Expand Service Coverage Research Articles

A new coding- and interference-aware routing protocol in wireless mesh networks

Wireless Mesh Networks (WMNs) have the advantages of low up-front costs, ease of deployment, enhanced capacity and expanded service coverage. However, critical problems such as limited frequency resources, interference, noise and channel fading, make it difficult to improve the throughput of WMNs. Current routing schemes based on network coding either passively wait for potential coding opportunities or fail to reflect the essence of wireless interference. Therefore, a novel Coding and Interference Aware Routing (CIAR) protocol is proposed in this paper, which not only actively detects potential coding opportunities in establishing paths but also takes into account the interference cost in path selection. The CIAR protocol can well make the tradeoffs for routing choices between facilitating more coding gains and mitigating interference. The simulation results demonstrate that our proposed CIAR protocol performs better than traditional schemes in terms of average end-to-end throughput, average end-to-end delay and buffer overflow probability.

From government-driven to commercially-driven mergers: changing drivers for upscaling in the Dutch water supply sector

Over the past century the Dutch water supply sector has undergone a process of upscaling in which the number of utilities dropped from 230 in the late 1930s to 14 in 2007. Although the policy of upscaling service provision has been continued over this period, the driving forces behind the upscaling process have changed from government-steered upscaling to mergers which are initiated and executed by the water utilities. The shift in drivFing forces reflects two interlinked changes in the Dutch water supply sector. First, it highlights a shift in objectives that public water utilities are expected to achieve. The government-driven mergers in the first part of the 20th century focused on expanding service coverage to the unserved population. The mergers of the past decade highlight the increasing emphasis on efficiency and “market position”. Secondly, the change in driving forces behind the mergers in the Dutch water supply sector, as illustrated by the case of Friesland, reflect the shift to a “new model of public management” in the water services sector in which public water utilities are expected to operate as autonomous agencies and on the basis of commercial principles (meaning that economic considerations for mergers predominate).

Resource dependency and community participation in primary health care

Great hope is accorded to community participation in health. A large number of potential benefits are attributed to participatory processes, including better addressing community needs through more locally adapted organizational processes and improvement in health outcomes. To this end, many governments around the world have adopted policies and programmes of community participation as part of their strategy to implement primary health care services. In Mexico this is, in great part, realized through the module programme of the Ministry of Health. A module is characterized by various village based health posts ( casas de salud), each operated by a community volunteer and associated with a health committee, all of which are supervised by a nurse from a nearby health centre. The southern Mexican state of Oaxaca was chosen for a study of the module programme (during the period 1987–1992) to gain a better understanding of how organizational processes impact on the implementation and outcomes of community participation programmes in large institutions (i.e. the Ministry of Health). The resource dependency perspective formed the basis for the theoretical framework used. Some 75 towns and villages were visited and about 170 health related personnel from all over the state were interviewed to obtain data on the operation and impact of the module programme. As predicted by resource dependency theory, which postulates that organizations will react to pressures in their external environment to secure the resources needed for survival, the findings of this research led to the conclusion that the Ministry of Health had co-opted the resources of the communities it was involving in the module programme in order to meet its policy objectives, especially those related to expanding service coverage. Community participation in the module programme was found to have been implemented entirely for its utility in supplying resources and not for democratic or intrinsic values. This strategy, identified as the resource dependency approach to community participation, led to several flaws in the participatory process and resulted in far less than what could potentially have been achieved in terms of improving health outcomes. Ultimately, the participatory mechanisms became additional dependencies of the health system and not integral components of a process of community development. Large institutional programmes of community participation can benefit by understanding this approach and avoiding its inherent problems.

Medicaid Policy Statement

The American Academy of Pediatrics recognizes the achievements of the Medicaid program in improving access to health care services for poor children. Despite recent legislative expansions to extend eligibility to more poor and disabled children and to broaden the scope of preventive and treatment services in all states, several additional program improvements are needed to eliminate the following barriers to access: 1. Federal and state fiscal crises are creating major roadblocks to Medicaid program implementation and expansion. 2. Thousands of poor children will not be eligible for Medicaid until October 1, 2001.1 3. Only a portion of those who are potentially eligible for Medicaid apply for coverage, and many eligible children do not utilize services. 4. Fewer Medicaid funds are available for primary and preventive care because of the increasing need for long-term care services. 5. Early and periodic screening, diagnosis and treatment (EPSDT)/preventive health services are being received by too few children and the implementation of expanded service coverage under EPSDT, granted in 1989, is subject to a great deal of inconsistent state interpretation. 6. Inadequate provider reimbursement reduces children's access to health care services. The Academy has developed the "Children First" proposal which calls for the elimination of Medicaid and replaces it with a one-class, private insurance system of universal access to health care for all children through age 21 and for all pregnant women.2 However, until the "Children First" proposal, or a similar health care reform initiative is implemented, the Academy recommends the following policy actions to improve the current Medicaid program.

Doctors' roles in primary health care.

Doctors in developing countries where the majority of the population live in rural areas are facing difficult adjustments of their roles to attain health for all of the rural population. In Thailand, doctors directing remote district hospitals act as the focal points of other health care facilities serving the entire population of the districts. To supplement the existing governmental health service network and in accordance with principles of primary health care, community primary health care volunteers are being developed to expand service coverage to rural communities. These lead to changes in doctors' roles. Doctors are required to be not only competent clinicians but also good managers of health promotive and preventive programmes, effective hospital administrators, competent trainers and qualified researchers. They must not only work within the hospital but also support the health personnel and activities of the entire district, and in particular the community primary health care workers. However, as it is now, they are graduates of traditional medical schools, whose educational programmes do not equip them adequately for their emerging new roles in rural hospitals. Reorientation of the existing health system, including its health personnel, is needed. The critical factor in such a process is the development of appropriate attitudes at all levels of health services. This is a difficult but challenging task, as it involves long established medical institutions which hold firmly to old traditions and values.