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Background: The goal of the public procurement of pharmaceuticals is to purchase sufficient quantities of high-quality pharmaceuticals at cost-effective prices for a given population. This goal can be undercut if corruption infiltrates the procurement process. Good procurement practices can help mitigate the risks of corruption and support equitable access to affordable and high-quality medicines. Objectives: This paper aims to 1) examine manifestations of corruption in the pharmaceutical procurement process and key factors behind them, and 2) identify how to design and implement effective anti-corruption, transparency and accountability mechanisms within this process. Methods: This paper was informed by a narrative literature review from 1996 to the present. The search focused on publications that addressed the issue of pharmaceutical procurement and governance and corruption issues. Our search included peer-reviewed literature, books, grey literature such as working papers, reports published by international organizations and donor agencies, and some media articles. Some documents used in this paper were already known to the authors. Results: Procurement is highly vulnerable to corruption particularly in the health sector. What is more, corruption in the procurement process does not appear to be limited to any one level of government or type of health system. The better integration of accountability, transparency and anti-corruption mechanisms in the procurement process is needed to reduce the risk of corruption. Conclusions: Lessons learned suggest that anti-corruption, transparency and accountability mechanisms in the pharmaceutical procurement process, such as open contracting and integrity pacts are helpful towards reducing the risk of corruption. [ABSTRACT FROM AUTHOR]

Well-functioning purchasing arrangements allocate pooled funds to health providers, and are expected to deliver efficient, effective, quality, equitable and responsive health services and advance progress toward universal health coverage (UHC). This paper explores how improvements in purchasing functions in three Nigerian schemes—the Formal Sector Social Health Insurance Program (FSSHIP), the Saving One Million Lives Program for Results (SOML PforR), and Enugu State's Free Maternal and Child Health Program (FMCHP)—may have contributed to better resource allocation, incentives for performance, greater accountability and improved service delivery. The paper uses a case-study approach, with data analyzed using the Strategic Health Purchasing Progress Tracking Framework. Data were collected through review of program documents and published research articles, and semi-structured interviews of 33 key informant interviews. Findings were triangulated within each case study across the multiple sources of information. Improvements in benefits specification and provider payment contributed to some service delivery improvements in all three schemes: higher satisfaction with the quality of care in FSSHIP; increased use of insecticide-treated nets; greater prevention of mother-to-child HIV transmission; expanded pentavalent-3 coverage in SOML PforR; and greater service utilization in FMCHP. Resource allocation to public health facilities was enhanced and lines of accountability were better defined. These scheme-level improvements have not translated to system change, because of the small amount of funding flowing through these schemes and the high level of health financing fragmentation. The institutionalization of strategic purchasing in Nigeria to advance UHC will require raising awareness among decision makers, strengthening purchasing agencies' capacity, and reducing fragmentation. [ABSTRACT FROM AUTHOR]

The proper management of natural resources and its proceeds is critical for resource-rich countries. Many resource-rich countries have arguably been plagued by aspects of what scholars call 'the resource curse'. Overcoming 'the curse' has thus occupied center stage in studies about extractive resource governance. The Extractive Industries Transparency Initiative (EITI) has been promoted as having the potential to overcome some aspects of the resource curse especially the 'rentier politics'. Several countries have adopted and domesticated the initiative. However, studies on transparency present contradictory findings about the usefulness of the initiative. This paper examines Tanzania's adoption and implementation of transparency in extractive sector governance. The paper examined Tanzania's EITI implementation process, its reconciliation reports and how these reports are used by the parliament, media and civil society to push for governance improvements in the sector. The review of these key documents found that adoption and implementation of the EITI has improved the extractive sector governance by making it more transparent and accountable. [ABSTRACT FROM AUTHOR]

Pharmaceutical sector corruption undermines patient access to medicines by diverting public funds for private gain and exacerbating health inequities. This paper presents an analysis of UN Convention Against Corruption (UNCAC) compliance in seven countries and examines how full UNCAC adoption may reduce corruption risks within four key pharmaceutical decision-making points: product approval, formulary selection, procurement, and dispensing. Countries were selected based on their participation in the Medicines Transparency Alliance and the WHO Good Governance for Medicines Programme. Each country’s domestic anti-corruption laws and policies were catalogued and analysed to evaluate their implementation of select UNCAC Articles relevant to the pharmaceutical sector. Countries displayed high compliance with UNCAC provisions on procurement and the recognition of most public sector corruption offences. However, several countries do not penalise private sector bribery or provide statutory protection to whistleblowers or witnesses in corruption proceedings, suggesting that private sector pharmaceutical dispensing may be a decision-making point particularly vulnerable to corruption. Fully implementing the UNCAC is a meaningful first step that countries can take reduce pharmaceutical sector corruption. However, without broader commitment to cultures of transparency and institutional integrity, corruption legislation alone is likely insufficient to ensure long-term, sustainable pharmaceutical sector good governance. [ABSTRACT FROM AUTHOR]

