Perceptions of Private Practitioners Regarding Revised National Tuberculosis Control Program- A Cross-sectional Study in Sonepat, Haryana

Background: A substantial proportion of tuberculosis patients either take treatment from private care providers or first-time visit private hospitals to diagnose tuberculosis. Hence the role of private providers is too essential to ignore to realize the ambition of tuberculosis elimination in India. Aim and Objectives: To understand the perception of private practitioners of Sonepat district of Haryana state regarding. Setting and Design: A cross-sectional study was done among the private practitioners of the Sonepat district of Haryana Methods and Material: 78 randomly selected practitioners from the list provided by the district health authority were interviewed using a pretested semi-structured questionnaire. The ethics committee of the study institute approved the study. Statistical analysis used: Descriptive analysis in terms of proportion and percentages was conducted. Results: One-third of the study participants were in the age group of 30-40 years. Half of the practitioners were reportedly practicing medicine for less than twenty years. A significant proportion agreed that the government could not single-handedly eliminate tuberculosis without collaborating with private providers. Mostly agreed on the effectiveness of Tuberculosis regimens under the program; however, over-relying on the sputum examination was perceived as a negative component of the program. Conclusions: Private providers understand their pivotal role in tuberculosis-related programs. However, their full participation has not been realized in the program.

Recursos Públicos na Esfera Privada: Política de Educação Especial em um Município Paulista de Grande Porte / Public Resources in the Private Sphere: Special Education Policy in a Large Municipality of São Paulo

RESUMO: A Educação Especial brasileira tem marcas históricas da privatização, uma delas é focalizada neste artigo, que tem por objetivo analisar o repasse de recursos financeiros públicos da educação para a esfera privada em um município paulista de grande porte, entre 2012 e 2017. Adotando abordagem qualitativa, são analisados os valores liquidados em favor da Educação Especial direcionados à esfera privada a partir de fontes documentais, abrangendo contratos com empresas terceirizadas, termos de colaboração e aditamento, relatórios de remuneração de profissionais da Educação Especial e documentos de repasse de recursos à esfera privada. Os resultados indicam aumento dos recursos destinados a essa modalidade na esfera privada em decorrência, principalmente, da necessidade de contratação de cuidadoras(es), até aquele momento sem provimento de cargo nessa rede de ensino. Também expressam que a inclusão escolar reproduz modos de financiamento que marcam a história da Educação Especial no Brasil. A parceria com instituições privadas sem fins lucrativos e a contratação de empresas terceirizadas vão ao encontro da perspectiva gerencial da administração pública. No caso analisado, por um lado, a política de inclusão escolar terceirizou a manutenção dos serviços a partir da concessão para a esfera privada; por outro lado, houve crescente aumento do financiamento do setor público municipal.

ABSTRACT: Brazilian Special Education has historical marks of privatization, one of which is focused on this article, which aims to analyze the transfer of public financial resources from education to the private sphere in a large municipality in São Paulo, between 2012 and 2017. Adopting a qualitative approach, the amounts settled in favor of Special Education directed to the private sphere are analyzed based on documentary sources, covering contracts with outsourced companies, terms of collaboration and additions, reports on remuneration of Special Education professionals and documents for the transfer of funds to the private sphere. The results indicate an increase in resources allocated to this modality in the private sphere, mainly due to the need to hire caregivers, until that moment without filling a position in this teaching network. They also express that school inclusion reproduces funding modes that mark the history of Special Education in Brazil. The partnership with non-profit private institutions and the contracting of outsourced companies are in line with the managerial perspective of public administration. On the one hand, in the analyzed case, the school inclusion policy outsourced the maintenance of services from the concession to the private sphere, on the other hand, there was a growing increase in funding from the municipal public sector.

