Public-private Approach Research Articles

Shining a spotlight on the inclusion of disabled participants in clinical trials: a mixed methods study

BackgroundIt is crucial to include a wide range of the population in clinical trials for the outcome to be applicable in real-world settings. Existing literature indicates that under-served groups, including disabled people, have been excluded from participating in clinical trials without justification. Exclusion from clinical trials exacerbates disparities in healthcare and diminishes the benefits for excluded populations. Therefore, this study was conducted to investigate potential obstacles that prevent disabled people from participating in clinical trials in the United Kingdom (UK).MethodsThe study was carried out through an explanatory sequential mixed methods design. The Imperial Clinical Trials Unit devised and implemented an online questionnaire-based survey (with open/closed-ended questions) and an online focus group discussion. The target population were disabled people, family members/carers of disabled people and staff involved in clinical trials, whereupon the sample was recruited by convenience sampling methods via posters and emails through various networks. The Qualtrics XM survey system was used as the host platform for the online survey, and Microsoft Teams was used for an online focus group discussion. The focus group discussion was conducted to gain a deeper understanding of the themes identified from the survey responses. We analysed responses to the survey via descriptive analysis and used thematic analysis to synthesise the free-text answers from the survey and focus group discussion.ResultsWe received 45 responses to the survey questionnaire and 5 disabled people took part in a focus group discussion. Our findings highlighted the differences between the perspectives of researchers and those “being researched” and different types of barriers experienced by disabled people: opportunity barriers (inadequate recruitment strategy and ambiguous eligibility criteria), awareness barriers (perception of disability) and acceptance/refusal barriers (available support and adjustment, and sharing of trial results).ConclusionOur findings support perspectives drawn from the Ford Framework regarding the need to consider all barriers, not just up to the point of enrolment into trials but also beyond the point of inclusion in clinical trials. We support calls for the introduction of legislation on including disabled people in clinical trials, implementation of industry/community-wide participatory approaches and the development of guidelines, a combined public–private approach.

A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh

BackgroundExpanding the health workforce to increase the availability of skilled birth attendants (SBAs) presents an opportunity to expand the power and well-being of frontline health workers. The role of the SBA holds enormous potential to transform the relationship between women, birthing caregivers, and the broader health care delivery system. This paper will present a novel approach to the community-based skilled birth attendant (SBA) role, the Skilled Health Entrepreneur (SHE) program implemented in rural Sylhet District, Bangladesh.Case presentationThe SHE model developed a public–private approach to developing and supporting a cadre of SBAs. The program focused on economic empowerment, skills building, and formal linkage to the health system for self-employed SBAs among women residents. The SHEs comprise a cadre of frontline health workers in remote, underserved areas with a stable strategy to earn adequate income and are likely to remain in practice in the area. The program design included capacity-building for the SHEs covering traditional techno-managerial training and supervision in programmatic skills and for developing their entrepreneurial skills, professional confidence, and individual decision-making. The program supported women from the community who were social peers of their clients and long-term residents of the community in becoming recognized, respected health workers linked to the public system and securing their livelihood while improving quality and access to maternal health services. This paper will describe the SHE program's design elements to enhance SHE empowerment in the context of discourse on social power and FLHWs.ConclusionThe SHE model successfully established a private SBA cadre that improved birth outcomes and enhanced their social power and technical skills in challenging settings through the mainstream health system. Strengthening the agency, voice, and well-being of the SHEs has transformative potential. Designing SBA interventions that increase their power in their social context could expand their economic independence and reinforce positive gender and power norms in the community, addressing long-standing issues of poor remuneration, overburdened workloads, and poor retention. Witnessing the introduction of peer or near-peer women with well-respected, well-compensated roles among their neighbors can significantly expand the effectiveness of frontline health workers and offer a model for other women in their own lives.

