Belgian Government Research Articles

Evaluation of “CLE” an Intermediate Family Centered Developmental Care Program Based on the Theoretical Concept of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

The Belgian government has always been very supportive con-cerning the implementation of individualized family-centered developmental care in newborn units. Since 2012 the implemen-tation of NIDCAP has been subsidized by the government. This project evolution demonstrated the benefit of NIDCAP on care practices1 and revealed the need for intermediate NIDCAP-based programs.2,3 This requires facilitation of NIDCAP implementation in Newborn Intensive Care Units (NICUs) on the one hand, and development of programs adapted to the reality of Intermediate Newborn Care Units on the other hand. These findings matched the observations of the Brussels NIDCAP training center.

Could the decrease in Belgian government debt-servicing costs offset increased age-related expenditure?

This paper argues that none of the secular trends that have driven down real interest rates over the past decades is likely to reverse in the near future. Government debt-servicing costs have therefore decreased significantly and can be expected to decrease further over the coming years. We calculate the direct gains accruing to the Belgian government from lower net debt interest payments and contrast them to the projected future increases in age-related expenditures. If interest rates remain on their current levels and savings on interest payments are channelled to cover the increases in age-related expenditures, they will cover two thirds of financing needs in these areas until 2030.

Wartime Propaganda in the Gazette van Detroit (1914-1918)

ABSTRACTThe Gazette van Detroit was one of many immigrant newspapers started up in the United States shortly after the outbreak of the First World War. During the war, it kept the Belgian community of Detroit, wider Michigan and Southwestern Ontario (Canada) abreast of the developments in their former homeland, while also reporting on the hostilities elsewhere in Europe from a typically Belgian, and particularly Flemish perspective. It published to that end a variety of pieces under the scrutiny of the Belgian and later also the American government: (1) pieces submitted byregular contributors; (2) letters of Belgian soldiers; (3) articles gleaned from other news sources; and (4) pieces reproducing official information provided by the exiled Belgian government in Le Havre (France). Caught like most other media outlets in a powerful tide of national solidarity, much of this wartime reporting can be considered as propaganda, since it aimed to standardize public opinion by mobilizing the animosity of an entire community against a thoroughly evil enemy engaged in the victimization of an intrinsically good, heroic and unflinching opponent: the Belgian civilian population and army. To achieve this effect, the Gazette employed rhetorical strategies, such as over-lexicalisation, stereotyping and the kinship metaphor.

Heterogeneity in the tax pass-through to spirit retail prices: Evidence from Belgium

On 1st November 2015, the Belgian government increased the excise tax on alcoholic beverages. For spirits with 40% of alcohol and bottle size of 70 cl, this tax change is equivalent to an amount of 2,43 € per bottle of spirits. This paper studies the impact of this tax reform at the store level on the (posted) retail price of six major brands of spirits, using a difference-in-differences method. The estimation is based on a balanced panel of scanner data from a major supermarket chain (with a 33% market share) and uses the retail prices of the same brands sold in France by the same supermarket chain as a control group. Having information on each store location, we show spatial variations in the tax pass-through for homogeneous products. We find that these variations are strongly related to the intensity of local competition and to a lesser extent to the proximity to the borders (mainly with Luxembourg which is the low-price country). We find that the tax was quickly passed through during the first month of tax implementation and that it was mostly over-shifted. However, we also find that both the border and the competition effects are not instantaneous, but arise several months after the tax reform. These findings have important implications for alcohol control policies as they highlight that the incidence of alcohol taxation can vary greatly across space and affect differently households depending on where they live.