Background: The presence of corruption in State institutions and broader society presents a significant obstacle to the right to the enjoyment of the highest attainable standard of health. The Universal Periodic Review, a Member State-led peer review system administered by the Human Rights Council, is a core tool of human rights, including the right to health accountability. This paper builds on existing research to examine processes that support State engagement on the issue of corruption. We identify opportunities for States to use the Universal Periodic Review to support anti-corruption, transparency and accountability to control corruption in the health-care sector. Objectives: This paper focuses on health sector how human rights mechanisms, and particularly the Universal Periodic Review, can be a tool for greater accountability for the right to health for corruption in the health sector. Methods: The research team applied qualitative content analysis methods to analyze all 135 Universal Periodic Review documents produced during 2018 in order to analyze how human rights mechanisms address the impact of corruption on the realization of the right to health. Results: Although health rights violations are often addressed within human rights mechanisms such as the UPR, corruption remains under-addressed, suggesting that there are gaps in understanding how corruption can seriously undermine the right to health. Conclusion: Human rights mechanisms should drive greater attention to the importance of addressing corruption in health. In order to make the UPR more effective, this paper suggests that there is a need to generate more awareness of corruption-based violations of the right to health in order to promote greater health accountabilityPractical tools such as strategic litigation and social audits can also contribute to creating greater transparency and accountability in dealing with corruption. [ABSTRACT FROM AUTHOR]

A full understanding of the pathways from efficacious interventions to population impact requires rigorous effectiveness evaluations conducted under realistic scale-up conditions at country level. In this paper, we introduce a deductive framework that underpins effectiveness evaluations. This framework forms the theoretical and conceptual basis for the 'Real Accountability: Data Analysis for Results' (RADAR) project, intended to address gaps in guidance and tools for the evaluation of projects being implemented at scale to reduce mortality among women and children. These gaps include needs for a framework to guide decisions about evaluations and practical measurement tools, as well as increased capacity in evaluation practice among donors and program planners at global, national and project levels. RADAR aimed to improve the evidence base for program and policy decisions in reproductive, maternal, newborn and child health and nutrition (RMNCH&N). We focus on five linked methodological steps – presented as core evaluation questions – for designing and implementing effectiveness evaluation of large-scale programs that support both the needs of program managers to improve their programs and the needs of donors to meet their accountability responsibilities. RADAR has operationalized each step with a tool to facilitate its application. We also describe cross-cutting methodological issues and broader contextual factors that affect the planning and implementation of such evaluations. We conclude with proposals for how the global RMNCH&N community can support rigorous program evaluations and make better use of the resulting evidence. [ABSTRACT FROM AUTHOR]

In this work, we present a framework that facilitates the sharing of EHRs among the community of health-care providers (HCPs). However, the sharing might be obstructed by patients’ privacy and the controlling legislation. Nevertheless, our sharing scheme of EHRs strives to respect patients’ privacy and comply with relevant legislator guidelines, e.g., HIPPA. The proposed work introduces two services while sharing the EHRs: privacy and non-repudiation. To this end, we introduce the partners and the role of each during the course of exchanging of EHRs. The principle of sharing EHRs among HCPs has to be reinforced to save patients’ lives while cryptographic primitives have to be employed to serve this purpose. In this paper, we are motivated to introduce the notion of non-repudiation private membership test (NR-PMT). In NR-PMT, we help patients receive medical services with great flexibility while maintaining their privacy and thwarting all possible threats to disclose their identities. In addition, a formal security analysis based on Kailar’s accountability framework has been used to analyze the proposed framework. Also, a complexity analysis has been conducted. [ABSTRACT FROM AUTHOR]

This paper considers teachers’ use of data from national school tests. These national tests are part of the Norwegian top-down accountability school system. According to official regulations, teachers have to use the test results to improve learning outcomes even if the test system is not able to deliver necessary data. However, previous research has shown that teachers apply teaching-to-test strategies. The focus of this paper is twofold. First, we ask, ‘How do teachers perceive and interpret the data from national tests?’ Second, ‘How do teachers view their actions related to the data from national tests?’ We base our research on data from semi-structured 5th-grade-teacher interviews. The transcribed text is subject to qualitative content analysis. We find that teachers are in a state of data illiteracy towards complex Item Response Theory tests. Inspired by Bernstein’s concept of the pedagogic device, we see that the test data rules both teacher work in the classroom as well as knowledge provided to the pupils. The national tests seem to undermine teachers’ autonomy, restrict teachers’ practice and reinforce the impact of unfair structures on pupils’ learning. [ABSTRACT FROM AUTHOR]

This paper addresses the publication of results from national tests in primary and lower secondary schools by Norwegian national authorities. Test results must be made available to the public, and are published in an aggregated format at school, municipal, county and national levels on a public website. These aggregated test results are meant to provide information on school quality for local government, as well as for school development. However, how the data are presented influences their usability, and this is further affected by the fact that many municipalities and the majority of schools are quite small. Hence, in many instances the information that can be retrieved from aggregated test results at school or municipal level are of little or no value to the users. When presenting the aggregated data to the public, the government should clearly state that the data might not be useful for small schools or small municipalities with regard to analysing their own performance and for quality enhancement. [ABSTRACT FROM AUTHOR]

The landscape of higher education continues to evolve in ways that have significant implications for the academic profession, including the shaping of academic identities. In a context of increasing marketisation, it is essential to understand more about the complex relationship between academic identities and structural change within the tertiary education sector. This study sought to review research evidence to gain insight into how academics are experiencing change in higher education environments, and how this may influence their work and identities. A literature review, which focused on empirical studies involving academics working in higher education, was conducted to examine the relationship between academic identities and the changing higher education context. A search identified 44 relevant articles and these were analysed using a content analysis approach. According to the analysis of literature, a growing number of empirical studies is exploring how academics respond to, adapt to, and are vulnerable to changes in the higher education context. Studies drew attention to the fluid nature of identity processes during these changes, with academics sometimes developing hybrid identities, prioritising certain activities and/or seeking to achieve balance. Issues evident included high workload, with increases linked to administrative tasks and performance expectations. The review of literature raises important questions about the core of the academic profession and the potential risk of detachment from its central principles. In a context of transition within higher education, it points to the need to value the agency of academics in their work and recognise this as integral to, rather than peripheral to, institutional decision-making. [ABSTRACT FROM AUTHOR]

