We contacted 91 institutions involved in child health, located in 27 countries from five continents, and the response rate to our survey was 49.5%. The current priority health needs of children in developing countries most frequently stated in the literature are the reduction of the burden of malnutrition, diarrhoeal diseases, respiratory diseases, perinatal health, HIV/AIDS, measles and malaria. Based on the survey results, malnutrition (78% of respondents) and perinatal health were the most frequently quoted. Less than 15% of the survey respondents provided an example of a successful application of research in the field of infectious diseases. Political support and conflict of interest are the main constraints mentioned. Malnutrition and non-communicable diseases are considered as main areas of neglect in the field of child health research. Our study shows that the perception of field actors in child health on research priorities does not always correspond to the reality of health needs of children in developing countries. Furthermore, it appears that descriptive epidemiology, evaluation and priority setting strategies are essential tools to guide adequate research activities and further improvement of child health.

A recent report of the Senate revealed the difficulties of elaborating an effective cancer policy in France. Senators particularly pointed to the necessity of establishing cancer care priorities and to the tremendous need for medical coordination. This paper will develop the annual state debate on social security funding. The authors will show that health policy is entirely dependent on health economics. We believe that health priorities and health outcomes should be defined before any financial decision is made, this preliminary debate being an essential contribution to evidence-based policy-making in public health.

Copyright of Mondes en Developpement is the property of De Boeck Universite and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Lien Social et Politiques is the property of Institut National de Recherche Scientifique (INRS) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

With the example of a study on population health in the Swiss cantons Jura and Neuchâtel, the paper proposes a mechanism for priority setting of problems that could be acted upon preventively. Concepts are reviewed: public health needs as defined by epidemiology, supply of preventive activities, demands expressed by the population and different stakeholders. The role of general practitioners is stressed, not only as preventive services suppliers, but also as actors of priority setting.

A gradual decrease in energy output for adults in the Western countries has been observed through the XXth century. The mechanization in industrial societies result in a decline of customary physical activity and consequently in the potentially vicious spiral of inactivity leading to deconditioning and thence, via loss of physiological capacity, to a further reduction in activity. The sedentary life has injurious effects on the health of individuals and specially increase the risks of cardiovascular disease. Furthermore there is a supposed relation between inactivity with obesity and hyperlipemia in young people and with osteoporosis in elderly. In contrast, many papers showed that high levels of physical activity have been associated with a diminished occurrence of hypertension, coronary artery disease, non insulin-dependent diabetes, colon cancers... In addition physical fitness is obviously related to the quality of life. Because of all these reasons several developed countries have elaborated plans of physical reconditioning for their people. In France some experimental actions have been completed but any national programme has been determined. Moreover it is now crucial to promote scientific researches about the fundamental biological mechanisms which explain the beneficial effects of physical training on the prevention and/or the treatment of several illness.

As the national movement for health care reform gives priority to activities that will achieve better and more efficient delivery of health care services, the cost-effectiveness of services will need to be calculated in some type of standard fashion. Although the cost-effectiveness of preventing and controlling acute diseases (for example, through mass immunization programs) has been well appreciated, less attention has been paid to the chronic diseases, which, in fact, account for the majority of illness and death in the United States today. This paper uses prevention of a common chronic disease, stroke, as a model to illustrate how cost savings measures may be developed and used to guide public policy.