Planning Belgian Congo’s network of medical infrastructure: type-plans as tools to construct a medical model-colony, 1949–1959

ABSTRACTThroughout the 1950s, the Belgian colonial government constructed a vast network of hospital infrastructure as part of its Ten-Year Plan, a colony-wide socio-economic scheme emblematic for the era of ‘welfare colonialism.’ This network played a key role in Belgian colonialism, by providing healthcare, but also by boosting labour productivity, facilitating state presence and control, and by advertising Congo as a medical model-colony. In this article, we unpack the extensive administrative apparatus that was necessary to buttress this ambitious building programme, and we highlight type-plans as crucial government tools to construct such a vast network of healthcare infrastructure. At first glance, the use of type-plans confirms classic characterizations of the Belgian colonial government as an omnipotent and technocratic state apparatus that implemented large, top-down government plans through authoritative methods, often discarding local realities. However, tracing hospital construction on the ground reveals that type-plans did not function as immutable models, but rather as modular blueprints that allowed local administrations to adapt hospitals to local needs and contingencies. As such, our article illustrates how, facilitated by surprisingly flexible type-plans, everyday colonial policymaking in Belgian Congo was, contrary to the still dominant discourse, deeply reliant on the agency and aptitude of local officials.

Jean Bourgain, problem solver

Jean Bourgain, a truly exceptional and prolific problem solver who transformed multiple areas of mathematics, died on December 22, 2018, aged 64, after a prolonged battle with cancer. Jean Bourgain, 1954–2018. Image courtesy of Institute for Advanced Study/Andrea Kane. Jean received almost every award in the field of mathematics, ranging from the Fields Medal in 1994 (widely regarded as the premier award for mathematicians under the age of 40) to a baronetcy by the Belgian government in 2015. He was elected to the National Academy in 2011, but as a colleague of his noted after his death, “Even considering this, it is hard not to think that in some ways the weight of his contributions has still somehow gone underappreciated within the larger mathematical and scientific community.” Jean’s early work was in the geometry of high-dimensional (or infinite-dimensional) spaces, as well as closely related objects such as large (or infinite) matrices. For instance, he showed how to efficiently approximate a high-dimensional convex body using randomly selected points in that body, and (with Tzafriri) showed that starting from an arbitrary large matrix (obeying some mild conditions), one could select a large number of columns to create a submatrix that … [↵][1]1Email: tao{at}math.ucla.edu. [1]: #xref-corresp-1-1

The Gold of the Vanquished. Belgian Claims on the Order of the Golden Fleece’s Treasure in the Aftermath of the First World War

ABSTRACTOne of the most brilliant symbols of the splendour of the Burgundian period remains the Order of the Golden Fleece and the ornaments which constitute its ‘treasure’, preserved since the end of the eighteenth century in Viennese museums. With the defeat of the Austro-Hungarian Empire in 1918, some politicians and opinion makers in Belgium saw the perfect opportunity to reclaim this prestigious ensemble as a national artefact inherent to the Belgian territory. By virtue of the Treaty of Saint-Germain, the Belgian government was authorized to set up a committee in charge of demonstrating property rights to ‘national’ works of art that could be claimed as a compensation for war damages. The present contribution aims to explain who, in Belgium, militated for the restitution of the treasure of the Golden Fleece. This judicial case, abundantly covered by the contemporary press and revealing a national identity that drew upon an idealized Burgundian past, was nevertheless doomed to failure.

Le recrutement des travailleurs italiens destinés aux mines belges d’après-guerre : tensions et conflits d’un processus pas si simple

The post-war migration between Italy and Belgium rested upon a mechanism of group recruitment, of which the Italian government was largely in charge. Whenever required, the immigration country had to transmit to the Italian government the requested number of workers. The Italian Labour Department had to search for the candidates who were then presented to the Belgian Mission at the Emigration Centre in Milan, for final selection. Both the mining industry and the Belgian authorities were unsatisfied with the preselection carried out by Italy. In fact, they considered that too many migrants who did not meet the recruitment conditions arrived at the Emigration Centre, During the ten years’ organized migration of Italians for the Belgian coalmines, Fédéchar – with the Belgian government’s tacit consent – pursued a threefold objective : it looked for a way to improve the performance of what was considered a defective Italian administration, it wanted to impose its proper selection criteria, and it was eager to avoid that “ undesirable” candidates had an opportunity to emigrate to Belgium. Pursuing these objectives, they undermined in fact the Italian recruitment monopoly.