Undergirded by "economic theory of the principal–agent problem", the study investigated secondary school teachers' perception of the influence of large-scale testing accountability on teaching and learning. Cross-sectional survey design was used. Simple random sampling was also employed to select 200 teachers for this study. The exploratory factor analysis results showed that although large-scale testing accountability serves as a motivational factor for teachers to be more productive, it puts pressure on teachers and students. Teachers reported teaching to the test (i.e. washback) and spending a lot of instructional time preparing students for the test. Teachers suggested that large-scale testing results should not be seen as the sole basis for teacher effectiveness. Rather, they indicated that large-scale testing results should be used to foster equitable distribution of educational resources and support teachers' professional development to enhance teaching and learning. Implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Increasingly, scholars engage policy makers around fundamental, complex questions on environmental change in interdisciplinary settings. Researchers attempting to develop robust contributions to knowledge that can support policymaker understandings in this context face significant inferential challenges in dealing with the spatial dimension of their phenomenon of interest. In this paper, we extend an understanding of well-defined methodological challenges familiar to applied spatial scientists by explicitly articulating the Decision-Making/Accountability, Spatial Incongruence Problem, or DASIP. Three case studies illustrate how spatial incongruences matter to researchers who work on complex, interdisciplinary problems, while seeking to understand decision-making or policy-related phenomenon: urban heat-island mitigation research in Arizona, water transfer conflicts in Kansas, and hydraulic-fracturing debates in Texas. With such examples, we aim to evoke a deeper understanding of this problem in applied research and also inspire thinking about how scholars might innovate methods for creating knowledge about environmental change that supports spatially accountable decision making. [ABSTRACT FROM AUTHOR]

Despite China's regulatory initiatives to promote its research accountability, it still needs to prove itself as a trusted player in life science research. In addition, in contrast to its huge investment, China is losing the race in delivering quality application of stem cells. The trial implementation of the 2015 ministerial regulations seemed to offer hope in ending this dual 'lost-in-translation'. Yet skepticism remains. By examining China's regulatory trajectory in the last 15 years, this paper illustrates that it is a post hoc pragmatic policy rationale and a soft centralization regulatory approach that have hampered China's governance. To improve China's governance of accountability, policy-makers need to get beyond an 'act-in-response' regulatory ethos and to engage with diverse stakeholders. [ABSTRACT FROM AUTHOR]

Alongside debates concerning managerialism, marketisation and performativity, the question of accountability in higher education has come to the fore in recent commentary. Discussion of the subject has tended to be divided into two distinct camps. On the one hand, there are strong calls for more accountability to the public purse - a desire to witness more productive returns and efficiency on investment in higher education. On the other, there are academics who rail against the oppressive, panoptican-like nature of the audit culture, emphasising the debilitating effects of quality assurance mechanisms on academic life. The paper suggests that one way out of this impasse is to place the current accountability agenda - what Travers refers to as the 'new bureaucracy' - in the context of Max Weber's account of bureaucracy and rationality. Habermas' reconstructed version of Weber's work is identified as a possible means of delineating the reaches and limits of modern bureaucratic accountability. [ABSTRACT FROM AUTHOR]

Strengthening the accountability of government officials to achieve public satisfaction in democratic countries has been a crucial issue. We study the issue empirically using the concept of national governance based on a case study of the key Taiwanese financial regulator, namely, the Financial Supervisory Commission (FSC). This paper integrates theories of resource-based views, trust, and corporate governance to motivate the empirical analysis. The findings show that accountability is positively related to public satisfaction. Capability and integrity have a positive relation to the accountability of the regulator, suggesting that one of the most effective ways to get public satisfaction is to recruit staff with capability and integrity. [ABSTRACT FROM AUTHOR]

Political economists have raised concerns that EMU's asymmetric institutional design leaves the project's legitimacy vulnerable to fluctuations in the perceived advantages and disadvantages of the euro. The evidence presented in this paper suggests that overall support for EMU within the euro area remained high over the period 1999-2005, thus allaying concerns over the project's legitimacy. At the same time, public attitudes towards EMU did vary from one euro-area member to another with perceived rather than actual economic performance appearing to be an important factor behind this cross-country variation. In policy terms, these findings underline the need for a system of euro-area economic governance that promotes a high degree of support for the single currency over the long-term. This will necessitate a more effective approach to output legitimation as well as policies that seek legitimacy for EMU by emphasising process, values and inputs. [ABSTRACT FROM AUTHOR]

The first part of this paper presents the Church before the court of public opinion through a synthesis of the findings of research about media coverage of the Catholic Church in the last 20 years. Public opinion existswithinthe Church, although it is not called this because the Church is not a political or a democratic community. However, since it is a communion, it necessarily requires communication. All communication brings with it debate, which in the case of the Church is a kind of singular ‘public opinion.’ This is manifested in diverse ways depending on the issue concerned. In this study, I have chosen a threefold division of public opinion within the Church for analytical purposes, for in reality the different aspects occur together. First, when the matter is concerned with thedemands of the faith, ‘public opinion’ is calledsensus fideliumand behaves – or should behave – as one would expect in regards to dogma or doctrine and its demands for communion in the faith. Second, when it is concerned with questions of the government, which affect the good of the communion, the hierarchical principal rules – or should rule –, that is to saythe demands of communion. Third, when public opinion is concerned with contingent questions, we are – or we ought to be – in the area of free debate and opinion, in the area of disagreement, which supposes and requires both freedom and plurality. Developing this central idea is the objective of the second and third part of the article, after having presented synthetically the teachings about the subject of the Catholic Church and of the popes from Pius XII to John Paul II, and especially of pope Francis. In the third part, these ideas are applied to the cases of the sex abuse scandal, which are in the course of being resolved since the measures of Benedict XIV. The underlying thesis is that the problem was a practical ecclesiological error, not merely an error in communication. The study concludes with five recommendations for those in charge of ecclesiastical communication. [ABSTRACT FROM PUBLISHER]