Management of Severe Acute Malnutrition in Day Care Settings : Findings fromInnovative Public Private Partnership at Devbhumi Dwarka District, Gujarat

Introduction :Severe Acute Malnutrition (SAM) is a major public health concern that is linked to a high mortality rate in children under the age of five. Government of Gujarat has expanded treatment network from government facilities to private institutions and non-governmental organizations through various initiative in an effort to address the issue of SAM. To assess the treatment outcome among SAMObjective: children (0-5 years) admitted at Niramay Bal Poshan Kendra, Jam Khambhalia, Devbhumi Dwarka District of Gujarat. A longitudinal study was conducted among SAM children admitted at he Niramay BalMethod: t Poshan Kendra (Public Private Partnership model under Bal Poshan Yojana) which is a day care center providing treatment to SAM children for 14 days according to the protocol of NRC (Nutrition Rehabilitation Centre). Under Bal Poshan Yojana, RBSK medical officers screen children for SAM and refer them for treatment at empanelled NGO/Private institution. Total 1557 under five children were screened by them between 6 September 2021 and 5 February 2022. Out of them 121 SAM children were identified, 95th th children could be mobilized at the study site (Niramay Bal Poshan Kendra). Out of 95 children, 76 SAM children completed the treatment along with all three follow up at the study site. The data of these 76 Children was analyzed. Among 76 children, average weight gain was 566 grams at the time ofResults: discharge and 1000 grams at the time of third follow-up. An average weight gain for the cohort is 5.2 gram/kg/day. At the end of treatment, 92% children moved out of the SAM category at the completion of three follow-up, 55% moved to Moderate Acute Malnutrition and 37% to normal weight category. Conclusion: An average weight gain among the study population was satisfactory. Day care treatment model provides advantage of improved treatment completion rate and higher follow-up com

Assessment of public hospital drug supply financing through the public-private partnership: pharmacists' perspectives

In Nigeria, drug financing by the public has been challenged by financial constraints through public fund due to a limited fund available to the government to meet all its demands. The objectives of this study were to determine the variability of the hospital patient prices of same drugs under the PublicPrivate Partnership (PPP) and in Private Retail Community Pharmacy (PRCP), and to investigate the perceived efficiency and effectiveness of the PPP by comparing it with the Drug Revolving Fund (DRF) model in drug supply financing. This study was conducted in Nigeria utilizing a mixed method. Mann-Whitney U test analysis was used to compare the median drug price of the two facilities. The majority (76.19%) of the drugs were sold at a cheaper rate in the hospital than what was obtained in the PRCP with no significance difference (p > 0.05). Dominant responses from the focused group discussions supported the PPP model. This study shows that the median patient price of the basket of matched pairs of same drugs in the hospital under the PPP and in the PRCP was identical. Overall, the participants were of the opinion that the PPP model was more efficient and effective than DRFin the financing drug supply

Experts' perspectives on the application of public-private partnership policy in prevention of road traffic injuries / 中华创伤杂志(英文版)

PURPOSE@#Successful application experiences on public-private partnership (PPP) in different countries, suggest that PPP could be an option in road traffic injury (RTI) prevention. The present study aims at investigating the applicability of PPP policy in RTI prevention in Iran based on the experts' perspectives.@*METHODS@#This is a qualitative study with grounded theory approach which has been conducted in Tabriz University of Medical Sciences, Iran in 2018. The participants were 22 experts in the field of RTIs selected using purposive sampling method. Data were collected by semi-structured interviews and analyzed with content-analysis method.@*RESULTS@#The results were classified under 5 main themes (applicability, scopes and services, challenges, advantages, and strategies) for applying PPP policy and 37 sub-themes. Due to the prevalence of RTIs, the present challenges in public sector, existence of qualified private sector, and successful experiences in other areas, there are opportunities for private sector partnership in prevention of RTIs. Private sector could participate in different scopes and services regarding RTI prevention, including road construction and maintenance, maintenance and provision of vehicles safety and public education. The main challenges including legislation issues, ambiguities in collaboration, political and organizational unsustainability, government's financial hardship and lack of experienced experts in the field of RTI. However, there are significant advantages including high efficiency in program implementation, covering the weaknesses of public sector, effective and efficient management on application of PPP in RTI prevention. The strategies include identifying and prioritizing the assignable activities, identifying the qualified private sector, developing PPP policies and legal frameworks, creating a common language between public and private parties, trying to meet the expectations of the private sector by public sector, developing a comprehensive and sound contract, and cultivating public culture to accept private sector in the field of RTI prevention.@*CONCLUSION@#This study sought to determine whether PPP could be used as strategy to reduce the burden of RTIs in Iran. But it requires a lot of preliminary studies to provide the context and conditions for applying this policy.