The right to strike in the public sector in Europe

The European Trade Union Institute coordinated the production of factsheets on 35 countries, setting out the legal provisions on the right to strike, identifying in particular specific rules affecting the public services. This provides a wealth of information to trade unionists who can now compare and contrast the legislative requirements in their country with many other countries across Europe. Many groups of public sector workers are restricted or even banned from taking strike action. Procedural rules and requirements to provide minimum levels of essential services can also further limit their rights. Recent challenges to the right to strike The right to strike is fundamental for trade unions in underpinning their ability to organise, collectively bargain and represent their members. However, this right has often been restricted for public service workers and in recent years has come under attack. There have been a number of worrying developments in recent years where governments and international institutions have attempted to undermine the right to strike. These include the following: In July 2018, members of the UK public and commercial services PCS union delivered the highest ‘yes’ vote and turnout in the union’s history. However, the vote was invalid because of restrictions on public sector strike action introduced by the centre-right Conservative government in 2016. Eighty-six per cent of almost 60,000 PCS members voted in favour of action to demand a pay rise, but although representing 42 percent of the workforce, their number fell short of the required 50 percent turnout threshold; In June 2018, the Belgian government proposed new laws to limit the right of prison workers to take industrial action. In January 2018, as part of the package agreed with European lenders, the Greek Parliament voted on restrictions on the right to strike as well as further public sector job cuts and cuts to pensions and tax allowances; and In January 2017, Italian forestry workers took to the streets to demand a delay in their forced transfer to the Carabinieri police force, effectively militarising them and denying them the right to strike. Which workers are denied the right to strike? Although it is common for members of the armed forces, the security services, the judiciary, and police and prison officers to be excluded from the right to strike, union organisations have successfully challenged outright bans even in these areas. In the Czech and Slovak Republics, workers in whole sectors of the civil service, public utilities, ‘crucial enterprises’ and essential services are excluded from the right to strike. They include those in health and social care, where a strike could endanger people’s lives or health; employees operating nuclear power stations or equipment; fire and rescue workers; air traffic controllers; and telecommunications workers, where a strike could endanger life or health or damage property. In Denmark, certain categories of civil servants are considered bound by a special relationship of trust and are banned from striking. Since 2012, deputy police prosecutors, public prosecutors and state prosecutors have not been considered to be civil servants and therefore now have the right to strike. However, the latest figures show the number of Danish civil servants denied the right to strike stood at 44,000. In Estonia a civil servant who is an official, that is a person in a public-law service and trust relationship with the state or local government, is not allowed to strike. Although the ban does not apply to employees in public administration generally, it does apply to rescue workers and employees in the Ministry of Defence, Defence Resources Agency and the Defence League. In Turkey, a law completely barring public servants from striking was passed in 2001. As set out in the country reports, these same groups of workers do have the right to strike in other European states. Restrictions related to essential and minimum services The ILO defines essential services as those ‘whose interruption would endanger the life, personal safety or health of the whole or part of the population’. However, a far wider interpretation of ‘essential services’ restricts the right to strike in a number of countries. For example, in Albania, civil servants working essential services of state activity, including transport, public television, water, gas...

Du travailleur au clandestin. La politique de l’emploi et l’immigration de travail dans la Belgique de la fin des Trente Glorieuses (1965-1974)

On 1 August 1974, the Belgian Government imposed a ban on unskilled labour immigration from non-eec countries. This is commonly interpreted as a direct and logical consequence of the Oil Economic Crisis. This article aims to challenge this assertion by looking back at the evolution of the Belgian migration policy during the end of the Trente Glorieuses (1965-1974), and more precisely that of foreign labour immigration. It aims to demonstrate the conversion of a labour force policy into an employment policy from the second half of the 1960s onwards. The progressive deprivation to new migrant workers of any kind of social and legal status contributed to the restrictive inflection of the Belgian migration policy more than any change in the economic situation.