In this paper, we explore some of the keywords around which the practice of school inspection is ordered in England. As part of a project that explores the role of inspection in governing schooling in England, Scotland and Sweden, we have examined some of the key sources through which Ofsted (The Office for Standards in Education, Children's Services and Skills) publicly announces its role and purpose. In considering these texts, we have turned to Raymond Williams' conception of "keywords" (1988) to frame our analysis. We suggest that these sources are marked by the presence of a series of such keywords that underpin and legitimise the practice of school inspection by Ofsted. We conclude by considering some of the changing terminology that followed from the Coalition Government that took office in the UK in 2010 and which made education reform a centrepiece of its first period in power. [ABSTRACT FROM AUTHOR]

Global strategies and commitments for sexual and reproductive health and rights (SRHR) underscore the need to strengthen rights-based accountability processes. Yet there are gaps between these ambitious SRHR rights frameworks and the constrained socio-political lived realities within which these frameworks are implemented. This paper addresses these gaps by reviewing the evidence on the dynamics and concerns related to operationalising accountability in the context of SRHR. It is based on a secondary analysis of a systematic review that examined the published evidence on SRHR and accountability and also draws on the broader literature on accountability for health. Key themes include the political and ideological context, enhancing community voice and health system responsiveness, and recognising the complexity of health systems. While there is a range of accountability relationships that can be leveraged in the health system, the characteristics specific to SRHR need to be considered as they colour the capabilities and conditions in which accountability efforts occur. [ABSTRACT FROM AUTHOR]

Despite the strong global focus on improving maternal health during past decades, there is still a long way to go to ensure equitable access to services and quality of care for women and girls around the world. To understand widely acknowledged inequities and policy-to-practice gaps in maternal health, we must critically analyse the workings of power in policy and health systems. This paper analyses power dynamics at play in the implementation of maternal health policies in rural Malawi, a country with one of the world's highest burdens of maternal mortality. Specifically, we analyse Malawi's recent experience with the temporary reintroduction of user-fees for maternity services as a response to the suspension of donor funding, a shift in political leadership and priorities, and unstable service contracts between the government and its implementing partner, the Christian Health Association of Malawi. Based on ethnographic research conducted in 2015/16, the article describes the perceptions and experiences of policy implementation among various local actors (health workers, village heads and women). The way in which maternity services "fall apart" and are "fixed" is the result of dynamic interactions between policy and webs of accountability. Policies meet with a cascade of dynamic responses, which ultimately result in the exclusion of the most vulnerable rural women from maternity care services, against the aims of global and national safe motherhood policies. [ABSTRACT FROM AUTHOR]

In this paper I analyze some conceptual difficulties associated with the demand that global institutions be made more democratically accountable. In the absence of a world state, it may seem inconsistent to insist that global institutions be accountable to all those subject to their decisions while also insisting that the members of these institutions, as representatives of states, simultaneously remain accountable to the citizens of their own countries for the special responsibilities they have toward them. This difficulty seems insurmountable in light of the widespread acceptance of a state-centric conception of human rights, according to which states and only states bear primary responsibility for the protection of their citizens' rights. Against this conception, I argue that in light of the current structures of global governance the monistic ascription of human rights obligations to states is no longer plausible. Under current conditions, states are bound to fail in their ability to protect the human rights of their citizens whenever potential violations either stem from transnational regulations or are perpetrated by non-state actors. In order to show the plausibility of an alternative, pluralist conception of human rights obligations I turn to the current debate among scholars of international law regarding the human rights obligations of non-state actors. I document the various ways in which these obligations could be legally entrenched in global financial institutions such as the WTO, the IMF, and the World Bank. These examples indicate feasible methods for strengthening the democratic accountability of these institutions while also respecting the accountability that participating member states owe to their own citizens. I conclude that, once the distinctions between the obligations to respect, protect, and fulfill human rights are taken into account, no conceptual difficulty remains in holding states and non-state actors accountable for their respective human rights obligations [ABSTRACT FROM AUTHOR]

Performance measurement has been lauded as a tool that would increase managerial discretion while ensuring accountability to stakeholders. The challenges of developing such a system that can accomplish both ends have been more difficult than originally conceived. Typically, performance measurement systems lack sophisticated measures, limiting their use for purposes of improved productivity. Managers are expected to increase performance by utilizing insufficient measures. This paper discusses some of the challenges that remain in developing a performance measurement system that may serve both purposes—improved performance and accountability. [ABSTRACT FROM AUTHOR]

