Health information permeates healthcare delivery from point-of-care, across the continuum of care and throughout the healthcare system's policy, population health, research, planning and funding arenas. Health information managers (HIMs) expertly manage that information. This commentary theorises the health information management profession for the first time. Its purpose is to identify and contextualise, via a historiographical account, the societal and political drivers that have shaped contemporary Australian health information management and HIMs' scientific work. It seeks to build our knowledge of the socio-political influences on the profession's emergence and development, and the projected drivers of its future. Eight critical, socio-political drivers were identified and are addressed in temporaneous order. Scientific medicine has reflected the influences on medicine in the past century and a half of the medical record and other technologies, laboratory-based sciences, evidence-based medicine and evidence-based health. Standardisation has underpinned and guided the profession's practice. The hegemony of non-medical healthcare managers and resource- and performance-related accountabilities emerged in the 1960s, as did the efficiencies of bureaucratisation in healthcare and post-bureaucratic shifts to textualisation and technogovernance. Technologisation has driven constant change in health information management, as have the forces of the fast-paced risk society. Since the 1980s, the health consumer movement has propelled regulatory mechanisms that accord patients' access rights to their medical records and mandate information privacy protections. Finally, a nascent commodification of health information has emerged. These forces exert ongoing impacts on the profession. They will, we conclude, singularly and collectively continue to shape its discourses and direction.

The Australian Government's offshoring policy for hospital care of Christmas Island residents classified as “Asian” contradicted the spirit of the United Nations multilateral convention against racial discrimination Most of the population of the island were Asian people originating from Malaya, Singapore, China and the Cocos Keeling Islands, and were recruited to work as phosphate miners. As part of the transfer negotiations, it was agreed that Australian citizenship would be granted to those born on the island after the transfer. Residents who were British citizens were permitted to become Australian citizens. In 1957, there were about 2000 inhabitants on Christmas Island.1 At the time of the acquisition of Christmas Island, elements of Australian public policy were characterised by overtly racist ideology. Indigenous Australians were not counted in the national census and faced discrimination in many aspects of their lives. The White Australia Policy sought to prevent non-European immigration. A problem for the Australian administrators of this new Indian Ocean territory was the provision of hospital treatment. It was thought to be uneconomical to construct and maintain a major hospital for such a relatively small population. Nor did Australia have a universal national health insurance system. Except for Queensland (which had free public hospitals), charges for treatment in public hospitals were means tested. It was therefore decided in 1963 to finalise a formal treaty with the authorities in Singapore (at that time a British colony) to provide public hospital facilities for Christmas Island residents of Asian descent. The fact that the treaty was based on a racial criterion was no barrier to its acceptance by the United Kingdom Government. The treaty did not define “Asian” or specify how the identity of such persons was to be established. The treaty was for a period of two years and involved an annual payment to the Singapore Government of “twenty-five thousand Malayan dollars” for the treatment in Singaporean public hospitals of Asian residents of Christmas Island suffering from “mental disorder, tuberculosis, leprosy, opium addiction or needing orthopaedic or other surgical treatment”.2 Treatment was subject to the availability of beds in Singaporean hospitals and patients would only be transferred if treatment could not be provided on Christmas Island. Patients in the scheme were subject to laws governing immigration and health in Singapore. The Australian Government undertook to pay the travel costs of patients in the scheme, to provide the medical records of prospective patients and, except for emergency cases, to seek the approval of the Director of Medical Services in Singapore before sending patients for treatment. The opinion of Singapore Government medical officers “as to the desirability or necessity of any particular patient being hospitalised in Singapore”2 would be binding, and patients refused treatment after arrival would have their return transport costs covered by the Australian Government. In June 1965, it was necessary to renegotiate the treaty with the Government of Malaysia after Singapore's incorporation into the Federation of Malaysia in 1963.3 In 1968, a new treaty containing most of the provisions of the original agreement was agreed with Singapore, which had separated from Malaysia in 1965. This treaty restricted the treatment of Asian residents of Christmas Island to “free-class wards of Singapore hospitals” and stipulated that “if the patient wishes to be admitted to the paying-class wards he or she will be accepted as any member of the public and charged at rates chargeable to the public”. It was also agreed that “consultations and out-patient attendances shall be charged for at current rates”.4 Rising costs of hospital treatment led to a further treaty in 1982. This provided for a 20% increase in the yearly payment from the Australian Government. In addition, the original description of the wards was revised to reflect Singapore's changed policy on charging patients in public hospitals. Free class wards now became C class wards and paying class wards were termed higher class wards.5 By definition, Christmas Island patients would therefore be treated in lower class wards. It was not until 1985 that the scheme was ended by the final treaty in the series.6 By this time, Australia had established Medicare, a universal national health system open to all permanent residents, including those on Christmas Island. The scheme was ostensibly benevolent in intention, having at its core the welfare of the majority of the island's inhabitants by providing them with hospital care. It was also economically rational in that it saved the Australian Government the expense of constructing and maintaining specialist hospital facilities for a small population. It also obviated the need for complex financial administration by negotiating a flat fee-for-service with Singapore's authorities. In cases where urgent treatment was necessary, Singapore had the advantage of being about half the distance by air in comparison with Perth, Western Australia. There would also be potential savings for evacuation costs. Yet, as the title of the treaties made clear, the scheme was unashamedly based upon the racial classification and segregation of patients, although the terms of the agreements did not define “Asian”. Asians were to be treated in Asia. The scheme also had a residual colonial association: Asian patients would be treated in an Asian country that was once part of the same colony as Christmas Island. Moreover, the specific inclusion in the original treaty of leprosy and opium addiction in the types of illness to be treated could be considered as redolent of historical efforts to stigmatise Asians as part of efforts to prevent their immigration to a White Australia. Racial factors were also evident in employment practices for the island's phosphate industry, which was managed by the British Phosphate Commissioners. “Regionally engaged” workers recruited from Asian countries were paid at a lower rate than “mainland engaged” workers and were subject to limited-stay visas.7 This discriminatory wage policy was ultimately ended after a trade union campaign.8 These formal treaties, resulting in differences in medical management based on race, can be viewed as institutional racism. This is a practice which occurs when “organisations, institutions or governments discriminate, either deliberately or indirectly, against certain groups of people to limit their rights”.9 It is significant that, in this case, treaties based on racial discrimination continued despite Australia embracing the United Nations International Convention on the Elimination of All Forms of Racial Discrimination10 in 1975 and enacting legislation further to this treaty in the same year. Both measures were taken by an Australian Labor Party ministry led by Gough Whitlam. The Convention's preamble asserted “that the United Nations has condemned colonialism and all practices of segregation and discrimination associated therewith”. However, there were provisions under Article 2 for states to take “concrete measures to ensure the adequate development and protection of certain racial groups or individuals belonging to them”.10 Despite the racial basis of the treaties with Singapore conflicting with the spirit of the UN Convention, the Whitlam ministry did not seek to rescind the agreement. It could be argued that the special provisions for Asian patients in the treaties represented a form of special protection and were therefore permissible under the Convention, although these patients were restricted to lower class wards in Singapore's hospitals. It is perhaps telling that, in recent years, Christmas Island again featured in medical offshoring policies by the Australian Government. This time, the aim of policy appears to deny asylum seekers held in offshore detention centres in Papua New Guinea and Nauru from receiving medical care on the Australian mainland by detaining them on Christmas Island. This necessitated expanding hospital facilities and increasing staff numbers in the Christmas Island detention centre.11 Once again, racial identity could be considered a factor in health care policy as the asylum seekers were predominantly non-European. Open access publishing facilitated by Australian Catholic University, as part of the Wiley – Australian Catholic University agreement via the Council of Australian University Librarians. No relevant disclosures. Not commissioned; externally peer reviewed.