Down to Counsel: Towards A Transdisciplinary Toolbox for Non-directive Counseling in Prenatal Screening for Down Syndrome

Abstract Since the introduction of non-invasive prenatal testing (NIPT) in Belgium in 2013, expectant parents have had access to a new efficient and reliable test for genetic abnormalities, including trisomy 13, 18 and 21. In 2017, the Belgian government decided to cover over 95% of the cost for all women who choose to take this test. In this context, a diagnosis of trisomy 21 (Down syndrome) presents an especially challenging decision for parents: it is impossible to tell the severity of impairment prenatally, and although several medical risks are involved in the condition, many individuals with Down syndrome live a long, happy, and relatively independent life (Shakespeare, 1998; Scott et. al., 2014). Expectant parents face a very difficult situation: how to decide whether or not to terminate a pregnancy? It appears that termination is becoming the routinized outcome of the clinical encounter during which a diagnosis is delivered.The intricacy of the matter, and the fact that many actors are involved, lead to the necessity of a transdisciplinary methodology when scrutinizing the future of prenatal counseling. However, medical professionals tend to approach Down syndrome from an exclusively medical perspective (Skirton and Barr, 2010), leaving aside the economic, social and psychological dimensions of living with Down syndrome. This may result in unbalanced information; some (perhaps precipitously) refer to this phenomenon as ‘nudging practices’ (Hippman et. al., 2012; Reid et. al., 2009). In order to address this imbalance, we adopt a stakeholder approach in this project: we consulted <target target-type="page-num" id="p-39"/>experts with diverse backgrounds and fields of expertise. Through this transdisciplinary approach, we hope to bring about a more transdisciplinary perspective directly within the offices of gynecologists and GPs. More specifically, we aim to find ways to provide GPs and gynecologists with direct access to information about the aforementioned dimensions of Down syndrome.The next step is to define a strategy to achieve this goal. Given the fact that medical professionals often lack both time and easy access to concise information about Down syndrome to present a nuanced perspective (Ahmed et. al., 2007), but are still the first in the prenatal screening process, the output of this project is the idea of an online tool in a succinct Q&A format. The goal of such a website would be to provide up-to-date, easily accessible and balanced information for general practitioners and gynecologists on multiple aspects of Down syndrome. This way, in anticipation of and directing explicitly towards further counseling by a multidisciplinary team, physicians can provide expectant parents with a more balanced, transdisciplinary view of Down syndrome, thereby enhancing their capability to make informed, autonomous and hence sustainable decisions about their pregnancies.

The role of the Belgian government in enhancing the integration of healthcare for Mentally Ill Offenders: an analysis of the reform plan

Background: In 2016 The Belgian government launched a Reform program to optimize and integrate care for Mentally Ill Offenders MIO. Collaboration networks get the ‘mandate’ to implement the program, adapted to locoregional contexts. This paper aims to make a plan analysis of the government reform program and tries to analyze the characteristics of the mandate. Methods: Qualitative data were collected using document analysis and semi structured interviews with policy delegates cabinet and administration and regional healthcare- and justice coordinators. Data were analyzed using a continuous comparative method, including researcher triangulation. Results: The current policy framework sets a number of guiding principles to reorganize the field and care for MIO. Key principles are the focus on integration of care of services form different sectors and organizations, reintegration of MIO into society, developing smooth patient trajectories for MIO and emptying the prisons with MIO by means of introducing new types of facilities. The responsibility to implement this is mandated to policy implementation networks per regional Court of Appeal region. The Master Plan holds no detailed rules or procedures to guide the collaboration. The plan incorporates previously established locoregional steering groups and strengthens the role of steering group coordinators to enhance collaboration. These latter are the linking-pin between locoregional activity and the policymakers. The locoregional coordinators are supervised by a national coordinator. These coordinators have to facilitate the dialogue between organizations to realize the guiding principles, facilitate a common understanding of integrated care and facilitate intersectoral patient trajectories of different types of MIO’s. Discussion: The strategy of the Reform plan is in line with recommendations in literature to tackle wicked problems. The reform plan aims at developing common goals through locoregional dialogue of intersectoral partners. It tries to guide this process by creating a structure in which formally appointed linking pin-persons play a central role. The mandate is characterized by a low level of formalization. It mainly focusses on enhancing dialogue and interaction in the hope that mutual learning will emerge. The policy framework is however not yet in the stage of promoting the idea of networks as a whole. Conclusion: The current policy framework in the Belgian field of MIO is an example of a policy network model. It aims to facilitate dialogue and interaction between different types of players and assumes that local players will have the competence to implement the integration of care. Limitations: This plan analysis is part of a larger research project performing an implementation study of the reform and emerging networks. Suggestions for further research: To develop effective mandated networks research is needed on governance mechanisms and whole networks within the characteristics of the institutional field.