The present paper examines efforts by government and government agencies in England to prescribe and control the knowledge base of a teaching profession that has, under successive New Labour administrations since 1997, been subjected to 'modernisation'. A theoretical framework drawn from aspects of the work of Basil Bernstein, and of Rob Moore and Lynn Jones, is drawn upon to examine in some detail one key aspect of this ongoing process of governmental appropriation of professionalism: the specification by the Training and Development Agency for Schools of new 'standards' for both initial teacher training and teachers' subsequent career progression. It is argued that although this enterprise represents itself as a species of purely common-sense reform, it is in fact a mode of competency training that is rooted in selective appropriation of elements of post-fordist management theory and a loose form of behaviourist psychology. The capacity of this training discourse to suppress awareness of its own presuppositions and of alternative or competing conceptions of professions and professionalism is explored. [ABSTRACT FROM AUTHOR]

In an effort to determine the basis for the assumed relationship between accountability and performance that pervades much of contemporary administrative reform efforts, this paper applies a "social mechanisms" approach to elaborate the factors that might be involved in account giving and various forms of administrative performance. This search for mechanisms indicates that the relationship is paradoxical and either spurious or so contingent as to raise questions regarding administrative reforms based on it. Various theoretical approaches for dealing with the relationship are considered. [ABSTRACT FROM AUTHOR]

Report cards of government performance are a burgeoning phenomenon: 8 of the 14 report cards evaluated in this paper have been initiated since 1996. This paper assesses the validity of report cards and their ability to afford performance comparisons. The paper suggests best practices for issuing report cards, including: investing heavily upfront in report card design, controlling for intervening variables, adjusting previous report cards to reflect subsequent changes in measures, and joining with academics to disseminate results. [ABSTRACT FROM AUTHOR]

This paper explores the connections between School Effectiveness as a research paradigm and developments in policy and practice. With a particular focus on the English school system, ‘effectiveness’ is examined as a discourse which underpins the accountability regime, and in terms of its influence on the related field of School Improvement. Anti-democratic tendencies in areas such as school leadership, teacher professionalism, curriculum and pedagogy are related to a failure, at the heart of the ‘effectiveness’ concept, to give critical consideration to social and educational aims. [ABSTRACT FROM AUTHOR]

Having to explain a decision has often been found to have a positive effect on the quality of a decision. We aimed to determine whether different accountability requirements for judges (i.e., having to justify their decision or having to explicate their decision) affect evidence use. Those requirements were compared to instructions based on the falsification principle and a control condition. Participants (N = 173) decided on the defendant's guilt in a murder case vignette and explained their decision according to the instructions. The explication and falsification (but not the justification) instructions increased the use of exonerating evidence. There was no significant difference between the groups in guilt perception. The use of exonerating evidence was a significant positive predictor of acquittal rates. The implications for the different forms of instructions in practice are positive, but suggest a difference between the evidence considered and the evidence used to account for the decision. [ABSTRACT FROM AUTHOR]

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Background: Many countries are responding to the global shortage of midwives by increasing the student intake to their midwifery schools. At the same time, attention must be paid to the quality of education being provided, so that quality of midwifery care can be assured. Methods of assuring quality of education include accreditation schemes, but capacity to implement such schemes is weak in many countries. Objective: This paper describes the process of developing and pilot testing the International Confederation of Midwives' Midwifery Education Accreditation Programme (ICM MEAP), based on global standards for midwifery education, and discusses the potential contribution it can make to building capacity and improving quality of care for mothers and their newborns. Methods: A review of relevant global, regional and national standards and tools informed the development of a set of assessment criteria (which was validated during an international consultation exercise) and a process for applying these criteria to midwifery schools. The process was pilot tested in two countries: Comoros and Trinidad and Tobago. Results: The assessment criteria and accreditation process were found to be appropriate in both country contexts, but both were refined after the pilot to make them more user-friendly. Conclusion: The ICM MEAP has the potential to contribute to improving health outcomes for women and newborns by building institutional capacity for the provision of high-quality midwifery education and thus improved quality of midwifery care, via improved accountability for the quality of midwifery education. [ABSTRACT FROM AUTHOR]

To be effective, programs of regulatory reform must address the incentive conflicts that intensify financial risk-taking and undermine government insolvency detection and crisis management. Subsidies to risk-taking that large institutions extract from the financial safety-net encourage managers to make their firms riskier, harder to supervise, and politically and administratively more difficult to fail and unwind. Except in the very short run, repealing the Gramm-Leach-Bliley Act or breaking up so-called too-big-to-fail institutions will do little to arrest subsidy-induced activities. Rebuilding Glass-Steagall barriers between banking, securities, and insurance firms would instead make implicit taxpayer support of large institutions less transparent and serve foreign interests by encouraging conglomerate firms to operate affected businesses through foreign subsidiaries. To discourage financial institutions from abusing safety-net support, government supervisors must be made specifically accountable for delivering and pricing safety-net benefits fairly and efficiently. If it wants to make the system more stable, Congress should focus on: rewriting top officials' oaths of office; changing the ways top officials are recruited, trained, and compensated; reworking the ways they measure and report regulatory performance; and changing the kinds of securities that large institutions have to issue. [ABSTRACT FROM AUTHOR]

The Poverty Reduction Strategy (PRS) experiment, along with other innovations promoted by the international financial institutions over the past decade, has promised to secure pro-poor forms of accountability in relation to development policy-making. New consultative processes and new forms of conditionality each promise to re-order relationships between poor citizens and their governments, and between governments and donors respectively. Using evidence from Bolivia and Zambia, we identify three critical problems with these claims. First, there is a tendency to focus on promoting accountability mechanisms that are largely discretionary and lack significant disciplinary power, particularly those reliant on certain forms of civil society participation. Second, donors have failed to overcome the contradictions regarding the role of extra-national actors in securing accountability mechanisms within particular states. Third, there is a tendency within the PRS experiment to overlook the deeper forms of politics that might underpin effective accountability mechanisms in developing countries. Ensuring accountability is not simply a technocratic project, but rather is critical for a substantive politics of democratization which goes to the heart of the wider contract between states and citizens. The PRS experiment, as located within a broader project of 'inclusive liberalism', reveals little potential to address this challenge. [ABSTRACT FROM AUTHOR]

