Zugl.: Münster (Westfalen), Universiẗat, Diss., 2009.

Objective: The overall aim of the work is to contribute to a better understanding of the dynamics between health sector reform policies and practices as well as the factors that determine and shape the thinking about global public health; and to try out a framework for understanding the inter-linkages and interactions between the determinants for and the elements of health sector reforms and their implementation. Methods: The object of study was a contemporary phenomenon, consisting of a diverse array of interventions in many different directions and fields within a complex political, social and economic environment. It is difficult to attribute the effects of the reforms to any single intervention or to establish exact boundaries between the phenomenon and the context. Therefore, a multi-stage case study research strategy, based on the work of R.K.Yin, was chosen. The study involved two major sub-units of analysis, i.e., the macro and the micro level. Each of these involved several sub-units of analysis. The analysis of the micro level further comprised a cross-case analysis of 10 individual case studies conducted in six developing countries. Results: Clear linkages were found between the greater societal processes and the shape and results of reforms during the decade. The reforms had not been completed in any of the countries studied, but appeared to be stuck with undesired effects, lacking energy to move forward. Contributing to this was the diminishing role of the state, which bordered abdication from public health in most of the countries, leaving the drive to the market and individual demands and interests. The net effect could well be a reversal of some of the public health achievements of the past - however, it was also found that reverting to dedicated disease control programmes would not be the answer, as these were found unsustainable and undermining the health systems. Conclusion: There is a divide between libertarian and utilitarian values on the one side and communitarian and egalitarian values on the other. Thus, it is not just about public health practitioners not being good enough to implement, it is more so about what we want to achieve and what it acceptable respectively not acceptable and reaching compromises. This place the societal processes at centre-stage for public health. However, it is also about implementation, it is about how public health policy-makers and reformers can effectively dialogue and facilitate achieving consensus and translate the societal 'wants' and 'want nots' into managerial bites. Implementation becomes a process of constant adjustment and readjustment oscillating between political and technocratic levels

Thesis (D. Min.)--Trinity Evangelical Divinity School, 2001. / Abstract. Includes bibliographical references (leaves 320-331).

Thesis (D. Min.)--Trinity Evangelical Divinity School, 2001. / Abstract. Includes bibliographical references (leaves 320-331).

Chagas disease caused by the protozoan Trypanosoma cruzi is the leading cause of heart disease in Latin America. After an acute phase that typically includes few symptoms, a chronic cardiac phase occurs for many infected individuals. The progression to chronic heart disease is not fully understood in Guatemala. The objective of this study was to determine the association between T. cruzi infection and progression to Chagas heart disease in Guatemala and determine if the relation is modified according to vector predominance. Using a community-based cross-sectional approach, 813 individuals from two areas of Guatemala were included in the study: 478 (58.8%) from Jalapa and 335 (41.2%) from Chiquimula. Data including serologic evaluation, electrocardiography (ECGs) and demographics were collected to compare the degree of detectable cardiac abnormalities in infected and uninfected individuals. Overall, T. cruzi seroprevalence was 28.8%, 247 (30.4%) presented an abnormal electrocardiography and 79 (9.7%) were diagnosed as Chagas heart disease. Seroreactivity was statistically (p-value<0.05) associated with abnormal ECG, Chagas heart disease, community, age, occupation, time living in the area, knowledge of the vector, ventricular condition defects and ST-T waves changes. The age and sex-adjusted association between a positive seroreactive and abnormal ECG was higher in Jalapa OR=2.0 (CI95% 1.2, 3.1) than in Chiquimula OR=1.2 (CI95% 0.9, 1.8). These results show the high Chagas-cardiac burden in this population and support the idea that the vector predominance plays an importance role in the association and that this should be taken into account in the design of intervention for vector control.

Zugl.: Augsburg, Universiẗat, Diss.

La coutume n’est pas uniquement la cumulation de ses deux éléments que sont la pratique et l’opinio juris, elle est en plus, et peut-être surtout, une opération. L’opération coutumière permet le passage de la pratique à la conviction du droit. Cette opération n’est possible qu’en ce que la pratique n’est pas uniquement la répétition de conduites, mais avant tout l’observation de cette répétition par les destinataires de l’obligation en formation. Dès lors, la coutume peut se définir comme une opération imprévisible par nature, identifiable toujours après coup, par la production de conduites, leur observation par les destinataires de l’obligation, puis par l’existence d’une conviction du droit de ces mêmes destinataires. La conviction en l’existence de l’obligation consiste finalement en une explication, pour les destinataires, de la répétition observée. Pourquoi une telle répétition existe, si ce n’est parce qu’il existe une obligation y contraignant. De ce point de vue, la coutume de droit international pénal, bien qu’identifiée abondamment par les juridictions internationales pénales, présente des difficultés d’identification inédites : les conduites pertinentes sont souvent cachées, elles ne sont pas observables, en particulier en temps de guerre et dans le cadre des hostilités, les destinataires sont les personnes physiques et, enfin, le droit international pénal s’est développé par l’intermédiaire de l’activité de juridictions ad hoc, ayant quasiment une obligation de résultat quant à leur compétence et l’existence de condamnations. Il en ressort une modalité d’identification des normes coutumières posant des questions inédites. / Custom is not only the accumulation of these two elements that are the practice and the opinio juris, it is additionally, and maybe mostly, an operation. The customary operation allows to pass from practice to the conviction of law. This operation is only possible in that practice is not only the repetition of conducts, but above all, the observation of this repetition by the addressee of the obligation in formation. Therefore, custom can be defined as an operation which is, in nature, unforeseeable, identifiable afterwards, by the production of conducts, and their observation by the obligation’s addresses. The conviction in the existence of the obligation actually consists in an explanation, to the addressees, of the observed repetition. Why would the repetition exist if not because of an obligation constraining it to be so. From this point of view, the custom of international criminal law, bears unprecedented identification difficulties. Indeed the pertinent conducts are often hidden and cannot be observed, particularly at times of war and in the context of hostilities. Furthermore, the addressees are natural persons. Lastly, international criminal law has developed through the activity of ad hoc jurisdiction that had practically an obligation of result concerning their jurisdiction and the existence of condemnations. From these difficulties emerges an identification method of customary rules bearing unprecedented issues.