From TOD to TAC: Why and How Transport and Urban Policy Needs to Shift to Regenerating Main Road Corridors with New Transit Systems

The need for transit oriented development (TOD) around railway stations has been well accepted and continues to be needed in cities looking to regenerate both transit and urban development. Large parts of suburban areas remain without quality transit down main roads that are usually filled with traffic resulting in reduced urban value. The need to regenerate both the mobility and land development along such roads will likely be the next big agenda in transport and urban policy. This paper learns from century-old experiences in public–private approaches to railway-based urban development from around the world, along with innovative insights from the novel integration of historical perspectives, entrepreneurship theory and urban planning to create the notion of a “Transit Activated Corridor” (TAC). TACs prioritize fast transit and a string of station precincts along urban main roads. The core policy processes for a TAC are outlined with some early case studies. Five design principles for delivering a TAC are presented in this paper, three principles from entrepreneurship theory and two from urban planning. The potential for new mid-tier transit like trackless trams to enable TACs is used to illustrate how these design processes can be an effective approach for designing, financing and delivering a “Transit Activated Corridor”.

The state market relationship as a real estate technology: FHA multifamily development and preservation, 1934 – present

ABSTRACT Between the 1930s and the 1950s the United States Federal Housing Administration (FHA) developed a set of programs to spur the private development of hundreds of thousands of multifamily rental and cooperative units. To do so, the government crafted real estate technologies, working through iterative processes that weigh the social need for housing with what makes developers and investors engage. This technology generated units as well as a public-private approach to housing production. We use archival, government and journalistic sources to investigate these technologies in practice in early FHA multifamily programs, locate the housing stock it generated in New York City, and explore how real estate technologies changed over time. The discourse of state market relations transforms what is legally a mortgage insurance program into proto-neoliberalism. The FHA multifamily programs provide a lens to view one way in which the negotiation of effective real estate technologies shape state market relations.

Binary Governance: Lessons from the GDPR's Approach to Algorithmic Accountability

Algorithms are now used to make significant decisions about individuals, from credit determinations to hiring and firing. But they are largely unregulated under U.S. law. A quickly growing literature has split on how to address algorithmic decision-making, with individual rights and accountability to nonexpert stakeholders and to the public at the crux of the debate. In this Article, I make the case for why both individual rights and public- and stakeholder-facing accountability are not just goods in and of themselves but crucial components of effective governance. Only individual rights can fully address dignitary and justificatory concerns behind calls for regulating algorithmic decision-making. And without some form of public and stakeholder accountability, collaborative public-private approaches to systemic governance of algorithms will fail. In this Article, I identify three categories of concern behind calls for regulating algorithmic decision-making: dignitary, justificatory, and instrumental. Dignitary concerns lead to proposals that we regulate algorithms to protect human dignity and autonomy; justificatory concerns caution that we must assess the legitimacy of algorithmic reasoning; and instrumental concerns lead to calls for regulation to prevent consequent problems such as error and bias. No one regulatory approach can effectively address all three. I therefore propose a two-pronged approach to algorithmic governance: a system of individual due process rights combined with systemic regulation achieved through collaborative governance (the use of private-public partnerships). Only through this binary approach can we effectively address all three concerns raised by algorithmic decision-making, or decision-making by Artificial Intelligence (“AI”). The interplay between the two approaches will be complex. Sometimes the two systems will be complementary, and at other times, they will be in tension. The European Union’s (“EU’s”) General Data Protection Regulation (“GDPR”) is one such binary system. I explore the extensive collaborative governance aspects of the GDPR and how they interact with its individual rights regime. Understanding the GDPR in this way both illuminates its strengths and weaknesses and provides a model for how to construct a better governance regime for accountable algorithmic, or AI, decision-making. It shows, too, that in the absence of public and stakeholder accountability, individual rights can have a significant role to play in establishing the legitimacy of a collaborative regime

Regulatory challenges of nanomedicines and their follow-on versions: A generic or similar approach?