A relação público-privado e a gestão do trabalho nas fundações estatais de saúde / The public-private relationship and the management of work in state health foundations / La relación público-privado y la gestión del trabajo en las fundaciones estatales de salud

Resumo As discussões sobre a relação público-privado atentam para a necessidade de imprimir à gestão pública maior autonomia, agilidade e flexibilidade gerenciais e administrativas em setores estratégicos do sistema de saúde. A pesquisa qualitativa que deu origem a este artigo objetivou analisar a gestão do trabalho na Fundação Estatal de Saúde da Família da Bahia e na Fundação Estadual de Saúde de Sergipe, usando técnica de triangulação de dados e análise hermenêutica-dialética. Participaram gestores, trabalhadores e usuários dos dois estados, totalizando vinte entrevistas semiestruturadas. Os fatores contextuais e os atores foram analisados utilizando-se um modelo que enfatizou as dimensões do macro e do microcontexto. O desempenho satisfatório relativo à gestão do trabalho pode ser atribuído à variedade e complexidade de fatores enfrentados pela administração direta. A inter-relação do microcontexto com subdimensões do macrocontexto contribuiu favoravelmente para a implementação das fundações. Como contribuição aos gestores, construiu-se um quadro contendo indicadores para o monitoramento das atribuições da gestão do trabalho nas fundações estatais. Os resultados e potencialidades dessas experiências podem auxiliar no enfrentamento dos desafios à gestão em saúde, dotando-a de maior efetividade, celeridade e resolubilidade na atenção à saúde e na gestão do trabalho no Sistema Único de Saúde.

Abstract The discussions on the public-private relationship highlight the need to provide public management with more managerial and administrative autonomy, agility and flexibility in strategic sectors of the health care system. The qualitative research that was the origin of the present article had the aim of analyzing the work management at the State-Owned Family Health Foundation of Bahia (Fundação Estatal de Saúde da Família da Bahia, in Portuguese) and at the State Health Foundation of Sergipe (Fundação Estadual de Saúde de Sergipe, in Portuguese), using the technique of data triangulation and hermeneutic-dialectical analysis. Managers, workers and users from both states took part in the study, totaling twenty semi-structured interviews. The contextual factors and the actors were analyzed using a model that emphasized the dimensions of the macro- and microcontexts. The satisfactory performance regarding work management may be attributed to the variety and complexity of the factors faced by the direct administration. The interrelationship of the microcontext with subdimensions of the macrocontext contributed favorably to the implementation of the foundations. As contributions to the managers, we developed a table containing indicators for the monitoring of the attributions of the work management at the state-owned foundations. The results and potentialities of these experiences may help face the challenges to management in health, providing it with more efficacy, speed and solvability in health care and work management in the Brazilian Unified Health System.

Resumen Las discusiones sobre la relación público-privado enfatizan la necesidad de imprimir a la gestión pública más autonomía, agilidad y flexibilidad gerenciales y administrativas en sectores estratégicos del sistema de salud. La pesquisa cualitativa que dio origen a este artículo tuvo el objetivo de analizar la gestión del trabajo en la Fundación Estatal de Salud de la Familia de Bahia (Fundação Estatal de Saúde da Família da Bahia, en portugués) y en la Fundación Provincial de Salud de Sergipe (Fundação Estadual de Saúde de Sergipe, en portugués), usando la técnica de triangulación de datos y análisis hermenéutica-dialéctica. Participaron gestores, trabajadores y usuarios de los dos estados, totalizando veinte entrevistas semiestructuradas. Los factores contextuales y los actores han sido analizados utilizando un modelo que enfatizó las dimensiones del macro y del microcontexto. El desempeño satisfactorio relativo a la gestión del trabajo se puede atribuir a la variedad y complejidad de factores enfrentados por la administración directa. La interrelación del microcontexto con subdimensiones del macrocontexto contribuyó favorablemente para la implementación de las fundaciones. Como contribución a los gestores, se construyó un cuadro conteniendo indicadores para el monitoreo de las atribuciones da gestión del trabajo en las fundaciones estatales. Los resultados y potencialidades de esas experiencias pueden ayudar en el enfrentamiento de los desafíos a la gestión en salud, dotándola de más efectividad, celeridad y resolubilidad en la atención a la salud y en la gestión del trabajo en el Sistema Único de Salud de Brasil.

