Comparison of satisfaction with care between two different models of HIV care delivery in St. Petersburg, Russia
Prior to 2010, medical care for people living with HIV/AIDS was provided at an outpatient facility near the center of St. Petersburg. Since then, HIV specialty clinics have been established in more outlying regions of the city. The study examined the effect of this decentralization of HIV care on patients' satisfaction with care in clinics of St. Petersburg, Russia. We conducted a cross-sectional study with 418 HIV-positive patients receiving care at the St. Petersburg AIDS Center or at District Infectious Disease Departments (centralized and decentralized models, respectively). Face-to-face interviews included questions about psychosocial characteristics, patient's satisfaction with care, and clinic-related patient experience. Abstraction of medical records provided information on patients' viral load. To compare centralized and decentralized models of care delivery, we performed bivariate and multivariate analysis. Clients of District Infectious Disease Departments spent less time in lines and traveling to reach the clinic, and they had stronger relationships with their doctor. The overall satisfaction with care was high, with 86% of the sample reporting high level of satisfaction. Nevertheless, satisfaction with care was strongly and positively associated with the decentralized model of care and Patient-Doctor Relationship Score. Patient experience elements such as waiting time, travel time, and number of services used were not significant factors related to satisfaction. Given the positive association of satisfaction with decentralized service delivery, it is worth exploring decentralization as one way of improving healthcare services for people living with HIV/AIDS.
This article describes the results of sociological research on estimation of condition and development prospects of federalism in Russia, which was conducted by ZIRCON Research Group in January - May 2011. The opinion of population and elite groups of four regions about the foundations of Russian federalism development, administrative-territorial system of the Russian Federation and its principles, relations between subjects-regions and federative centre is presented. The results of the research indicate that at the moment a request for political and administrative autonomy of the subjects of the Federation is not obviously formulated by either citizens or regional elite groups. Regional identity is not a common phenomenon. The authors mark out necessary factors of federalism development: expansion of economic self-dependence of regions, existence of ethno-national or regional identity of citizens, democratization and decentralization.
This report analyzes the architecture of fiscal decentralization in one hundred and ten countries as well as in major metropolitan areas. In the majority of these countries, local authorities are taking on more and more responsibilities for public investment and the provision of services that are essential for both economic development and the well being of their citizens. If increasing fiscal decentralization has been a global trend in recent decades, there are significant variations across and within regions and countries. Local budgets make up on average 25% of public expenditure in the countries of the European Union but less than 5% in many developing countries. Decentralization in terms of revenue and expenditure autonomy has also increased, however this has been uneven across countries and has seen greater advances in expenditure than in revenues, where sources remain limited and uncertain, especially for small and middle size cities. With accelerating urbanization and important shifts in the global context (climate change, increasing risk of natural disaster, migration, and demographic changes among others), current funding levels are insufficient for local governments to respond to the urbanization of poverty, growing investment requirements and other pressing needs. The economic and financial crisis that began in 2008 only worsened the situation. This book identifies universal challenges facing local government finance, as well as those more regional and country specific. Some of the most common are inadequate sources of revenue, unpredictable transfers and grants, excessive higher-level budget controls, and unfunded mandates. In addition to analyzing these challenges and opportunities, the report proposes recommendations to strengthen the fiscal role and performance of local governments around the world.
This book studies the role of civil society organisations in the fight against HIV/AIDS in Russia. The book investigates civil society organizations’ contribution to social change and civil society development in post-Soviet Russia, and thus situates a specific type of civil society actors into a broader socio-political context and questions their ability to represent civic interests, particularly in the field of social policy-making and health.
The paper looks at the impact of imperfect assessment of water discharge on the level of surface water pollution and allocation of environmental budget in a framework of one river basin region. Analysis is based on the partial equilibrium model with unidirectional spatially accumulated external effect in the presence of partial natural absorbtion. The effect of water discharge assessment imperfection on the level of water pollution at every location and social welfare is investigated. It is shown that decentralization accompanied by the improvement in water discharge quality assessment may reduce the welfare loss. However, even under complete elimination of assessment imperfections resource allocation under decentralization is still inefficient.
качество воды, потери в благосостоянии, искажения в оценке загрязнения, децентрализация, Water discharge quality, welfare loss, imperfect assessment, Decentralization
In the 1990s, sub-national authoritarian regimes – local-based monopolies of ruling elites – emerged in many of Russia’s regions and cities against the background of spontaneous decentralization of government and competitive electoral politics. In the 2000s, the decline of political competition and recentralization of the Russian state led to incorporation of sub-national authoritarian regimes under federal control and cooptation of local-based actors into the dominant party, United Russia. This paper is devoted to a comparative analysis of sub-national authoritarianism in Russia in light of the experience of local political machines in other countries, ranging from US cities from the 1870s-1930s to Southern Italy from the 1950s-1980s. Unlike the American political machines, which were demolished from below as a by-product of modernization processes, Russia’s sub-national authoritarian regimes were integrated from above into the nation-wide authoritarianism. One might expect further stagnation of sub-national authoritarian regimes in Russia until major regime changes will occur on the national level.
The deepening rift between the system's potential and the challenges of rapidly changing socio-economic conditions make the transformation of Russia's state apparatus a matter of the nearest future; while, barring a radical overhaul, its preservation until 2025 is virtually impossible. Two major trends and resulting changes in administrative organization will determine Russia's political development processes in the coming years: reformatting relations between the authorities and society and reconfiguring arrangements between the federal center and regions. The center-regions relations dynamics is analyzed in terms of long pendulum oscillations with pendulum moving now from the model of 'federation of corporations' to the model of 'federation of regions'.
MICCAI 2016, the 19th International Conference on Medical Image Computing and Computer Assisted Intervention, will be held from October 17th to 21st, 2016 in Athens, Greece. MICCAI 2016 is organized in collaboration with Bogazici, Sabanci, and Istanbul Technical Universities.
The annual MICCAI conference attracts world leading biomedical scientists, engineers, and clinicians from a wide range of disciplines associated with medical imaging and computer assisted intervention.
The conference series includes three days of oral presentations and poster sessions. MICCAI 2016 will also include workshops, tutorials, and challenges on the days preceding and succeeding the conference. These satellite events will offer a comprehensive forum to further explore topics relevant to MICCAI.
This paper examines the data from federal surveys of small enterprises. It outlines the methodology and the main stages in the development of the program for survey of innovation and analyzes the innovation activity of small enterprises. The paper also includes suggestions to update the current survey instruments and develop new methods of measurement of research and development results, their implementation in the production processes and transfer to the real economy.
The manual is intended for students of Department of computer engineering MIEM HSE. In the textbook based on the courses "Economics of firm" and "the development strategy of the organization." Discusses the key conceptual and methodological issues of the theory and practice of Economics and development planning of the organization. The use of textbooks will enable students: to analyze key performance indicators, and use the tools of strategic analysis with reference to concrete situations in contemporary Russian and international business. Special attention is paid to the methods and systems of information support of the life support functions of business organizations and management methodology of innovation and investment. An Appendix contains source data for analysis of competition in a particular industry.