Nanomedicines and follow-on versions (also called nanosimilars in the EU) have been on the market partially for decades although without recognition of their nano properties in the beginning; a substantial number is in clinical development. Nanomedicines are typically synthetic and belong to the non-biological complex drugs. They show a high variability in form, structure, and size. Additionally large molecule biologics show nano-characteristics meaning nano-dimension in size (1-100 nm) or specific properties related to these dimensions. The high complexity of nanomedicines with their heterogeneous structures do not allow a full physicochemical quality characterization, challenging the regulatory evaluation especially for follow-on versions upon comparison with the reference product. The generic paradigm with the sameness approach for quality and bioequivalence in blood plasma is not appropriate for nanomedicines where a similar approach is needed. After experiencing non-equivalence of authorized parenteral colloidal iron follow-on versions, EMA and FDA issued reflection papers and draft guidances for industry to present their current thinking on the evaluation of such complex products. A stepwise approach to evaluate the extent of similarity, from quality, including critical quality attributes (CQA) and assessment of nano properties, to a non-clinical biodistribution assay, required in the the EU but not in the US, and to clinical evaluation makes sense. The cumulated totality of evidence for the authorization of nanomedicine follow-on versions goes case-by-case. Interchangeability, or substitutability, is a challenge. However, a defined or even harmonized approval pathway for these follow-versions is still missing and causes potential differences in approval. To progress, a science-based discussion platform among stakeholders and experts in the field is necessary. An agenda has been agreed [5], namely CQA assessment, publication of scientific and clinical findings, consensus on nomenclature and labelling, and regulatory actions on substandard complex drug products. Consensus created in a public private approach will support progress towards a defined and harmonized regulatory pathway for nanomedicines and their follow-on versions. This will provide drug innovation but also larger access to follow-on versions of nanomedicines, both a benefit for the patient.

Ensuring Continued Support for the Rules-Based Multilateral Trading System: The Need for a Public–Private Approach

The stability and resilience of intergovernmental and supranational institutions is increasingly being tested. The constraints that the WTO Agreement places on executive organs in its Members are being questioned in academia and by politicians. Reform of institutional aspects of the WTO’s dispute settlement process is coupled to the re-appointment of Appellate Body Members. These are interesting times for the rules-based multilateral trading system, to say the least. This think piece raises more questions than it can possibly answer. Yet, a central element that runs as a common thread through this contribution is the question whether trade liberalization, free movement of capital, and the resulting facilitation and emergence of GVCs have resulted in an inability of WTO Members to address domestic problems such as unemployment among workers in the manufacturing industry. Technological innovations such as automation and digitalization have equally contributed to a shift in the labour market from the manufacturing sector to other sectors. This raises questions as to the most appropriate and effective way to address the negative aspects of globalization and to ensure that the support for the rules-based multilateral trading system is not eroded. This contribution addresses the current criticism of the negative side effects of globalization and examines proposals at the bilateral level that are aimed at “conditionalizing” the liberalisation of trade. Thereafter it advocates a “public-private” approach at the domestic level which involves all stakeholders, as it is essential that those “left-behind” by globalisation are actively engaged with.

Governance Options to Enhance Ecosystem Services in Cocoa, Soy, Tropical Timber and Palm Oil Value Chains

Dutch policies have advocated sustainable commodity value chains, which have implications for the landscapes from which these commodities originate. This study examines governance and policy options for sustainability in terms of how ecosystem services are addressed in cocoa, soy, tropical timber and palm oil value chains with Dutch links. A range of policies addressing ecosystem services were identified, from market governance (certification, payments for ecosystem services) to multi-actor platforms (roundtables) and public governance (policies and regulations). An analysis of policy narratives and interviews identified if and how ecosystem services are addressed within value chains and policies; how the concept has been incorporated into value chain governance; and which governance options are available. The Dutch government was found to take a steering but indirect role in all the cases, primarily through supporting, financing, facilitating and partnering policies. Interventions mainly from end-of-chain stakeholders located in processing and consumption countries resulted in new market governance, notably voluntary sustainability standards. These have been successful in creating awareness of some ecosystem services and bringing stakeholders together. However, they have not fully addressed all ecosystem services or stakeholders, thus failing to increase the sustainability of value chains or of the landscapes of origin. We argue that chains sourced in tropical landscapes may be governed more effectively for sustainability if voluntary, market policy tools and governance arrangements have more integrated goals that take account of sourcing landscapes and impacts along the entire value chain. Given the international nature of these commodities. These findings have significance for debates on public-private approaches to value chain and landscape governance.

Universal health coverage and public-private participation: towards a new balance?