Knowledge, attitude and practice among private medical professionals enrolled in public private partnership program for prevention of mother to child transmission of human immunodeficiency virus in three districts of Karnataka

Background: Human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), is one of the world’s most serious public health challenges. Nearly all young children newly infected with HIV are infected through mother-to-child transmission. Only about half of the HIV infected mothers received ART and quarter of the babies born through HIV infected mothers receive ARV prophylaxis. This low coverage due to a high proportion of women delivering in private health facilities. Lack of policy for the private sector, inadequate knowledge and fear of occupational exposure are some barriers.Methods: A cross sectional study conducted among private practitioners enrolled in parent to child transmission (PPTCT) program in three districts of Karnataka. 175 obstetricians and pediatricians engaged in giving care to HIV infected mother and children were selected randomly and were interviewed using a pre tested semi structured questionnaire and the scores were graded.Results: Mean age of the participants was 38.95 years with SD of 9.12 years. The mean years of experience was found to be 14.36 years with SD of 6.45 years. The knowledge was average scoring 66.56%. The attitude and practice were 69.21% and 64.21% respectively. The mean score for KAP was 28.89 (9.56) out of 43 questions. There was significant association between age of the participants, specialization and years of experience with scoring.Conclusions: The knowledge, attitude and practice among private practitioners were average. To enhance the coverage of PMTCT, there is a need for strengthening private sector with strong political will thus reducing morbidity and mortality of the disease.

Direito ao esporte: possibilidades a partir de políticas multicêntricas, regulatórias e redistributivas / Right to sports: possibilities from multicentric, regulatory and redistributive policies / Derecho al deporte: posibilidades a partir de políticas multicétricas, regulatorias y redistributivas

Objetivamos analisar exemplos de políticas estatais ou privadas que estabelecem contrapres-tações sociais a instituições esportivas ou educacionais que possuem apelo junto ao mercado e/ou que recebem recursos públicos. Construímos um ensaio pautado na análise de documen-tos intencionalmente selecionados, que ilustram políticas de repasse de serviços públicos à iniciativa privada, equiparação entregêneros ou desenvolvimento de modalidades esportivas ou faixas etárias diversas. Discutimos e finalizamos o texto apontando lacunas na legisla-ção/política esportiva brasileira que poderiam ser supridas por políticas de caráter multicêntri-co, regulatório eredistributivo semelhantes às dos casos estudados, com potencial de contri-buir para garantia do direito ao esporte.

We aim to analyze examples of state or private policies that establish social compensations for sporting or educational institutions that have a market appeal and/or that receive public resources. We constructed an essay based on the analysis of intentionally selected documents that illustrate policies of transfer of public services to the private initiative, gender matching or development of sports modalities or diverse age groups. We discuss and finalize the text pointing to gaps in the Brazilian sports legislation/policy that could be covered by multicen-ter, regulatory and redistributive policies similar to those of the cases studied, with potential to contribute to guaranteeing the right to sport.

Objetivamos analizar ejemplos de políticas estatales o privadas que establecen contrapresta-ciones sociales a instituciones deportivas o educativas con el atractivo del mercado y/o que reciben recursos públicos. Construimos un ensayo pautado en el análisis de documentos in-tencionalmente seleccionados que ilustran políticas de traspaso de servicios públicos a la ini-ciativa privada, equiparación entre géneros o desarrollo de modalidades deportivas o bandas de edad diversas. Discutimos y finalizamos el texto apuntando brechas en la legisla-ción/política deportiva brasileña que podrían ser suplidas por políticas de carácter multicéntri-co, regulatorio y redistributivo similares a las de los casos estudiados, con potencial de contri-buir para garantizar el derecho al deporte.

A glance on public private partnership: an opportunity for developing nations to achieve universal health coverage

The government of India has joined hands with the rest of the world aiming at universal health coverage (UHC) and has set the target for 2022. The huge population, the difficult land terrain, unequal distribution of health care system, socio-economic and cultural factors are posing serious challenges. Public private partnership (PPP) even though not exactly a novel concept, some innovations can tackle these challenges to an extent and give us a smooth track towards UHC. In the past, PPP models were utilized to some extent for development and refurbishment of health infrastructure. But expanding the partnership between the two sectors to human resource, service delivery and financial management with supervision and monitoring by the government may bring out the needed significant difference.