Integrated care for mentally ill offenders in Belgium: an analysis of a mandated collaboration

Background : In 2016 The Belgian government launched a Masterplan to improve healthcare for Mentally Ill Offenders (MIO). The Plan aims at improving collaboration between different organizations to guarantee integrated healthcare trajectories. The core question of this contribution is to assess to what extent the policy framework and guidance facilitates or hampers the implementation of collaboration and integrated care for MIO’s. Methods : Qualitative data were collected using document analysis of the Reform program and semi structured interviews with representatives of hospitals, justice houses and regional coordinators. Data-analysis was done with a continuous comparative method of coding and analysis including researcher triangulation. Results : The Masterplan, the general reference text on the Reform, mandates locoregional steering groups to implement the reform. These groups are supported by formally appointed and funded regional coordinators. Locoregional actors get leeway to implement the reform within the overall framework. The interviews learn that intersectoral collaborations are needed to tackle problems on offering healthcare for MIO. Implementation problems emerge from the heterogeneous composition of steering groups and diverging interests, power struggles and differences in culture. Some participating organizations focus on forensic thinking while others have a broader overall mental health care approach. The steering groups need to find a balance between mutual interdependence and organizational interests. Historical partnerships versus integrating new services in this MIO-field challenge the definition of common goals and working practices. Moreover participating organizations are represented by different professional backgrounds (managers vs clinical professionals) which affects the view on the problem and collaboration. At last, the interactions are affected by the regulations of the partners from different policy sectors. Discussion : Heterogeneity and complexity challenges collaboration. Policy implementation networks need learning time and mutual adaptations in order to become sustainable. The experiences drawn from the Belgian MIO field converge with findings in network literature, but vary because of the particular MIO field characteristics in Belgium. Conclusion : The choice of the Belgian government to initiate locoregional mandated heterogeneous networks is a potentially useful tool to tackle the complex problem of integrated care for MIO. However because of this heterogeneity governance questions are undervalued. Limitations : This implementation study relies on an inventory of experiences of an ongoing change process. The collaborative networks have not matured yet. Therefore we could not yet address the issue of the life circle of a reform program and the maturing of networks. Suggestions for further research : Further research is needed on steering mechanisms. It currently lacks research on how facilitating instruments like coaching sessions, exchange programs etc. could support the development of innovative networks aiming at integration of care.

