National Leadership (national + leadership)

Distribution by Scientific Domains

Selected Abstracts

Heroin-assisted treatment in Switzerland: a case study in policy change

ADDICTION, Issue 1 2010
Ambros Uchtenhagen
ABSTRACT Background Switzerland introduced a pragmatic national drug policy when the former conservative abstinence-orientated politics proved unable to cope with an escalating number of users and related negative consequences for public health and public order. The high visibility of ,needle parks' and the size of the acquired immune deficiency disorder (AIDS) epidemic called for a new approach and for national leadership. Aims To describe the intentions, the process and the results of setting up the new treatment approach of prescribing heroin to treatment resistant heroin addicts, as an example of drug policy change. Materials and Methods A systematic collection of relevant documents is analysed and used as evidence for describing the process of policy change. Results Measures to reduce the negative consequences of continued use and to prevent the spread of AIDS were started mainly by private initiatives and soon taken up officially in the ,four-pillar' drug policy (including harm reduction, prevention, treatment and law enforcement). Medical prescription of heroin to chronic, treatment-resistant heroin addicts was one of the innovations, based on extensive scientific and political preparation. Detailed documentation and evaluation, ample communication of results, adaptations made on the basis of results and extensive public debate helped to consolidate the new policy and heroin-assisted treatment, in spite of its limitations as an observational cohort study. All necessary steps were taken to proceed from a scientific experiment to a routine procedure. Discussion Comparable policy changes have been observed in a few other countries, such as The Netherlands and Germany, based on the Swiss experience, with equally positive results of heroin-assisted treatment. These experiments were designed as randomised controlled trials, comparing intravenous heroin against oral methadone, thereby demonstrating the specific value of pharmaceutical diamorphine for maintenance treatment in opiate dependence. The positive impact of policy change and the positive outcomes of heroin-assisted treatment were acknowledged increasingly nationally and internationally, but made it difficult to continue the process of adapting policy to new challenges, due to the low visibility of present drug problems and to changing political priorities. Conclusion A major change in drug policy was effectively realised under typical conditions of a federalist country with a longstanding tradition of democratic consensus building. Facilitating factors were the size and visibility of the heroin problem, the rise of the Aids epidemic, and a pragmatic attitude of tolerating private initiatives opening the way to official policy change. [source]

Emergency demand access block and patient safety: A call for national leadership

Judy A Lowthian
First page of article [source]

Imperfect Federalism: The Intergovernmental Partnership for Homeland Security

Peter Eisinger
The terror attacks of September 11, 2001, posed a set of security challenges for the nation's cities that the increasingly decentralized federal system was poorly prepared to meet. Although it was generally agreed that domestic security required a close intergovernmental partnership, strong national leadership and support were lacking in creating and guiding this partnership. To make matters more difficult, political considerations in Congress generally trumped the assessment of security risks in the distribution of federal fiscal aid. This article explores the strains in the intergovernmental homeland security partnership, their causes, and efforts to adapt and reform. Despite some progress toward a more rational public administration of homeland security, the partnership still reflects the deficiencies of imperfect federalism. [source]

Seven Challenges in International Development Assistance for Health and Ways Forward

Devi Sridhar
This paper outlines seven challenges in development assistance for health, which in the current financial context, have become even more important to address. These include the following: (1) the proliferation of initiatives, focusing on specific diseases or issues, as well as (2) the lack of attention given to reforming the existing focal health institutions, the WHO and World Bank. (3) The lack of accountability of donors and their influence on priority-setting are part of the reason that there is "initiavitis," and resistance to creating a strong UN system. (4) Other than absolute quantity of aid, three other challenges linked to donors relate to the quality of aid financing particularly the pragmatic difficulties of financing horizontal interventions, (5) the marginal involvement of developing country governments as aid recipients, and (6) the heavy reliance on Northern-based organizations as managers of funds. (7) The final challenge discussed focuses on two unintended consequences of the recent linking of health and foreign policy for international development assistance. The paper then provides three suggestions for ways forward: creating new mechanisms to hold donors to account, developing national plans and strengthening national leadership in health, and South-South collaboration. [source]

Aiming High for the U.S. Health System: A Context for Health Reform

Karen Davis
Policy officials often assert that the U.S. has the best health care system in the world, but a recent scorecard on U.S. health system performance finds that the U.S. achieves a score of only 65 out of a possible 100 points on key indicators of performance in five key domains: healthy lives, access, quality, equity, and efficiency, where 100 represents the best achieved performance in other countries or within the U.S. The U.S. should aim higher by adopting a set of policies that will extend affordable health insurance to all; align financial incentives for health care providers to enhance value and achieve savings; organize the health care system around the patient to ensure that care is accessible and coordinated; meet and raise benchmarks for high-quality, efficient care; and ensure accountable national leadership and public-private collaboration. The incoming president and Congress should aspire to have the best health system in the world , not just assert it , and can do so by learning from examples of excellence within the U.S. and abroad. [source]