Analysis of public-private-partnership projects in hospital energy stations based on system dynamics model / 中华医院管理杂志

By promoting the socialization of hospital logistics professional skill services, the logistics support ability and safety production supervision level can be improved. By using the theory and method of system dynamics, the income decision model of public-private-partnership projects in the energy station of Nankai hospital is established. Then, the qualitative factors in the decision-making model are transformed into calculable quantitative factors by using the mathematical method of fuzzy logic, and the reasonable charging interval negotiated between Nankai Hospital and the project company is given. According to the income range and in consideration of the balance of interests of all stakeholders, the concession period and the concession price are adjusted to provide decision-making and analysis reference for energy station construction projects.

Analysis of public-private-partnership projects in hospital energy stations based on system dynamics model / 中华医院管理杂志

By promoting the socialization of hospital logistics professional skill services,the logistics support ability and safety production supervision level can be improved.By using the theory and method of system dynamics,the income decision model of public-private-partnership projects in the energy station of Nankai hospital is established.Then,the qualitative factors in the decision-making model are transformed into calculable quantitative factors by using the mathematical method of fuzzy logic,and the reasonable charging interval negotiated between Nankai Hospital and the project company is given.According to the income range and in consideration of the balance of interests of all stakeholders,the concession period and the concession price are adjusted to provide decision-making and analysis reference for energy station construction projects.

Assessment of the programs for promoting the Public Private Partnership for global business development of Healthcare Technologies and Services in Japan / 国際保健医療

  The way of Public Private Partnerships in development including Global Health has been changing dramatically. Japan is also making efforts to promote Public-Private Partnership to promote the Japanese medical technology and services globally. Since the program schemes are varied, we collect the information mainly through WEB at July 2017 to compare the features of each program and policy. We made a list of programs conducted by Ministries and responsible organizations. The programs are categorized in two directions, inbound which means inviting foreign patients to Japan for treatment, and outbound which means exporting Japanese medical devices, medicines, system, and services. Those are also categorized in two groups by objective and content, support for establishing foundation/core facilities, and support for the system and human-resource development. We created the correlation diagram based on these categorizations to show the relationship between each scheme/program. Programs undertaken by different agencies such as the Cabinet Secretariat, Ministry of Economy, Trade and Industry, Ministry of Health, Labor and Welfare, Ministry of Foreign Affairs, Japan International Cooperation Agency seems comprehensive and exhaustive. Therefore, we can expect a bigger impact if the appropriate support through those programs were provided in right time, especially for the outbound support. There is a need for developing overarching strategy among each program to the target country based on the needs assessment, local adaptability of the technology and services. From the fact that it has become clear that issues related to developing private funds for development by public funds as priming water such as the motivation for investment behavior and the different results are different in the public and private sectors, it is necessary to clarify the guidelines in Japan in order to strengthen such Public-Private Partnership.

An analysis of public-private partnership contractual incentives in Brazilian citizen service centers / Un análisis de incentivos contractuales en arranjos de asociación de atención al ciudadano / Uma análise de incentivos contratuais em arranjos de parceria de atendimento ao cidadão

Abstract This research uses a multiple case study approach to assess theoretical propositions from transaction costs economics, the theory of incentives, and the theory of incomplete contracts. The Poupatempo and the Unidades de Atendimento Integrado (UAI), which are two major Brazilian regional citizen service centers, were the cases selected based on an unusual opportunity: the parallel occurrence of two different arrangements of public-private partnership, applied to the same public service. Poupatempo has expanded its network of units since 2007 by building partnerships through outsourcing, whereas UAI has applied the Brazilian legal framework for public-private partnership to develop its services. This multiple case study is based on a contractual analysis that identifies the partnerships' formal incentives and on an examination of private agents' performance. Also, subsidiary semi-structured interviews allowed the observation of non-contractual variables.