Abstract This commentary discusses the emergence of a new paradigm to address the health policy issues through Public-Private Participation (PPP). The discussion provides a detailed literature review of PPPs by presenting an initial overview of the ideological shift from state to market intervention, then identifying arguments in support of or against public-private approaches and finally exploring the emergence of this new paradigm of PPP or its hybrid forms. It then discusses the contextual realities of Public-Private Participation in health care, and whether an optimal balance is possible with better government stewardship and private provision. Conceptually, the premise of stewardship in governance is that it is possible to create not only efficient but also effective systems. These ideas may find a receptive audience in many countries, especially in the emerging economies with improving standards. In East Asian societies, the concept of stewardship bears a strong resemblance to Confucian ideals of morality in government, with social expectations of those who govern to be principled and virtuous. Increasingly, a pragmatic theory of development seems to apply in public-private, similarly, through it is expected, that public-private participation in the healthcare system should also achieve the goal of Universal Health Coverage through good governance.

Potential Assistance for Disadvantaged Workers: Employment Social Enterprises

By integrating a business mission into a transitional jobs program, employment social enterprises (ESEs) provide temporary work and a supported work environment to reduce the barriers facing disadvantaged workers while generating revenue to cover production costs. This study uses surveys of workers in and financial statements from seven ESEs to provide information for three sets of complementary analyses: a pre-post analysis examines changes in employment between the time a person starts ESE work and about one year later; a case study uses propensity score methods to compare changes in employment between ESE workers and similar people who did not work in an enterprise; and a cost-benefit analysis estimates the potential value of ESE jobs. Results suggest that individuals have close to 21% gain in employment one year after starting ESE work; taxpayers gain at least $0.42 for every dollar spent on an ESE job; the return to society of developing an ESE is at least 34%; and the social returns to converting a profit-driven business into an ESE exceed 100%. Although the study cannot control for many of the factors that would allow estimation of causal impacts, it provides some of the first preliminary evidence of the value of the ESEs’ public-private approach to increase workforce skills and employment and stabilize lives of individuals with employment barriers.

Good practices for advancing urban mobility innovation: A case study of one-way carsharing

Transforming urban mobility requires integrating public with private services into a single transportation system. Local governments and private companies face the challenge of how to coordinate themselves. An emblematic example is one-way carsharing (shared use of a fleet of vehicles that are typically free-floating throughout an urban area).Surprisingly, good practices for public and private players innovating together remain relatively undocumented. This paper proposes a systematic and balanced public-private approach to foster transportation innovation management. We review both public policy and business management literature and build a framework to help governments and companies collaborate (organizational structures, project management processes, and profitability assessment tools).We use this framework to examine both public and private experiences through a case study analysis with five one-way carsharing services in Europe (Paris, Munich) and the United-States (San Francisco, Portland, Seattle). For each we conducted expert interviews with the government and the private operator. This paper provides recommendations for both sectors. First, public and private players should have specific organizations, separated from the core business. Second, they should co-manage innovation since pilot projects lack certainty and require risk management. Third, a new approach to value emphasizing the role of project learning and capability building is necessary.