How to evaluate a Nation-wide Whole System Change in Health Care towards Integrated Care for people with Chronic Conditions? Part II: the co-construction of a monitoring system involving multiple databases

Background: The Belgian government program “Integrated Care for better health” (www.integreo.be) aims at a Nation-wide Whole System Change in health and social care towards Integrated Care (IC), by means of geographically defined pilot projects. Each of the +/- 20 pilot projects will implement IC in a loco-regional area covering up to 150.000 inhabitants. The ultimate goal is to improve the ‘Triple Aim’ quality of care,equity and healthcare professional work life (‘TA2+’). Pilot projects will run for several years serving both as large-scale implementation projects and test cases. Successful projects will be upscaled to cover – ultimately - the entire Belgian territory. A scientific team was appointed for evaluation of the projects. A priority task for this team is to set up sustainable monitoring tools that can evaluate the projects in a longitudinal way. To evaluate the impact of Integreo on TA2+, both content (outcome indicators) and methods of data collection must be defined. However, the scale of the projects - both concerning the number of included persons and the duration of the project - is incompatible with the usual approach of data collection and analysis. Aim: To reflect with the target audience on the process and dynamics of selecting outcome indicators and data collection methods for such large-scale projects. Format: Interactive workshop with ‘teasing’ questions to the target audience combind with presentation of the lessons learned. This workshop follows Part I and – if necessary – both can be given in one workshop. Speakers on behalf of the research group: Elien Colman, Elias Van Deun, Jean Macq, Geert Goderis Target Audience: Researchers and professionals active in the field of IC and system change. Learnings: 1- On the indicator selection - Define their utility: the quantitative evaluation of the indicators alone will not allow to determine causal relationships, but must be part of a global analysis, including qualitative research methods and implementation evaluation. - Set goals: first define the indicator set by evaluating the added value for measuring the change objectives. - Find an equilibrium between ambition and feasibility. The impossibility to use usual data collection methods has a direct impact on the indicator selection itself. - Define transversal indicators first as a common base for all projects. Afterwards, add project-specific indicators in full co-creation. 2- On the research methodology - The methods of data collection must be routinely applicable and sustainable in the long running. - The collected data from hospitals, General Practice, Patient Reported Outcomes, etc., must also be as much as possible routinely collected and automatically merged with claims data at patient level. - Plan with a clear time line: -- Evolving technological, legal and practical issues determine the data collection possibilities -- Each new database adds complexity to an already complex project: therefore, start small, plan expansion at the appropriate moment. 3- On the co-creation process - It requires time and organization to involve all necessary actors, allowing them to review and process the data. - Moving from existing logics of intra-organisational data-analysis (e.g. in hospitals), towards inter-organisational data-analysis.

How to evaluate a Nationwide Whole System Change in Health Care towards Integrated Care for people with Chronic Conditions? Part I: the co-construction of an evaluation framework

Background : The Belgian government program “Integrated Care for better health” www.integreo.be aims at a Nationwide Whole System Change in health and social care. This implies change in its structures, finances, processes and paradigms towards more Integrated Care IC. It concerns geographically defined pilot projects that should cover in ‘full implementation” more than 3.670.000 people, about one third of the total Belgian Population. Pilot projects are both large-scale implementation projects and test cases. Each pilot aims at changing the organization of their loco-regional area network covering up to 150.000 inhabitants towards more IC. Changes are directed at 14 components, structured at three levels: 1 the patient level e.g. case management; 2 the inter-professional collaboration level e.g. shared medical file; and 3 the inter-organizational collaboration at loco-regional level e.g. quality culture The ultimate goal is to improve the ‘Triple Aim’ quality of care, equity and the work life of healthcare providers ‘TA2+’. A scientific team was appointed to : design and implement an evaluation framework alongside the pilot-projects-in-development. function as a support mechanism to the pilot projects in assisting and accompanying them with their self-evaluation process. function as a support mechanism for the government agencies who induced and guide the change management program. Existing research on achieving sustainable change of loco-regional networks towards more IC and Triple Aim within a nation-wide program is scarce. Moreover, existing research is highly context specific. This need to be taken into account in the generalization process. Aim : To reflect with the target audience on the necessity of changing research paradigms towards theory driven appraisals when engaging into Whole System Change evaluation in healthcare. Format : Interactive workshop with both ‘teasing’ questions to the target audience and presentation of our lessons learned Speakers: Geert Goderis, Jean Macq, Nathan Charlier, Elien Colman. Target Audience : Researchers and professionals active in the field of IC and system change. Learnings : - System change towards IC cannot be conceived as a delineated intervention, but as a complex strategy or even a policy to innovate and implement long-lasting change. This complexity often manifests as shifting and unpredictable contexts, deep differences among perspectives, and even conflict among stakeholders. - Scientific evaluation is necessary and imposes a paradigm change for the involved scientists. ‘Laboratory like’ methodologies type ‘Randomized Controlled Trials’ are unfit and must be replaced by theory driven approaches, describing the processes and contextual factors leading to desired outcomes. - The evaluation should transcend the question ‘what works?’ towards questions on how, why, for whom and in what circumstances the program brings the desired outcomes, in order to allow upscaling of the program to a system change covering entire Belgian territory. - Scientists engage in a co-creative process producing new knowledge, in partnership with all other involved stakeholders like e.g. health professionals and government agents. This co-creation process disables the possibility to plan a fixed endpoint: the design is tribute to multiple issues that evolve over time. Meanwhile, the whole program serves as a leverage to create breakthroughs in these issues.