Accountability is best understood as a referee of the dynamics in two-way relationships, often between unequal partners. The literature on accountability distinguishes between political, fiscal, administrative, legal and constitutional accountability. This paper focuses on accountability mechanisms in health care and how they mediate between service providers and communities and between different kinds of health personnel at the primary health care level. It refers to case studies of participatory processes for improving sexual and reproductive health service delivery. Information, dialogue and negotiation are important elements that enable accountability mechanisms to address problems by supporting change and engagement between participants. In order to succeed, however, efforts towards better accountability that broaden the participation of users must take into account the social contexts and the policy and service delivery systems in which they are applied, address power relations and improve the representation of marginalised groups within communities and service delivery systems. [Copyright &y& Elsevier]

Participatory approaches that engage affected populations are increasingly applied in humanitarian health programs in concert with emerging accountability frameworks and the rapid growth of research in these settings. Participatory initiatives within this domain appear to be largely adopted at an operational level and are infrequently reported as a component of research efforts. Yet the evidence of the benefits of research involving community members is growing worldwide. This is the first review of participatory research (PR) in humanitarian settings. This study sought to understand the extent to which PR values and practices have been adopted in humanitarian health programs and to explore key issues in applying PR in this context. This scoping review was based on the approach developed by Arksey and O’Malley. The search for relevant peer-reviewed articles included scientific databases, a humanitarian database, targeted journals and online resources published since 2009. Eleven articles were retrieved and reviewed to identify practices and key issues related to conducting PR in humanitarian settings. Four key themes were identified: building trust with local research stakeholders and participants; the importance of contextual understanding; implications of collaborating with affected populations in PR, and neutrality of researchers and Non-Governmental Organizations (NGOs). Study teams considered PR as a valued approach where there was mistrust or a need for contextualized understanding. The studies described how adaptations made during the study optimized collaboration with affected populations and how the presence of NGOs influenced the approach and results of PR. One of the most important contributions of humanitarian health programs is to develop ‘medical practices that are better adapted to the living conditions and priorities of patients who are generally ignored’. Participatory approaches, such as PR, support the development of health-related practices that are more relevant and sustainable for affected populations. [ABSTRACT FROM AUTHOR]

Over recent decades we have witnessed a growing emphasis on educational quality assurance and evaluation (QAE) around the globe. The trend, not only to intensify evaluative measurements, but also to publish school-specific indicators, has become visible also in the Nordic countries. In Sweden, Denmark and Norway, the governments have launched web-portals, in which various indicators can be observed and compared at the school level. However in Finland, the data is published only at a general level. In this article we compare the discourses of educational experts on comprehensive school QAE policies and practices in four Nordic countries, Sweden, Denmark, Norway and Finland. Our aim is to clarify how the discursive practices reflect the current evaluation and publication policies and how the discourses construct the rationales of educational governance. We have approached our data (58 interviews) from the framework of discursive institutionalism, which sees both the underlying ideas and beliefs, and the discursive practices as the dynamic factors behind institutional change. We argue, that in all the Nordic countries these discursive practices take place in a balancing discursive triad between global competence, neo-liberal accountability pressures and the traditions of the egalitarian Nordic comprehensive school—however with varying country-specific rationales on school accountability and transparency. [ABSTRACT FROM AUTHOR]

Background: Information from patient complaints - a widely accepted measure of patient satisfaction with services - can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems. Objectives: The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research. Methods: We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands. Results: Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients' awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context. Conclusions: Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints. [ABSTRACT FROM AUTHOR]

The overall aim of this article is to investigate Swedish preschool teachers’ perceptions of the interaction between home and institution in relation to children’s introduction to preschool. The focus of this article is on their talk about how they manage the gap between home and preschool in the introduction process. A discourse analysis is carried out, based on focus group interviews with seven preschool teacher teams that have started to use a more parent-active approach during the introduction of children to preschool. The results show that a parent-active introduction positions and governs parents to take a more self-regulative role in preschool from the beginning. The construction of the parent-active introduction discourse/practice produces new subject positions for the parents (and teachers) and creates expectations of intensified parental involvement in this institutional practice. Furthermore, the results indicate that the parents’ active introduction also changes the teachers’ own role and their attitudes toward the parents. The boundary work between the home and preschool seems to consist of negotiations and of the construction of an intermediate domain between home and preschool that draws on discourses of responsibility, performativity and efficiency. [ABSTRACT FROM AUTHOR]

In arguing for alternatives to test-based accountability, researchers have suggested that teacher-assigned student grades could be used for high-stakes purposes. In this study, Sweden serves as an example of a school system in which teacher-assigned grades have a major role in performance management and accountability. We study how politicians view and legitimise the strengths of grading in an outcome-based accountability system. Based on two-part analysis, we show how grades, through complex processes of legitimation, have acquired and retained a central position in governing the overall quality of the educational system in Sweden. We argue that in the Swedish system, grades used in an administrative rather than a pedagogical way function as a quick language that effectively reduces the complexity of communication between various actors with regard to what students learn and accomplish in education. As such, grades are legitimate in terms of their communicative rationality. However, their use in communicating student learning has not been sufficient to meet the needs of government. We conclude that in order to turn grading into an instrument that can moderate some of the downsides of testing regimes, a broader view of what constitute outcomes in education needs to follow. [ABSTRACT FROM AUTHOR]