Résumé Objectifs Il s’agit de reprendre la question du diagnostic « démence type Alzheimer », et de mettre en lumière les limites de cette catégorisation nosographique, voire son inconsistance. L’objectif est de dévoiler le paradoxe existant de fait avec les recommandations des autorités de santé, notamment les mesures préventives et thérapeutiques, de type stimulation ou rééducation, qui y sont associées. Notre visée est de montrer la place que cela laisse à une clinique du sujet. Méthode Une revue de littérature d’une diversité scientifique – rassemblant les domaines de la sociologie, la psychiatrie, la neuropsychologie, ou les sciences politiques – nous sert à préciser ce que recouvre le concept « maladie d’Alzheimer », tant en ce qui concerne son historique, sa définition médicale, que sa transformation sociale. Résultats Nous relevons que cette dite maladie repose à l’origine non sur une véritable découverte scientifique mais sur une invention nosographique. Une observation de cas paraissant plutôt curieux, dont la spécificité pathologique était mise en doute, voire déniée par Aloïs Alzheimer lui-même, est devenue un siècle plus tard une maladie extrêmement fréquente, aussi perçue comme « la maladie du siècle ». Les incessants changements de définitions au fil des années et des nosographies – dont la distinction avec la démence dite « sénile » a été l’objet de questionnements – ainsi que les critiques de plus en plus nombreuses portant sur les hypothèses au sujet de l’étiologie neurobiologique, soutiennent le constat d’une création nosographique. Les recherches postulant que ce diagnostic est le résultat d’une construction sociale sous-tendue par des logiques économiques et politiques (celles qui désignent Alzheimer comme un « fléau à combattre »), ainsi que par le modèle biomédical de nos sociétés occidentales, vont également en ce sens. C’est par ailleurs dans ce contexte, et seulement depuis la dernière décennie, que l’on voit apparaître une distinction entre différents stades de cette dite maladie, dont le « stade préclinique », asymptomatique, qui étaye la visée de prévention et de dépistage des autorités de santé. Discussion Si la notion de « maladie d’Alzheimer », en tant qu’entité homogène causée par des facteurs moléculaires, commence à être remise en question, cela ouvre la possibilité d’étudier les états hétérogènes se manifestant dans le cadre large du vieillissement cérébral et cognitif. Cela implique également, par conséquent, de réinterroger la différence entre un vieillissement « normal » et « pathologique ». Conclusions « La maladie d’Alzheimer est un mythe ». Voilà ce que laissent transparaître diverses études. Le problème est que ce diagnostic tend à effacer les sujets dans leur singularité. Or, pour l’accompagnement des personnes âgées dans notre société, il s’agit d’un enjeu éthique et déontologique de prendre la mesure de l’incohérence de ces mesures préventives et thérapeutiques, et de pouvoir laisser une place à une clinique du sujet. Aims This paper sets out to review the issue of diagnosis of “Alzheimer-type dementia”, and to cast light on the limitations of this nosographic categorisation, and indeed its lack of substance. The aim is to show the paradoxical aspects of the recommendations of the health authorities, and in particular the preventive and therapeutic recommendations in the areas of stimulation or rehabilitation. The purpose is to show that this leaves room for a clinical approach centering on the subject. Method A broad review of the scientific literature ranging from sociology to psychiatry, neuropsychology and political science, enables a definition of what is covered by the concept “Alzheimer's disease”, at once with regard to its history, its medical definition, and its social history. Results We observe that this “pathology” was originally based not on a genuine scientific discovery, but on a nosographic invention. A rather curious case study, on the subject of which Alois Alzheimer himself expressed doubts as to its pathological specificity, one century later has become an extremely common condition, often viewed as the “disease of our time”. The constant changes in definition across the years and across nosographies – where the distinction with respect to so-called “senile” dementia has been questioned – and increasingly numerous criticisms of the hypotheses of a neurobiological aetiology, are all in favour of a nosographic invention. The research postulating that this diagnosis results from a social construction underpinned by economic and political logics (whereby Alzheimer's disease is seen as a “scourge” to be fought), and by the biomedical model of our Western societies is likewise in favour of this nosographic creation. It is in this setting, and only in the last decade, that we have seen the emergence of definitions of different stages in the disease, including a “pre-clinical”, asymptomatic stage, supporting the screening and prevention strategies of the health authorities. Discussion At a time when the notion of “Alzheimer's disease” as a homogeneous entity caused by molecular factors is beginning to be questioned, there is scope for research on the heterogeneous manifestations occurring in the broad setting of cerebral and cognitive ageing. This implies a reappraisal of what differentiates “normal” from “pathological” ageing. Conclusion “Alzheimer's disease is a myth” – as is suggested by various studies. The problem is that this diagnosis tends to obliterate the singularity of each subject. Yet for the accompaniment of the elderly in our society, the ethical and deontological challenge is to take the full measure of the inadequacy of existing preventive and therapeutic measures, so as to make way for a clinical approach centred on the subject. [ABSTRACT FROM AUTHOR]