Establishing Sexual Assault Care Centres in Belgium: health professionals\u2019 role in the patient-centred care for victims of sexual violence

BackgroundHaving ratified the Convention of Istanbul, the Belgian federal government commits itself to the foundation of Sexual Assault Care Centres (SACC). In the light of researching the feasibility of these centres, this study aimed to evaluate the care for victims of sexual violence (SV) in Belgian hospitals anno 2016 as well as to formulate recommendations for the intended model.MethodsBetween April and October 2016, a questionnaire was distributed to 159 key health professionals active in 17 different hospitals attached to an AIDS Referral Centre. The survey covered four parts, i.e. the health professionals’ profile, their knowledge, attitude and practices, an assessment of the hospital’s policy and the caregivers’ opinion on the care for victims of SV and on the intended SACCs. Subsequently, a descriptive analysis using ‘IBM SPSS Statistics 23’ was performed.ResultsA total of 60 key health professionals representing 15 different hospitals completed the questionnaire resulting in a response rate of 38%. The results showed a lack of knowledge and practical experience of caregivers’ regarding the care for SV victims. Approximately 30% of responders face personal or professional difficulties upon provision of care to victims of SV. Participants evaluate the current care as good, despite the limited psychosocial support, follow-up, insight for the needs of vulnerable groups and support for family, relatives and health professionals. Yet, the majority of health professionals appraise the SACCs as the best approach for both victims and caregivers.ConclusionsBy introducing a SACC, the Belgian federal government aims to provide holistic and patient-centred care for victims of SV. Essential in patient-centred health care is an extensive and continuous education, training and supervision of health professionals concerning the care for victims, support for family, relatives and caregivers.At the end and as a result of a participatory process with many professional experts as well as victims, a specific Belgian model, adjusted to the health care system anno 2016 was developed for piloting. The main challenges in establishing SACCs are situated at the institutional and policy level. Collaborating with other institutions and further research are herewith required.

‘Still so many illusions to cast off!’: The territorial unification of the Ngbaka (Belgian Congo) in the 1920s

ABSTRACTIn the 1920s, the Belgian colonial government appointed a territorial administrator named René Pecheur, a former missionary, to organise the territorial unification of what was conceived as the Ngbaka ethnicity, in the Ubangi region of the Equatorial Province of the Belgian Congo. This project had its place in the larger colonial tendency from the end of the First World War onwards, to replace the former assimilationist policy by an indigenist one. Initially, Pecheur was convinced of the necessity and feasibility of his task, but gradually lost faith and resigned in 1928. He was confronted with the divergence between Belgian ideals and Congolese realities, which led to his moral and mental exhaustion. His case and that of his successor Gaston Crabbeck indicate how individual trajectories and personal crises had a significant impact on the hampered implementation of colonial rule in the Belgian Congo.