Resumen Este artículo conduce un estudio de casos múltiples para observar proposiciones teóricas de la teoría de los costos de transacción, teoría de los incentivos y teoría de los contratos incompletos. Los casos fueron seleccionados a partir de una oportunidad no usual: la ocurrencia simultánea de dos casos diferentes de arreglos público-privados aplicados para un mismo tipo de servicio público. El Poupatempo y las Unidades de Atención Integrada (UAI) son dos de los principales servicios estaduales brasileños de atención presencial al ciudadano y recientemente implementaron diferentes modelos de asociación con socios privados. Para expandir la red de puestos, el Poupatempo pasó a subcontratar sus unidades en 2007. El UAI, a su vez, desarrolló una asociación público-privada en el contexto legal brasileño. Este estudio de casos múltiples se desarrolló sobre la base de un análisis contractual que identificó la estructura formal de incentivos de las asociaciones y la evaluación del desempeño de los socios privados. De manera subsidiaria, se realizaron entrevistas semiestructuradas que permitieron el análisis de variables no contractuales.

Resumo Este artigo conduz um estudo de casos múltiplos para observar proposições teóricas da teoria dos custos de transação, teoria dos incentivos e teoria dos contratos incompletos. Os casos foram selecionados a partir de uma oportunidade não usual: a ocorrência simultânea de dois casos diferentes de arranjos público-privados aplicados para um mesmo tipo de serviço público. O Poupatempo e o Unidades de Atendimento Integrado (UAI) são dois dos principais serviços estaduais brasileiros de atendimento presencial ao cidadão e recentemente implementaram diferentes modelos de parceria com parceiros privados. Para expandir a rede de postos, o Poupatempo passou a terceirizar suas unidades em 2007. O UAI, por sua vez, desenvolveu uma parceria público-privada no contexto legal brasileiro. Esse estudo de casos múltiplos foi desenvolvido com base em uma análise contratual que identificou a estrutura formal de incentivos das parcerias e na avaliação de desempenho dos parceiros privados. De maneira subsidiária, foram realizadas entrevistas semiestruturadas que permitiram a análise de variáveis não contratuais.

Reconsideration and definition on the concept “Public Private Partnership” in the field of international health / 国際保健医療

Objectives  Recently, a Public Private Partnership (PPP) has drawn attention as an efficient strategy to response toward increasing different needs for health in low-income and middle-income countries under tremendously growing private sectors and restricted public finance. Neveretheless, in the society of international health development, there is no commonly acceptable definition of PPP. To make the targets and purpose of the PPP clear, the study attempted to define the PPP, reconsidering the relationship among five concepts, which have been recently used to solve social issues, such as BOP business, social business, Corporate Social Responsibility (CSR), and Creating Shared Values (CSV) as well as PPP.Methods  We conducted scrutiny of definitions of PPP in other literatures using bibliographic retrieval and associated PPP with the other four concepts in order to attempt to define PPP.Results and conclusion  We analysed the contents and relationship of the five concepts. Thus, the PPP can be defined as a process in which public and private sectors collaborate to aim to solve a social issue, not only to reply to societal expectation but also to achieve company growth.

Practice and exploration of establishing blood purification training center with ppp (Public Private Partnership) model / 第二军医大学学报

Blood Purification Training Center of Shanghai University of Medicine & Health Sciences is the first blood purification training center with PPP (Public Private Partnership) model in China. In this paper, we systematically analyzed the background and different aspects of basic design and teaching management practice of the blood purification training center, and provided the specific improvement opinions for its ownership structure, operation mode and credibility while considering the existing problems of the blood purification training center.

A comparative study of commercial insurance institutions participating in long-term care insur-ance:An analysis of Haidian District in Beijing and Qingdao in Shandong Province / 中国卫生政策研究

This article attempts to compare the similarities and differences of the two typical models of the com-mercial insurance institutions participating in the long-term health care insurance from the perspective of public-pri-vate partnership and the prospect of its application. By the comparison of the long-term health care insurance opera-tion model in multiple pilot areas,this paper selects Haidian district and Qingdao city as typical representative mod-els. The commercial insurance institutions in the two models are introduced by the urban government bidding and en-trusted a corresponding institution to supervise. However,the degree of participation of commercial insurance institu-tions in the Haidian district model is deeper than that in the Qingdao city model,and in the aspects of profit and loss, the Haidian district model is better than the Qingdao city model. The Qingdao city model of commercial insurance in-stitutions bears more risks of profit and loss. From the point of view of the application prospects of the two models, the Haidian district model is suitable for the promotion of large cities with large population, industrialized economy and high management level,while the Qingdao city model is more suitable for cities with smaller population, higher risk and weak supervisory power of commercial insurance institutions.