While the health sector has attracted significant foreign aid, evidence on the effectiveness of this support is mixed. This dissertation examines the allocation of health aid within the context of placement, service utilization, and benefit. The first paper examined the sub-national allocation of Chinese development aid projects across Africa. I determined how political preferencing of Chinese aid specifically, allocating aid to the birth region of the current political leader differs across sectors such as health, education, and transportation. I find some evidence that aid, more broadly defined, is subject to political preferencing in recipient countries, which could potentially limit its intended effects. The second paper examines the influence of health aid on malaria service utilization in Malawi. It tests the hypothesis that health aid boosts a facility’s readiness to provide malaria services, thereby increasing the utilization of malaria services in a facility’s service area. Findings indicate that while increased health aid is associated with increased health facility readiness to diagnose malaria, these improvements are not generally related to increased health care utilization. The final project focuses on population level health effects of health aid placement in the Democratic Republic of the Congo, specifically whether all‐cause child mortality is lower in regions receiving malarial aid interventions. Among the most promising evidence xi found on the potential benefit of health aid is that investments, such as malaria bed nets, are associated with reductions in child mortality, particularly in rural settings and among those with low malaria burden. These latter findings suggest health aid should be carefully targeted and should consider local disease risks to fully realize the benefits of population‐level improvements in child health. When taken together, my findings indicate that health aid is positively associated with limited improvements in health outcomes. Overall, these results support a need for researchers to avoid the temptation to aggregate aid flows and health outcomes at the country level, and instead examine sector‐specific aid flows at the lowest sub-national geographic unit possible in order to inform policies designed to allocate health aid.

Depuis la création de l'article XXIV du GATT, les recherches et les analyses liées à la relation entre le droit de l'OMC et les accords commerciaux régionaux ont été basés principalement sur cet article et sur la recherche pour la compatibilité des ACR avec les conditions et les critères proposés par ce dernier. Autres dispositions liés au même thème ont été créés, comme l'article V de l'AGCS et la Clause d'habilitation, qui cherchent à couvrir le commerce des services dans ces accords et regarder d'octroi de préférences en fonction du niveau de développement des Membres de l'OMC. Avec le temps, il a été constaté que l'application de ces dispositions et procédures d'évaluation de la compatibilité n'ont pas eu l'effet souhaité par les négociateurs des règles de l'OMC. Les ACR ont continué à se multiplier en parallèle avec le système de l'OMC et des relations de complémentarité, de concurrence et de conflit ont été établis entre eux. Face à l'inefficacité d'articuler les ACR avec le droit de l'OMC uniquement pour l'utilisation de dispositions conçus pour cela, on doit chercher dans d'autres dispositions de l'OMC, des outils pour atteindre cet objectif. En outre, ces dispositifs permettent l'utilisation de règles de droit international public dans certaines limites et ces règles peuvent être très utile pour l'articulation des ACR et de droit de l'OMC. Pour ce faire, il faut diviser l'analyse en deux phases, la première de recherche d'une articulation normatif et la seconde portait sur le traitement de la multiplicité des fora / Since the creation of article XXIV of the GATT, research and analysis related to the relationship between WTO law and Regional Trade Agreements (RTAs) have been based primarily on this article and the search for compatibility of RTAs with conditions and criteria proposed by the latter. Other provisions related to the same theme were created, such as Article V of the GATS and the Enabling Clause, that seek to cover trade in services in these agreements and look for the granting of preferences based on the level of development between WTO Members. However, over time, the application of these provisions and procedures for assessing the compatibility have not reached the desired effect by the negotiators of WTO rules. The RTAs continued to increase in parallel with the WTO system and complementary relationships, competition and conflicts have been established between them. The ineffectiveness to articulate RTAs with WTO law solely using the article XXIV of the GATT leads us to search for new legal tools to achieve this articulation. More particularly, these tools allow us to use the rules of public international law within certain limits and may be very useful for the articulation between RTAs and WTO law. This research of legal tools is divided in two phases: the first one analyzes normative tools for articulation and the second one analyzes the treatment of multiple fora. Some of the items to be discussed will be the limitation of standards in the WTO, the rules of interpretation of WTO law and the attractiveness of the DSB for resolving conflicts among Members of the Organization

The aim of this thesis is to analyze international environmental agreements. It characterises the process of the making of international environmental agreements, the background in which they are made, the subjects, who take part in the process and generally define the position they have in international law. The focus is to point out their differences from the other international agreements. The second part concentrates on the analyses of the individual agreements, at first the general historical development and then follow the specific groups of agreements, divided by topics with the emphasis on the most important ones.