Contracting for Control of Landscape-Level Resources

I. INTRODUCTIONPolicy discussions increasingly envision a role for private actors in a wide variety of governance contexts.1 Growing awareness that industry actors and nongovernmental organizations play vital leadership roles in the development of law and policy call traditional notions of the government as a unilateral decisionmaker into question.2 Environmental law is a particularly fertile ground for studying public-private approaches.3 Collaborative environmental governance4 and new governance5 approaches are increasingly evaluated for their flexibility and nimbleness in addressing complicated environmental problems.6We focus on a specific subset of private governance of environmental resources: the use of contract. Contracts govern multiple natural resources on vast western landscapes. Any single land parcel is potentially subject to a multitude of contracts. Contracts governing landscape-level resources7 range from oil and gas extraction to exploitation of mineral rights, reciprocal use of private roads to conservation of endangered species. Yet, we know little about the conditions under which contractual regimes are likely to emerge, and even less about their substantive content or normative desirability.The need for contract-or some form of governance arrangement-to control landscapes emerges from tension between manmade property divisions, such as land parcels, and natural resources.8 Legal discussion about land operates almost exclusively through the construct of property, in which land is divided and owned.9 Chopping land into neat bundles serves human purposes by reducing conflict and encouraging investment through the establishment of entitlements and boundaries. However, the property paradigm that divorces land from landscapes also imposes costs on those seeking to govern large-scale natural resources that cannot be constrained into neatly defined lines.10 As a result, areas of shared public-private control emerge.11Landscape-level resources are often imagined to be controlled almost entirely by agencies operating under state and federal laws.12 Yet, the majority of American lands, and the natural resources upon them, are privately owned. Effective resource management thus requires participation by private parties. Land itself is managed on a parcel-by-parcel basis, but resources can seldom be effectively managed, exploited, or conserved in the same way. Synergistic uses produce more effective resource outcomes than competing or conflicting uses on a parcel-by-parcel basis. Transaction costs subsume small-aquifers, scale attempts to monetize resources. Conservation, preservation, recreation, and wildlife resource management operate best when there is a single, cohesive landscape-level management approach. The need for coordination among private actors gives rise to private bargaining, which can be understood in part as a system of private ordering.13 Private bargaining leading to contractual arrangement is one form of governance for landscape-level resources crossing multiple property lines.14We examine how laws, landowner-resource-use preferences, and transaction costs affect the choice of a governance mechanism to manage landscape-level resources. We provide an overview of several areas in which contractual arrangements govern resource management, including: groundwater, oil and gas, wildlife, marine fisheries, scenic landscapes, and conservation. Then, we turn towards exploring the conditions under which private contacting emerges.15 A series of case studies of the various contractual arrangements used to manage wildfire illustrate that the homogeneity of resource use among landowners, low transaction costs, and laws that favor individualistic outcomes promote the use of contracting as a resource-management tool. These observations suggest that contracting is most difficult when land is fragmented and land uses are heterogeneous among landowners. Yet, this is precisely the setting in which the use of contract can be most important to effective resource use and conservation. …

Food Safety and Developing Markets: Research Findings and Research Gaps

To better inform donor support for public food safety interventions, this paper reviews the literature on the impact of more stringent food safety standards on developing-country markets. This literature has primarily focused on the market access and economic implications of higher standards in export markets rather than on the extensive debate around market failure and public health benefits that dominates the literature in developed countries. We find that the market access benefits from compliance with public and private food safety standards are clear, as is the market exclusion that results from noncompliance. These benefits are now well documented, with more recent evidence pointing to added benefits of poverty reduction and spillovers for health and productivity. Rigorous evidence is also found concerning the positive role of technical assistance and public or donor support. Most of the literature, however, has focused on the relatively small market for EU horticultural products, which will provide opportunities for only a fraction of developing-country producers. This narrow focus causes important gaps in the literature informing meaningful public roles in addressing food safety in developing countries. Future research should examine and rigorously evaluate alternative models for how best to support improved food safety management outside of the export channels that have been the focus of the literature thus far. Further, evaluating the impact of public-private approaches on reduction in enforcement costs and improving compliance through supporting industry-led efforts would better inform donor support for food safety reforms, as would research among developing-country consumers with respect to food safety reforms and public health.

Crowd-sourcing delivery system innovation: A public–private solution

We propose the establishment of a public–private approach which creates and maintains a “delivery systems innovations knowledge management system” to define, describe, and assess novel delivery approaches. The public sector could provide the foundational technology, resources and convening power for this innovations database. The private sector would contribute practical innovations that could guide annual strategic planning and implementation.A crowd-sourced effort would jump start delivery system reform. We believe that providing a comprehensive knowledge resource will not stifle competition or private sector opportunities but rather augment and speed the application of effective innovation.

Public-Private Partnership (PPP) Projects for Malaysian Tolled Highways – An Insight using a Political Economy Approach

Tolled highways in Malaysia are built under the public-private approach in which the government provides the opportunities for the involvement of the private sector in the construction of these infrastructures. Using a political economy approach, this paper seeks to identify the main concession holders of the Malaysian tolled highways and ascertain in what way the tolled highways influence the political and economic arenas. This paper finds that the tolled highways in Malaysia play a significant role in achieving the country’s economic objectives.