Résumé Les données de santé donnent lieu à une multiplicité de qualifications. L’exercice auquel sont contraints les acteurs n’a rien d’inhabituel pour le système juridique. Dans le cas des données de santé, et tout particulièrement dans l’hypothèse où ces données sont traitées via des dossiers auxquels plusieurs catégories d’acteurs doivent avoir accès, cet exercice peut néanmoins s’avérer problématique. Les dossiers médicaux électroniques, dans lesquels les pouvoirs publics ont, depuis quelques années, investi énormément d’espoirs et d’argent, ne parviennent pas à franchir le cap d’une généralisation qui était pourtant présentée comme devant être salutaire pour notre système de santé publique et de financement des dépenses de santé. Sans exagérer la portée sociale des problématiques liées à l’interprétation et à l’application des normes applicables en la matière, on peut raisonnablement penser que ces dernières ne sont pas étrangères à cet état de fait. Après avoir présenté les deux grands corps de normes initialement applicables aux traitements de données de santé à caractère personnel, cet article développe l’analyse de leur confrontation avant de brosser à grands traits le statut qui est actuellement celui d’une des questions les plus complexes qui soit en matière de dossiers de santé électroniques, celui du consentement des personnes aux divers traitements dont leurs données peuvent être l’objet. Health data give rise to a plurality of qualifications. The exercise players are forced this not unusual for the legal system. In the case of health data, especially when these data are processed through folders to which several categories of actors need access, it may still be problematic. Electronic medical records, in which the authorities have in recent years invested a lot of hope and money, fail to cross the course of a generalization though it was presented as being beneficial for our public health system and financing of health spending. Without exaggerating the extent of social problems related to the interpretation and application of standards, it is reasonable to think that they are partly responsible for this fact. After presenting the two great bodies of norms which where initially protecting personal health data, this paper develops the analysis of their confrontation before highlighting the status of one of the most complex issues in this field, that is the people's consent to the various treatments that their data may be subject of. [ABSTRACT FROM AUTHOR]

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Where the government cannot meet wide-ranging health needs of the population and when people are given the opportunity to manage their own affairs and to be involved in decision-making, they can become very efficient. This was demonstrated by an experiment in a senegalese town (450 000 inh.) between 1975 and 1981. A strategy for priority health care with the active participation of the local community was developed to provide a network of acceptable and accessible health services. This was with government support. --The government provides the basic structure of its health services to which the community contributes. It provides the medical staff, technical guidance and logistic support and helps the community volunteers to develop sound accounting procedures. --The community contributes financial and human resources to improve the coverage of the health units. Based on a self-financing system controlled by a health committee per each health unit, communities are in decision making concerning the utilization and management of the community's resources. Procedures to control the community's financial contribution are especially well detailed in the paper. In view of this successful experiment, the minister of public health with the agreement of the government, has recommended that community participation in financing health care services be extended to all regions of the country.

Abstract: What is the regulation of clinical research? Which administrative steps must be carried out? Who are the different actors and what are their responsibilities in the management of biomedical research? What are the characteristics of clinical research in nutrition? Which methodology should be used? The objective of this paper is to answer these questions, keeping in mind that the rules are regularly modified, and that the elements described today will not apply tomorrow. Moreover, the law does not always respond to all situations and to all questions. [ABSTRACT FROM AUTHOR]

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In April 2005 the Centers for Medicare and Medicaid Services (CMS) posted on its Web site a draft guidance document describing a new approach to coverage policy called "coverage with evidence development" (CED). CED offered an option for coverage of promising drugs, biologics, devices, diagnostics, and procedures that would not otherwise meet Medicare's evidentiary standards for being "reasonable and necessary." An updated guidance was posted 12 July 2006, clarifying several key statutory, regulatory, and operational issues. This paper traces the history of this policy approach, explains the rationale behind the policy, and describes the major challenges that will need to be addressed for CED to become an important advance in evidence-based coverage decision making. [ABSTRACT FROM AUTHOR]

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The Republic of Guinea-Bissau (RGB), a fragile state marked by a context of political and institutional instability, has since 1993 carried out the Strategic Planning for the Health Sector (SPHS). Sectoral strategic documents – National Plans of Sanitary Development (NPSD) – demonstrate a capacity for resistance to governmental adversities. This longitudinal policy review has a double purpose, namely to analyse the SPHS processes and to guard these memories to allow an understanding of the trajectories in question. This paper concludes that the SPHS mainly responded to the requirements of funding institutions, and it has not always been implemented. The NPSD III (2018-2022) aims to reverse this situation by implementing a strategy which aims to integrate the different health actors.

