Chaos, co-existence, and the potential for collective action: HIV-related vulnerability in Brazil's international borders

In a country where quality HIV/AIDS prevention and care has been foremost on the national agenda, Brazil's extensive and diverse borders are one of the last unstudied potential hotbeds of HIV vulnerability. We carried out a rapid assessment of HIV-related services and the social context of HIV/AIDS at the Brazilian borders including current governmental and community response. The assessment was implemented in six frontier municipalities using the WHO's strategic approach methodology, which combines existing epidemiologic data with field-based qualitative data collection techniques, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. This paper focuses on the qualitative findings regarding the role of the social context in shaping HIV vulnerability at the Brazilian borders. We documented a profound lack of governmental structure and response to HIV/AIDS at the borders as well as a notable absence of social cohesion and mobilization among the diverse population groups and communities situated at the borders with regard to HIV/AIDS. The weak governmental and community response is situated within a larger socio-political context of economic inequity and social division, which must be addressed if an effective response to HIV can be developed at Brazil's international borders. Possibilities for encouraging a collective response among the diverse border populations are explored.     

Mental health: market power and governance

This paper is concerned with the pricing behaviour of providers of residential care for people with mental health problems. Two aspects of pricing were considered. First, are there differences between providers' market power and their actual mark-up rates (e.g. due to differences in motivation)? Second, do the different governance arrangements used in sectors of the industry, such as unified public and non-profit organisation and private bilateral contracting, affect pricing behaviour? A theoretical model was developed to underpin the empirical analysis of 496 residents in 112 mental health care facilities. Private, bilateral organisation was found to be associated with comparatively lower potential price-cost mark-up but a greater propensity to use this power to make profits/surpluses.     

公立医院法人治理结构改革初探——以北京市门头沟区医院为例

目的：分析公立医院引入民营化管理对改善公立医院法人治理结构和绩效变化情况,并提出相关政策建议。方法：采用案例研究方法,通过焦点组访谈、个人深度访谈、问卷调查等,分析北京市门头沟区医院改革的做法与效果。结果：门头沟区医院2010年引入社会资本后法人治理结构得以优化,主要包括：建立医院法人治理结构,建立政府、监事会、第三方评估的多元监管体系和医院绩效考核指标体系,实施医院内部综合绩效考核制度,建立多元化投入机制等。结论与建议：改革后,医院在决策权、市场准入程度、问责机制、剩余索取权、社会功能等方面均发生改变,取得了初步效益,但也面临着一定的体制约束。公立医院治理机制改革需要创造良好的外部政策环境,进一步优化内部管理机制与考核制度,并注意在引入社会资本过程中保证提供服务的公益性。     

社区卫生委员会——公众参与基层卫生服务管理机制探讨

社区卫生委员会作为基层卫生服务管理的一种公众参与机制,通过建立自下而上的卫生社情民意沟通渠道和社区卫生监督体系,让社区居民(村民)参与基层卫生的决策和管理,改变自上而下的传统卫生管理模式,改善基层医疗服务,提高政府的治理能力.文章介绍了浙江GTF项目县社区卫生委员会运作情况,分析了这项试点的初步成效和创新经验,探索了社区居民参与基层卫生服务管理的新机制和新模式.     

抗生素耐药性全球治理的发展历程及对中国的启示

目的:归纳总结抗生素耐药性全球治理的发展历程和每个阶段的特点,并为中国参与抗生素耐药性的全球治理提供启示。方法:采用范围综述的方法在ISI Web of Science、Pubmed、Medline等外文期刊数据库中搜索并筛选有关抗生素耐药性全球治理的相关文献,同时收集世界卫生组织、联合国、联合国粮农组织以及世界动物卫生组织等发布的相关资料。结果:抗生素耐药性全球治理的发展历程大致可分为三个阶段:以临床监测为主要策略、由发达国家主导的萌芽阶段;从卫生领域到卫生、农业、环境等多领域共同治理的快速发展阶段;多国家参与并且多领域共同治理的全面覆盖阶段。结论:全世界对于抗生素耐药性全球治理的关注度日益提升,我国应借鉴世界各国采取的有效行动,鼓励多领域协同治理抗生素耐药性问题,以更加积极主动的姿态参与全球治理,并逐步提高社会公众对抗生素耐药性的重视。     

Guidance for the governance of public-private collaborations in vaccine post-marketing settings in Europe

IntroductionThe 2009 influenza pandemic highlighted challenges for vaccine post-marketing monitoring in Europe, particularly the need to have appropriate infrastructures to strengthen public-private collaborations (PPCs) with suitable processes to improve stakeholder interactions and collection and analysis of safety and effectiveness data. The ADVANCE consortium comprises public and private stakeholders who have worked together to build and test new system components for vaccine post-marketing projects, one component being a governance framework for efficient, transparent and trustworthy PPCs.MethodsBased on the results of a landscape analysis and screening of formalised existing governance structures, we identified the elements of a governance framework and developed recommendations to support stakeholders willing and able to implement collaborative projects. These proposals and their implementation were discussed by 70 experts during a workshop to gain from their experience.ResultsWe identified core governance principles and defined five fundamental functions (decision-making, scientific advice, quality control and audit, implementation and management, and financial administration) that can be attributed to individual partner organisations or to a committee with representatives from more than one partner organisation. We propose a generic governance model with options for its adaptation to specific contexts and projects. The advantages and disadvantages of PPCs were also examined. Stakeholders’ concerns (e.g. scientific integrity and public trust) were addressed through recommendations about transparent decision-making rules and conflict of interest management.ConclusionsNo one-size-fits-all solution for PPC governance exists but our recommendations could be used to set-up a tailored-made and fully transparent governance structure supporting collaborative projects in the European vaccine post-marketing environment. To allow the rapid establishment of robust projects, the next steps will involve this guidance being used by real-world collaborations to assess what works and what does not work and what added-value can be obtained from these collaborations.     

Science and Technology Ethics Governance,How to Put Ethics First?

Science and technology ethics governance, how to put ethics first? The purpose of “technological innovation, ethics first” is to build an ethical soft landing mechanism for scientific and technological innovation. Researchers of science and technology ethics should start from the practice of international and domestic science and technology ethics governance, and explore the realistic way of science and technology ethics governance on the basis of understanding and thinking about the innovative culture, value orientation and operation mechanism. First of all, it should be noted that seeking technical, management and institutional solutions in the current ethical governance of science and technology may not be perfect and thorough, but operable management measures can be explored and continuously improved under the framework of mainstream scientific and technological innovation. Secondly, the co-governance of science and technology ethics needs to further explore the corresponding group co-governance epistemology facing pluralistic co-governance. Finally, the ethical governance of science and technology should pay attention to the principle of proportionality, and avoid both lax and being too strict. © 2022, Editorial department of Chinese Medical Ethics. All rights reserved.     

The Ethical Principles of Science and Technology Need Concrete Research to Guide

On March 20, 2022, the General Office of the CPC Central Committee and the General Office of the State Council issued The Opinions on Strengthening Ethical Governance of Science and Technology, which put forward five ethical principles of science and technology:promoting human well-being, respecting the right to life, adhering to fairness and justice, reasonably controlling risks and maintaining openness and transparency. Ethical principles require to be studied and interpreted concretely by ethical scholars, that is, first, they need to be refined in order to be truly guided; second, the principle of balance is needed to truly guide; third, it is necessary to study ethical theory in order to truly guide; fourth, it is significant to explore Chinese civilization in order to truly guide. In this way, the ethical principles of science and technology can be practically applied and guide the concrete practice of science and technology. © 2022, Editorial department of Chinese Medical Ethics. All rights reserved.