Indiana Example of Collaboration and Innovation

What do we know about innovation in the social sector that can help policy makers support and take to scale great ideas that make a difference for students? Thanks to a collaboration between government and the private sector, Indiana high schools are being transformed into engaging, project-based learning environments. The launch and scale-up of Indiana's New Tech Network from 2001 to 2010 offer seven key lessons for other states. Lesson #1. Develop a broad vision for change. Key stakeholders in Indiana recognized the critical relationship between education improvement and economic growth. One of the earliest demonstrations of this emerging vision came in 2001 when the University of Indianapolis established the Center for Excellence in Leadership and Learning (CELL), the university's first foray into the K-12 arena, to bring together schools, communities, and businesses in a concerted effort to prepare all Indiana students for success in a global economy. Gov. Mitch Daniels was keenly interested in education reform as an economic growth tool. Rather than mandating change from the top down, the governor and his senior adviser for human capital supported CELL's efforts to identify high school transformation models that would support both education innovation and economic growth. Thus, by the end of 2002, Indiana had established a broad-based vision for a collaborative, public-private approach to education innovation and economic growth. Lesson #2. Anchor the vision to principles. In 2005, Indiana submitted a proposal to the National Governors Association (NGA) to help school corporations develop innovative high school models. As part of the NGA proposal, the state required any school corporation receiving a grant to demonstrate that its proposal was: 1) supported by the entire school community, 2) financially sustainable in the long term, 3) aligned with the community's economic growth strategy, and 4) focused on meeting the requirements of a 21st-century education. These principles, known around the state as nonnegotiables, made clear that participating school communities must own the initiative and that proposals must focus on the critical goals of the effort--to prepare students for the new global economy and to drive economic growth statewide. Lesson #3. Secure public and private financial support. Two important grants laid the groundwork for state and local communities to develop an even broader base of support from the public and private sector. The first was the initial Gates Foundation grant of $11.3 million to develop the Network of Effective Small Schools in Indianapolis (NESSI). The second was a $15 million grant from the Lilly Endowment to establish CELL at the University of Indianapolis. In 2007, NGA awarded Indiana $2 million to help implement new high school models. In that same year, Gates awarded an additional $2.3 million to the Indianapolis Public Schools to continue converting large high schools to small learning communities. Since 2006, the Indianapolis-based Tech-Point Foundation has provided more than $400,000 in financial and in-kind support and leveraged an additional $100,000 from community partners in support of New Tech High @ Arsenal Tech, a low-income, urban school in IPS. Techpoint is a social venture capital organization that supports Indiana organizations focused on helping at-risk youth develop skills for a global, information economy. Finally, in 2010, Lilly provided $20 million to Talent Opportunity Success (TOpS) 2015, an 11-county regional program focused on expanding the talent pipeline to support the growth of high-quality jobs in northeast Indiana. A portion of the funds was designated specifically to launch five STEM-focused New Tech High Schools in northeast Indiana. These schools now represent the largest concentration of New Techs in the country. Lesson #4. …

Experience in managing severe malnutrition in a government tertiary treatment facility in Bangladesh.