Over the last several decades, there has been an increased interest in cash-for-care programs internationally. Important among these reforms has been the emergence of direct payments (DPs), which are cash payments given directly to individuals so that they can purchase their own community care services. In the mid-1990s, both Ontario and Scotland implemented early direct payment programs with the explicit goals of providing greater choice and control over social services to adults with disabilities. Since then, however, the programs have diverged considerably. In Scotland, negative public perceptions resulted in DPs conversion into a program option embedded within the Self-Directed Support program. In Ontario, DPs have never been required by law and have instead expanded through multiple distinct programs funded through different government ministries. This paper compares the evolution of DPs in these two jurisdictions in order to better understand the actors and mechanisms that contributed to this divergence. Using the 3-I framework, we explore the ideas, interests and institutions that have shaped these reforms into their current structures. Our analysis offers several insights for other jurisdictions considering expanding direct payment reforms. These include recognizing: 1) policy conversion as a tool for managing negative perceptions of a reform, 2) policy levers for encouraging compliance among administering authorities, 3) divisions between health and social care as limiting possible expansion of the reform, and 4) program evaluations as justification for the reform's expansion. Les programmes de chèques services suscitent un intérêt croissant dans le monde depuis quelques décennies. Au nombre de ces réformes, une tendance importante a été l’émergence de paiements directs, qui sont des paiements en espèces versés directement aux bénéficiaires pour qu’ils achètent eux-mêmes leurs services de soins communautaires. Au milieu des années 1990, l’Ontario et l’Écosse ont tous deux mis en place de tels programmes de manière pionnière, avec comme but explicite d’offrir plus de choix et de contrôle sur les services sociaux aux adultes handicapés. Depuis, cependant, ces deux programmes ont divergé considérablement. En Écosse, une réaction négative de l’opinion publique à conduit à transformer les paiements directs en une option au sein du programme Self-Directed Support (soutien auto-administré). En Ontario, les paiements directs n’ont jamais été mis en place légalement et se sont développés à travers divers programmes financés par des ministères différents. Cet article compare l’évolution des paiements directs dans ces deux entités politiques afin de mieux comprendre les acteurs et les mécanismes ayant contribué à cette divergence. Suivant le concept 3-I, nous explorons les idées, les intérêts et les institutions ayant façonné ces réformes dans leur état actuel. Notre analyse fournit des indications aux autres entités tentées par des réformes de paiements directs, entre autres : 1) la conversion de politique comme un outil de gestion des perceptions négatives d’une réforme, 2) les leviers politiques pour améliorer l’adhésion des autorités administrative, 3) les limites potentiellement apportées à la réforme par la séparation entre le sanitaire et le social et, 4) les évaluations de programmes comme une justification de l’expansion de la réforme.

Within the British National Health Service (NHS), a number of different methods are currently in place which actively encourage patients to judge the provision of health by sharing their experiences of care and treatment, completing surveys, etc. Testimonials are also a way of evaluating the provision of health care and are posted regularly on NHS websites (Patient Opinion, NHS Choices, etc.), but also on special care and charity websites. Providing an outlet for patients to complain can be a useful way of not only ensuring that individual rights to quality health care are respected but also of increasing awareness of safety-related problems within health organisations, or various problems relating to health care delivery. However, such information and other data on user experiences are not currently well aggregated or used to drive improvements in health care delivery. So, while the right to reply and using patients’ experiences and/or complaints might be a way to improve care, this paper underlines a number of difficulties in collating and effectively using such information. It uses a case study of the Mid-Staffordshire Hospital Trust negligent care scandal of the period 2005 to 2008 to illustrate why a patient-led approach to monitoring care provision is essential but difficult to implement in practice.

This paper discusses preliminaries results of an evaluation research on services experience of Integrative and Complementary Practices in the city of Vitória-ES. Aims to analyze how the decisions of economics and politics affect the social right to health materialized in the SUS, using as basic the experience of PICs. The methodological procedures of a qualitative nature were defined from the critical perspective of analysis of class society. The results identified at although the experience has started in 1992 it consisted not in sufficient condition for a more significant consolidation. Is was found that PICs is subjected to the same contradictions that permeate the SUS management and still fall on them restrictions related to disagreement among health paradigms. It concludes that despite the respondents consider themselves committed to the institutionalization of PICs; it turns out in the daily practice there are still many restrictions to the model.

The significance of territory in health policy has been approached from different disciplinary fields without developing a conceptual body of work to register the complexity of the problems that exist at that critical juncture. This paper proposes to investigate the contribution that can be provided by a territorial approach to research and the practice of managers in primary health care, to throw light on the mutually conditioning relationship that exists in the two domains. This is a concept-based study that establishes links between the contributions from research on primary health care, the concepts provided by geography, and policy analysis. This approximation reveals two standpoints from which policies can be analysed: on the one hand the concept of care as a stage in a correlation involving differing notions of territory, and on the other, recognition of the fact that at the moment of implementation in the territory a process of institutional recreation at local level occurs where differing regulatory logic is put into play and negotiated.