¿Reforma silenciosa del Estado?: proceso político de la ley de Participación Público-Privada en Uruguay / Reforma do Estado silenciosa? Processo político de lei de Parceria Público-Privada no Uruguai / Silent State reform? The political process of the law on Public-Private Partnership in Uruguay

Resumen La aprobación de la ley de Participación Público-Privada en Uruguay, en el año 2011, puede ser vista como un indicador de un cambio de paradigma en relación al vínculo entre Estado y mercado, a pesar de que la misma no ha sido enmarcada como un eje importante de "Reforma del Estado". Tomando como ejemplo el proceso político que dio forma a la ley en el caso uruguayo, se evidencia la inexistencia de consensos políticos, y la ausencia o escasez de debate al interior del Frente Amplio en relación a estos temas. Por lo tanto, las marchas y contramarchas producto del ciclo político-electoral, pero sobre todo por la dificultad de construir acuerdos sobre el instrumento, determinan que los cambios en los liderazgos sectoriales y de gobierno le impriman inevitablemente rasgos de gradualidad y pragmatismo que afectarán necesariamente el impacto de los cambios, y dificultan la adopción de estrategias de desarrollo sistémicas.

Resumo A aprovação da lei sobre a Parceria Público-Privada no Uruguai, em 2011, pode ser entendida como um indicador de uma mudança de paradigma com respeito à relação entre Estado e mercado, embora não tenha sido enquadrada como um eixo maior da "Reforma do Estado". Tomando o exemplo do processo político que moldou a lei no caso do Uruguai, se afirmam a falta de consenso político e a ausência ou escassez de debate dentro do Frente Amplio em relação a essas questões. Portanto, os altos e baixos produto do ciclo político-eleitoral, mas principalmente por causa da dificuldade de acordos de construção do instrumento, determinam que as mudanças nas lideranças setoriais e de governo imprimam inevitavelmente características de gradualidade e pragmatismo, que afetam necessariamente o impacto das mudanças e dificultam a adoção de estratégias de desenvolvimento sistêmicas.

Abstract The passage of the Public-Private Partnership Law in Uruguay in 2011 can be seen as an indicator of a paradigm shift with regard to the link between the state and the market, despite the fact that it has not been framed as an important axis of "state reform." Taking as an example the political process that shaped the law in Uruguay, the lack of political consensus and absence or scarcity of internal debate within the Frente Amplio becomes apparent. Therefore, the oscillations that result from the political-electoral cycle, but above all the difficulty of building an agreement on this law, mean that changes in sectorial and governmental leadership will inevitably instil traits of gradualism and pragmatism that will necessarily affect the impact of changes and hinder the adoption of systemic development strategies.

A case study of public hospital using Public-Private Partnership model in Pudong new district / 中国卫生政策研究

Based on the experience of Public-Private Partnership (PPPs) model in domestic and foreign medical field, this study innovatively explored and designed the Build-Transfer-Operate-Transfer (BTOT) operational structure taking the second phase project of ZP Hospital in Pudong New District as a case study.The exploration results showed that the model established the social capital of private non-profit medical institutions by setting up the project company, and used the asset rental and operating management fees in the form of return path.In view of this, the study put forward some relevant countermeasures and suggestions from the aspects of the institution nature and national treatment, property right ownership and risk mitigation, balancing of interests and the cooperation period and solving the core staff etc.All of these measures were taken in order to explore the replicable PPP model in the field of public hospital reform and development.

Fronteiras Trabalho e Pena: das Casas de Correção às PPPs Prisionais / Boundaries, Labor and Punishment: from Reformatory Institutions to PPP Prisons / Fronteras, Trabajo y Pena: de las Correccionales a las Cárceles con Modalidad APP