Children with severe acute malnutrition, defined as weight-for-height <70% of the reference median or bilateral pedal oedema or mid-arm circumference <110 mm having complications, were managed in the Nutrition Unit of the Chittagong Medical College Hospital (CMCH) following the guidelines of the World Health Organization, with support from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children aged less than five years (mean +/- SD age 23.5 +/- 15.3 months) were admitted during June 2005-May 2006. Of them, 66% were aged less than two years, and 84.2% belonged to households with a monthly income of less than US$ 40. The main reason for bringing children by their families to the hospital was associated major illnesses: bronchopneumonia (33%), oedema (24%), diarrhoea (11%), pulmonary tuberculosis (9%), or other conditions, such as meningitis, septicaemia, and infections of the skin, eye, or ear. The exit criteria from the Nutrition Unit were: (a) for children admitted without oedema, an absolute weight gain of > or = 500 and > or = 700 g for children aged less than two years and 2-5 years respectively; and for children admitted with oedema, complete loss of oedema and weight-for-height >70% of the reference median, and (b) the mother or caretaker has received specific training on appropriate feeding and was motivated to follow the advice given. Of all the admitted children, 7.6% of parents insisted for discharging their children early due to other urgent commitments while 11.7% simply left with their children against medical advice. Of the 138 remaining children, 88% successfully graduated from the Nutrition Unit with a mean weight gain of 10.6 g/kg per day (non-oedematous children) and loss of -1.9 g/kg per day (oedematous children), 86% graduated in less than three weeks, and the case-fatality rate was 10.8%. The Nutrition Unit of CMCH also functions as a training centre, and 197 health functionaries (82 medical students, 103 medical interns, and 12 nurses) received hands-on training on management of severe malnutrition. The average cost of overall treatment was US$ 14.6 per child or approximately US$ 1 per child-day (excluding staff-cost). Food and medicines accounted for 42% and 58% of the total cost respectively. This study demonstrated the potential of addressing severe acute malnutrition (with complications) effectively with minimum incremental expenditure in Bangladesh. This public-private approach should be used for treating severe acute malnutrition in all healthcare facilities and the treatment protocol included in the medical and nursing curricula.

Juridical Bonds of Marriage for Jewish and Islamic Women

This paper examines the condition of women in both Israel and Islamic countries, specifically their freedom to leave a marriage, and compares respective models. First, the study analyses the peculiar relationship between secular and religious law in Israel and Islamic countries. Second, it studies the nature of marriage as a contract in these legal systems, comparing a totally private approach and a mixed, public–private approach. Third, it analyses the possibilities of dissolution of marriage in such legal systems, indentifying some aspects of gender disparity. Finally it discusses some juridical tools offered in these legal contexts, which are intended to rebalance the exercise of a woman's freedom to leave a marital relationship and its conditions.

Cross border Classical Swine Fever control: Improving Dutch and German crisis management systems by an integrated public-private approach

The objective of this research approach is to analyse in which ways crisis management measures against Classical Swine Fever (CSF) can be improved by a public private cross border model. A core activity contains the analysis of information and communication systems: In a case study it has been empirically analysed if a sufficient supply of public and private information enables crisis managers at both sides of the Dutch-German border area to take decisions about CSF control more efficient. At the end of this approach a new crisis management model had been developed. One of the most important aspects thereby is the assessment of data: (1) within private quality management systems in normal times according to the benefit for public management tasks in times of crisis and (2) within public crisis management systems according to the benefit for cross-border CSF-control activities. To this effect two different methodological approaches have been combined within the model: (1) a method to identify and illustrate public actors and their options in crisis management decision making and (2) a system of communication and information exchange between public and private as well as Dutch and German actors (engage& exchange model) which permit to collect and to evaluate data in addition for a predefined time period are activated.

Mesenchymal stem cells from umbilical cord: Do not discard the cord!

On 10th February 2007, English entrepreneur Sir Richard Branson, best known for his Virgin brand of over 360 companies, announced the establishment of a cord blood bank, the Virgin Health Bank, in London. What makes this bank different is a dual public–private approach. A fifth of the cord blood would be stored for private use for the child or a family member and the rest would be donated to the public part of the bank which will be accessible to anyone in the world who needs it, at no cost. Additionally, Branson has pledged to donate his 50% of proceeds from Virgin Health Bank to researchers investigating the potential of cord blood stem cells [1]. The idea for the dual bank emerged when he was visited by a senior director of the National Blood Center, asking for his support in a charitable role, because children were dying through lack of umbilical cord blood. Initially Sir Richard offered 3 million pounds to the National Health Service to help them increase their storage capacity for umbilical cord blood, but the center was not comfortable with accepting funds from private sources. So Sir Richard decided to set up a company to do the job. This is an initiative that should be applauded but we want to draw attention to a very important and urgent aspect. The routine procedure in umbilical cord banks has been to store the blood and discard other tissues, such as the cord and/or placenta, which is a much better source of mesenchymal stem cells than blood [2]. Umbilical cord