De Belgische evenwichtsoefening inzake de verplichte ADR-poging in het raam van een gerechtelijke procedure

This contribution examines how, when establishing the new Belgian legislation on the promotion of ADR, a delicate balance was sought between proponents and opponents of mandatory mediation. The Belgian government was in favour of compulsory mediation, but the Council of State, the High Council of Justice, members of parliament from the majority and the opposition, and representatives of professional organizations were opposed to it. A delicate compromise was found whereby the judge can impose a mediation, but if both sides are opposed to it, a mandatory mediation attempt is excluded.

Doctor Thomas e a medicina tropical na Amazônia no início do século XX

Resumo Harold Howard Shearme Wolferstan Thomas foi um pesquisador da Escola de Medicina Tropical de Liverpool que teve fugaz destaque na medicina britânica na época em que foi deslocado para a Amazônia (1905). Cinco anos antes, uma expedição da mesma Escola estivera na região para investigar a febre amarela. Thomas e Anton Breinl viajaram para Manaus ainda com o objetivo de estuda essa doença. Naquele intervalo, transcorreram processos muitos dinâmicos na medicina tropical, em particular no tocante às tripanossomíases. Thomas ganhou projeção ao demonstrar que o atoxyl era eficaz no tratamento de animais e humanos infectados por tripanossomos. No presente artigo, Thomas é o fio que conduz a uma trama formada por diferentes atores e doenças na América, Europa e África, cujas sinergias revelam contornos da medicina tropical e o lugar nela ocupado pela região amazônica no começo do século XX. Enfatizaremos especialmente as tripanossomíases. Até sua morte em Manaus, em 1931, Thomas envolveu-se com outros problemas de saúde locais e com médicos que lideravam a saúde pública e a medicina experimental no Amazonas - curso discrepante daquele tomado pela maioria dos médicos europeus que participaram de missões em colônias e áreas de influência das metrópoles imperiais. Nos anos 1950, Thomas foi ‘redescoberto’, ao receber (postumamente) parte de um prêmio conferido aos descobridores da cura da doença do sono. Sua memória teve outros revivals em ambientes acadêmicos.

Development of clinical pharmacy in Belgian hospitals through pilot projects funded by the government

Objectives The goal is to develop clinical pharmacy in the Belgian hospitals to improve drug efficacy and to reduce drug-related problems.Methods From 2007 to 2014, financial support was provided by the Belgian federal government for the development of clinical pharmacy in Belgian hospitals. This project was guided by a national Advisory Working Group. Each funded hospital was obliged to describe yearly its clinical pharmacy activities.Results In 2007, 20 pharmacists were funded in 28 pilot hospitals; this number was doubled in 2009 to 40 pharmacists over 54 institutions, representing more than half of all acute Belgian hospitals. Most projects (72%) considered patient-related activities, whereas some projects (28%) had a hospital-wide approach. The projects targeted patients at admission (30%), during hospital stay (52%) or at discharge (18%). During hospital stay, actions were mainly focused on geriatric patients (20%), surgical patients (15%), and oncology patients (9%). Experiences, methods, and tools were shared during meetings and workshops. Structure, process, and outcome indicators were reported and strengths, weaknesses, opportunities, and threats were described. The yearly reports revealed that the hospital board was engaged in the project in 87% of the cases, and developed a vision on clinical pharmacy in 75% of the hospitals. In 2014, the pilot phase was replaced by structural financing for clinical pharmacy in all acute Belgian hospitals.Conclusion The pilot projects in clinical pharmacy funded by the federal government provided a unique opportunity to launch clinical pharmacy activities on a broad scale in Belgium. The results of the pilot projects showed clear implementation through case reports, time registrations, and indicators. Tools for clinical pharmacy activities were developed to overcome identified barriers. The engagement of hospital boards and the results of clinical pharmacy activities persuaded the government to start structural financing of clinical pharmacy.