Capitalising on global HIV/AIDS funding: the challenge for civil society and government

After years of passionate advocacy informed by solid policy work on the ground, the global response to HIV/AIDS is better resourced. Poor countries can absorb considerably higher levels of aid than they currently receive, but recent increases in funding have generated a number of concerns. This paper analyses the capacity of NGOs, community-based organisations and governments to ensure that the influx of funds has a significant effect on the HIV epidemic and people's lives. Limited absorptive capacity may be an obstacle to the uptake of funding. To avoid community-based organisations being over-stretched by AIDS and to ensure capacity is maintained, HIV-positive staff must be enabled to continue their work through access to antiretroviral therapy and related services. Equally challenging, given that donors are increasingly using governments as intermediaries to fund civil society organisations, is increasing the capacity of developing country governments to disburse funds effectively. If donors do not accept that governments and civil society organisations need technical support in order to accept, distribute and account for increases in funding, there is a danger that home-grown responses will be replaced with imported solutions. The community sector is the glue that holds responses to HIV/AIDS together; now it needs to adapt to new partnerships with government and other emerging HIV/AIDS service providers.     

Mirror,mirror on the wall,who is the most improved of all?

This article examines the rhetoric and reality of clinical governance in the United Kingdom using the analogy of the New Year pantomime. The authors argue that processes to improve the quality of health care services provision have been in place for many years. Although the terms and language used to describe these processes have, over time, changed, the task remains the same. Clinical governance is the latest in a long list of such changes. The tensions involved in working towards achieving centrally driven targets and performance standards whilst at the same time addressing the huge modernization agenda are explored through managerial and clinical experiences. Whilst the clinical governance approach has undoubtedly achieved improvements, the sustainability of these is questioned. Organisational responses to the current system are explored and a glimpse into the future is given, as the present structures and processes change in 2004. The authors argue that practitioners and managers, who may have survived the current arrangements, might have considerably more difficulty in doing so in the future.     

Clinical governance and the learning organization

AIM: This paper compares and contrasts clinical governance and organizational learning. BACKGROUND: Clinical governance represents one of the most significant policy developments in recent years. It places on all health care delivery organizations a statutory duty to develop the systems, standards and processes necessary to improve health care quality and manage risk. At the same time, many health care organizations are seeking new ways in which learning can be retained and deployed more widely within the organization (organizational learning). KEY ISSUES: Both approaches emphasize cultural changes as essential underpinnings to quality improvement. However, the two approaches also differ fundamentally in their logic of action. Clinical governance is essentially 'top down', being built around formal standards, established procedures, and regular monitoring and reporting. In contrast, organizational learning emphasizes 'bottom up' changes in values, beliefs and motivations in such a way that learning and change are prioritized. The challenge for managers and practitioners lies in seeking a creative tension between these two contrasting styles of organizational change.     

Information governance--a view from the NHS

In this paper, a range of issues influencing and affecting NHS information governance policy and practice will be considered. The expansion of electronic information services within the NHS and with its other information partners has reinforced the need for effective security and confidentiality arrangements to apply at multiple levels and in a variety of different business contexts. Added to these, the need to consistently address issues of data protection, records management and data quality, has resulted in a NHS information governance initiative. This initiative is intended to provide approved tools, methods and guidance that may be applied consistently throughout the NHS and that will be underpinned through appropriate support and helpdesk services. This paper emphasises the need to consider a range of applicable topics when determining a responsible and extensible approach to the governance of information collected, used and shared by healthcare organisations.     

Clinical governance: its effect on surgery and the surgeon

Audit is the process by which clinical staff collectively review, evaluate and improve their clinical practice with the common aim of improving standards. Modern audit has developed from the initial concept promoted in the 1980s and is now part of the concept of clinical governance. Clinical governance is a framework through which health service organizations are accountable for continuously improving the quality of their services. Clinicians have always been accountable for maintaining high quality care; clinical governance merely imposes structure in this and makes it explicit. The features of this are: (i) full participation in audit by all hospital doctors; (ii) support and use evidence-based practice, including risk management, quality assurance and clinical effectiveness; and (iii) continuing professional development.     

A subtle governance: 'soft' medical leadership in English primary care

In many countries governments are recruiting the medical profession into a more active, transparent regulation of clinical practice. Consequently the medical profession adapts the ways it regulates itself and its relationship to health system managers changes. This paper uses empirical research in English Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) to assess the value of Courpasson's concept of soft bureaucracy as a conceptualisation of these changes. Clinical governance in PCGs and PCTs displays important parallels with governance in soft bureaucracies, but the concept of soft bureaucracy requires modification to make it more applicable to general practice. In English primary care, governance over rank-and-file doctors is exercised by local professional leaders rather than general managers, harnessing their colleagues' perception of threats to professional autonomy and self-regulation rather than fears of competition as the means of 'soft coercion'.     

上海某二级医院实行委托管理的探索

医院托管是将医院委托给有一定知名度及一定实力与经验的（医疗）管理有限公司或三级医院,根据＂政事分开、管办分开＂的精神,进行大胆改革的一种管理模式。本文将简要阐述目前医院托管的背景,通过以一家（非中心）二级医院为例,总结其托管后采取的举措和取得的成果,分析医院托管的成功和不足的相关因素,并得出结论：委托管理符合新医改的方向,是医疗资源整合的一种模式,也是二级医院生存发展的优选途径之一。     

我国医联体协同关系的构建和完善——制度约束和策略选择

"协同性"不足是医联体建设的瓶颈。本文根据协同理论识别影响组织协同关系的两个关键因素——"目标一致性"和"权力均衡性",并基于此对我国实践中医联体的不同协同模式进行剖析,对医联体建设的制度约束进行解构,提出推进医联体建设的协同策略和发展方向。本文认为受限于不同机构权力结构不均衡的制度约束,组织一体型协同模式是我国十四五时期推进医联体建设的主要方向,需要进一步打造组织一体化条件下的利益融合、区域整体治理条件下的跨部门协同和治理现代化条件下的机制协同。     

Globalized health and its governance

Globalization brings about a new era of more integrated human society. However, it is a double-edged sword: while enjoying the benefits of closer economic, trade and more frequent cultural exchanges among countries, we are encountered with a number of problems and risks, such as nuclear weapons proliferation, environmental pollution, natural disasters, spread of infectious diseases, etc. Given this fact, new concepts of global health governance have emerged in the health arena across the globe in recent years.     

Generation Scotland: consulting publics and specialists at an early stage in a genetic database's development

A preliminary consultation about Scotland's first family-based, population DNA database (Generation Scotland) involved 10 focus groups with diverse publics and a series of 17 interviews with key stakeholders in various locations in Scotland throughout 2003/2004. Unlike similar consultations on genetic databases, this took place at the concept phase of the proposed genetic research. We report on the specific concerns that arose around participation, access, use, feedback and public consultation. Broadly, we find differences between specialists and focus groups are mostly of degree and not of kind, although the specialists were more confident in some areas (e.g. governance). Given the salient and recurring nature of these issues when compared with the UK Biobank consultations, for example, we suggest that the efforts to consult have not been matched with equal effort on policy or institutional response. So, following from this, we offer compelling reasons for introducing more robust legislation and regulation.