Resumo As práticas punitivas historicamente têm se apresentando ora como meio de garantir a existência de mão de obra, ora como meio de alocar aqueles que não se adéquam ao “correto” funcionamento social. Loucos, mendigos, pobres, dentre outros, formam um grupo de “ociosos” que, estando à margem da sociedade são apontados como possíveis alvos do confinamento nos muros das instituições totais, com a participação de profissionais do campo psi. Enclausurados, é possível transformá-los em corpos disciplinados e habilitados para o trabalho. Propõe-se neste artigo impulsionar a discussão acerca da relação trabalho e marginalidade interrogando o tipo de trabalho destinado aos fora da ordem e seu uso em contextos de encarceramento e assim criar condições e oferecer elementos para questionar as práticas psi no sistema prisional. Nessa linha enseja-se problematizar o projeto de Parcerias Público-Privadas no complexo penal. Ver-se-á que muito mais do que a improvável combinação de qualidade e eficiência apresentada pelos ideólogos da privatização, o que se observa é a conversão da prisão em um meio de controle lucrativo daqueles que não participam do mercado de consumo e de produção capitalista. Se fora das grades estes estão excluídos do modo de produção ou, ainda, sua produção não é capturável ou interessante ao capital, intramuros, são transformados em matéria-prima para alcançar o objetivo desse projeto de privatização: o lucro....(AU)

Resumen Historicamente, las prácticas punitivas se han presentado ora como medio de garantizar la existencia de la mano de obra, ora como medio de alojar aquellos que no se ajustan al “correcto” funcionamiento social. Locos, mendigos, pobres y otros hacen parte de un grupo de “ociosos” que, por estar al margen de la sociedad, son vistos como posibles blancos del confinamiento en los muros de las instituciones totales, com la participación de profesionales de campo psi. Enclaustrados, es posible tornar los cuerpos disciplinados y habilitados para el trabajo. En este artículo se propone impulsar el debate acerca de la relación trabajo y marginalidad, buscando crear condiciones y ofrecer elementos que permitan cuestionar las prácticas psi en el sistema penitenciario. Siguiendo esta reflexión, se busca problematizar el proyecto de Asociaciones Público-Privadas en el sistema penal. Además de la improbable combinación entre calidad y eficiencia presentada por los ideólogos de la privatización, lo que se observa es la conversión de la cárcele nun medio de control lucrativo por medio de aquellos que no participan del mercado de consumo e de la producción capitalista. Si fuera de las rejas estes están excluídos del modo de producción - o, todavia, suproducción no es interesante al capital -, intramuros, son transformados en materia prima para alcanzar el objetivo de este proyecto de privatización: el lucro....(AU)

Abstract Punitive practices had been historically presented either as a way to guarantee the labor availability, or as a way of allocating those who do not fit into to the “correct” social functioning. Crazy, beggars, poor people, among others, form a group of “idle” people who are on the margins of society and are cited as possible targets for total institutions containment walls, with the participation of psychology professionals. Cloistered, it is easier to produce disciplined bodies and, therefore, able to work. This paper aims to promote the discussion about the relationship between work and marginality, seeking to create condition and offer tools in order to question the psi practices in the prison system. This text also intends to discuss he public-private-partnership model on the penitentiary complex. More than the unforeseen combination of quality and efficiency stated by the privatization of prison’s ideologues, what it seems to occur is the conversion of the prison into a lucrative way to control those that do not participate in the mode of capitalist production. If outside bars they are deleted from the mode of production, within them, the same system that excludes them, transforms them into raw material in order to achieve the goal of this privatization project: profit....(AU)

Multi-ownership of community health services and the transferred govrenment leadership in China / 中国卫生政策研究

Objective:About half of Community Health Services ( CHS) in China are not government-owned, forming a multi-ownership situation of CHS .This study aims to examine the effect of “multi-ownership policy” on the development of CHS and put forward suggestions for improving the governance of CHS .Methods:We applied maxi-mum variation sampling to select health workers of different CHS specialties and administrators from local health bu -reaus in District T of Shaanxi province and District X of Shandong province .Inductive thematic analysis was utilized to interpret the development and ramification of multi-ownership policy , and then to formulate substantive theory .Re-sults:The adoption of multi-ownership in two districts was an adaptive strategy based on the limited public finance , institutional restriction of government , and diversity of health resources .This policy promoted the establishment of CHS network , and meanwhile the government's leadership of CHS development was transferred to multiple owners of CHS, which caused the lack of CHS autonomy , fragmented regulation power and deviated development of CHS .Con-clusions:The key problem of multi-ownership situation in CHS development is the problematic partition of governance power.In order to redeem the leadership of CHS development to the local government , it is necessary to strengthen service regulation while to decentralize the facility management power to CHS , to adjust service price ,and to deepen medical insurance coverage of CHS to enhance autonomy of CHS .