Value-added models (VAMs) are being used in education to link the contribution of individual teachers and schools to students’ learning. The use of VAMs has been surrounded by controversy and high-profile public debates. On April 8, 2014 the American Statistical Association (ASA) released a statement on VAMs related to their use in education practice. In this article, we lay out the discussion of the main points raised in the ASA statement within the large amount of scholarly literature published over the past decade in statistical, education, and economics journals. We identify the issues that are critical for the understanding of the VAMs’ strengths and weaknesses, and related consequences of their use for high-stakes decision-making. We conclude that the cautionary points raised in the ASA statement are supported by the findings in the existing research that, with a few exceptions, challenges the assumptions underlying the use of VAMs and demonstrates the issues that should be taken into consideration when using VAMs for consequential decisions. [ABSTRACT FROM PUBLISHER]

This study explored the nature and effects of leadership for learning in the context of Hong Kong primary schools. Employing a mediated model of leadership for learning, the study examined how school leadership practices are perceived and shaped in the high accountability context of Hong Kong school education. Consistent with other recent empirical studies of school leadership effects, the research explored the relationship between school leadership, school-level capacity for improvement and student learning outcomes. Regression analyses found a negative impact of principal leadership practices related to strategic direction and policy environments, but a positive impact of staff management and resource management practices in terms of enhancing support for students. Contrary to expectations, schools' capacity in supporting students had less impact on student academic outcomes than the negative impact of resources capacity andworkload of teachers. Instead, mixed impact was found between principal leadership and student academic outcomes; it was negative regarding practices in strategic direction and policy environment, but positive in leader and teacher growth and development. The study refines our understanding of how the socio-cultural and organisational contexts of schools shape successful school leadership. [ABSTRACT FROM AUTHOR]

The Millennium Development Goals (MDGs) are eight international development goals to be achieved by 2015 addressing poverty, hunger, maternal and child mortality, communicable disease, education, gender inequality, environmental damage and the global partnership. Most activities worldwide have focused on maternal and child health and communicable diseases, while less attention has been paid to environmental sustainability and the development of a global partnership. Up to now, several targets have been at least partially achieved: hunger reduction is on track, poverty has been reduced by half, living conditions of 200 million deprived people enhanced, maternal and child mortality as well as communicable diseases diminished and education improved. Nevertheless, some goals will not be met, particularly in the poorest regions, due to different challenges (e.g. the lack of synergies among the goals, the economic crisis, etc.). The post-2015 agenda is now under discussion. The new targets, whatever they will be called, should reflect today's political situation, health and environmental challenges, and an all-inclusive, intersectoral and accountable approach should be adopted. [ABSTRACT FROM AUTHOR]

Background:Many in education argue for the importance of incorporating teacher judgements in the assessment and reporting of student performance. Advocates of such an approach are cognisant, though, that obtaining a satisfactory level of consistency in teacher judgements poses a challenge. Purpose: This study investigates the extent to which the use of a two-stage method of assessment involving calibrated exemplars provides judgements from teachers that are consistent. Teachers were not given extensive training and moderation. We chose the assessment of early writing as a context to investigate the method as it is fundamental to students’ progress in schooling. Sample: Stage 1: Eleven teachers of four- to seven-year olds (kindergarten to year 2) were invited to collect their students’ performances. Sixty performances that represented the range of ability were selected from approximately 300 performances. Fifteen teachers from 12 schools made pairwise comparisons of performances. Stage 2: Fourteen teachers representing six schools plus the co-ordinator of the study participated in this stage of the exercise. Convenience sampling of teachers was employed. Design and method: Stage 1: The method of pairwise comparison was used to calibrate the performances of students by developing a performance scale. These performances were then used as exemplars, which are referred to here as calibrated exemplars. Stage 2: Teachers assessed student performances simply by judging which calibrated exemplar a performance was most alike. In a separate exercise, two experienced markers assessed another set of 118 writing performances using both (1) a criterion-based rubric and (2) the calibrated exemplars. Results: The two-staged process showed a level of consistency in teacher judgement-making. In addition, judgements made by experienced markers with the calibrated exemplars correlated well with judgements made using the criterion-based rubric. Conclusions: The findings suggest that using calibrated exemplars has potential as a method of teacher assessment in contexts where extensive training and moderation is not possible or desirable. Further research is needed to establish whether the findings generalise to the classroom context and whether consistency could be demonstrated on a large scale in this and other curriculum areas. Research is also needed to investigate whether the calibrated exemplars can be supported with qualitative information for use in formative assessment. [ABSTRACT FROM PUBLISHER]

Introduction: In South Africa, there are renewed efforts to strengthen primary health care and community health worker (CHW) programmes. This article examines three South African CHW programmes, a small local non-governmental organisation (NGO), a local satellite of a national NGO, and a government-initiated service, that provide a range of services from home-based care, childcare, and health promotion to assist clients in overcoming poverty-related barriers to health care. Methods: The comparative case studies, located in Eastern Cape and Gauteng, were investigated using qualitative methods. Thematic analysis was used to identify factors that constrain and enable outreach services to improve access to care. Results: The local satellite (of a national NGO), successful in addressing multi-dimensional barriers to care, provided CHWs with continuous training focused on the social determinants of ill-health, regular context- related supervision, and resources such as travel and cell-phone allowances. These workers engaged with, and linked their clients to, agencies in a wide range of sectors. Relationships with participatory structures at community level stimulated coordinated responses from service providers. In contrast, an absence of these elements curtailed the ability of CHWs in the small NGO and government-initiated service to provide effective outreach services or to improve access to care. Conclusion: Significant investment in resources, training, and support can enable CHWs to address barriers to care by negotiating with poorly functioning government services and community participation structures. [ABSTRACT FROM AUTHOR]

Background: Teacher education in Scotland has developed its own trajectory for many years and this distinctiveness appears to have increased since the creation of the Scottish Parliament in 1999. Teachers' pay and conditions were addressed in 2001 by the agreement A teaching profession for the 21st century. This agreement led to a number of innovations in teacher education and development. More recently, there has been a report of the Review of Teacher Education in Scotland by Graham Donaldson and a committee is currently reviewing teachers' pay and conditions. Purpose: This article examines the extent to which the development of teacher education in Scotland has been affected by the global financial crisis and its impact on the provision of public services. Three policy contexts are explored in turn, those of politics and economics, education and teacher education, so that the analysis moves from the wider societal perspective towards the specifics of teacher education. Sources of evidence: The article draws on a close analysis of relevant policy documents, including those produced by the Organisation for Economic Cooperation and Development, the Scottish Government and the General Teaching Council for Scotland. Additionally reference is made where appropriate to a wide range of published research and to reports such as the Review of Teacher Education in Scotland. Main argument: The ways in which teacher education policy in Scotland is developing is a result of the interaction between history, culture and politics played out at a national level under the wider influence of UK, European and global affairs, both economic and political. There are real tensions in the current conjunction of policies and trends, which create major challenges for all those involved. The promotion of career-long professional learning and enhanced school autonomy proceed alongside the review of teachers' professional conditions (McCormac Review), high levels of intermittent employment among new teachers, fluctuations in student numbers and staffing in university Schools of Education, and contracting resource to support school-level curriculum development and continuing professional development. The social partnership achieved between employers and practitioners is under increasing strain; and relations of partnership between universities and schools are subject to increasing critical scrutiny. Teaching in a time of crisis creates new challenges, and the need for innovative approaches to enduring challenges, in the short and longer term. Conclusions: The longstanding commitment to explicit values in Scottish culture and education is all the more important in a context where pressures for accountability and efficiency are greater than ever. [ABSTRACT FROM PUBLISHER]

Standards-based accountability (SBA) has been a primary driver of education policy in the United States for several decades. Although definitions of SBA vary, it typically includes standards that indicate what students are expected to know and be able to do, measures of student attainment of the standards, targets for performance on those measures, and a set of consequences for schools or educations based on performance. Research on SBA indicates that these policies have led to some of the consequences its advocates had hoped to achieve, such as an emphasis on equity and alignment of curriculum within and across grade levels, but that it has also produced some less desirable outcomes. This article summarizes the research on SBA in three areas: quality of standards, ways in which SBA has shaped educators' practices, and effects on student achievement. The article identifies lessons learned from the implication of SBA in the United States and provides guidance for developing SBA systems that could promote beneficial outcomes for students. [ABSTRACT FROM AUTHOR]

Using survey methodology and telephone interviews, this exploratory study proposes a framework for nonprofit leaders to promote accountability in their organizations, an important goal for both management and performance in the nonprofit sector. The study relies on Brody's (2001) four-part construct of organizational accountability (fiscal responsibility, good governance, adherence to mission, and program effectiveness) to examine the issue of promoting accountability in nonprofit organizations. We hypothesize that higher levels of nonprofit accountability are related to higher levels of an organization's commitment to operating standards and to higher levels of transformational leadership as exhibited by the organization's leader. Study results indicate that both predictor variables are positively and significantly related to nonprofit accountability, with transformational leadership being the stronger indicator of accountability. The findings of the study have significant implications for nonprofit managers and for nonprofit organizational performance. [ABSTRACT FROM AUTHOR]

Although high-stakes tests play an increasing role in students' schooling experiences, scholars have not examined these tests as sites for socialisation. Drawing on qualitative data collected at an American urban primary school, this study explores what educators teach students about motivation and effort through high-stakes testing, how students interpret and internalise these messages, and how student hierarchies develop as a result. I found that teachers located boys' failure in their poor behavior and attitudes, while arguing that girls simply needed more self-esteem to pass the test. Most boys accepted their teachers' diagnosis of the problem. However, the boys who felt that they were already 'doing their best' and 'working hard' began to doubt that educational success is a function of merit and effort. I conclude that students learn about much more than the three Rs through their experiences with high-stakes testing, and argue that future research should attend to the social dimensions of these experiences. [ABSTRACT FROM AUTHOR]

This article examines the consequences of the political 'incompleteness' of the monetary union for the democratic accountability of its external monetary policy, comparing the euro area to the United States. In most countries, exchange-rate policymaking is substantially delegated to the finance ministry and central bank; oversight by other domestic actors is relatively weak. While this is true of the United States, the role of the Congress provides the possibility for 'democratic override' when policy diverges substantially from the preferences of a broad set of private sector interests. Europe's monetary union, by contrast, lacks such a mechanism; no institution can provide an effective check on the policies pursued by the core actors, the ECB and Eurogroup. A comparison of the postures of the United States and euro area toward Chinese exchange rate policy suggests that these institutional differences affect policy outcomes. [ABSTRACT FROM AUTHOR]