Background: The Government of Botswana introduced user-fees for primary healthcare consultations in 1975. The policy has remained in place since then, although the fee has remained largely unaltered despite rising inflation. Early reviews of the policy pointed to problems in its implementation, but there has been no evaluation in the past 20 years. The aim of this study was to review the policy to assess whether documented issues with its implementation have been addressed. Methods: This qualitative study involved interviews with 32 key informants: 18 policy-makers and 14 front-line revenue collectors. Data were analysed thematically using a template approach with constructs from an established organizational capacity assessment framework used as predetermined categories to guide data collection and analysis. Results: Limited administrative and management capacity has been a major hindrance to effective implementation of the policy. The lack of infrastructure for effective revenue collection led to misappropriation of funds. Lack of clear guidelines for health facilities on how to implement the policy generated interdepartmental conflicts. Study participants believed the current policy was unlikely to be cost-effective since the cost of collecting fees probably exceeded the revenue it generated. Conclusion: If the Botswana Government persists with the policy then it needs to improve organizational capacity to collect and manage revenues efficiently. However, policy thinking since the turn of the century has turned away from user-charges in healthcare as they impede the move towards universal access. It is timely therefore to consider alternative financing approaches that are more effective and a more equitable means of paying for healthcare.

Background: Understanding the causes of patient safety incidents is essential for improving patient safety; therefore, reporting and analysis of these incidents is a key imperative. Despite its implemention more than 15 years ago, the institutionalization of incident reporting in Indonesian hospitals is far from satisfactory. The aim of this study was to analyze the factors responsible for under-reporting of patient safety incidents in Indonesian public hospitals from the perspectives of leaders of hospitals, government departments, and independent institutions. Methods: A qualitative research methodology was adopted for this study using semi-structured interviews of key informants. 25 participants working at nine organizations (government departments, independent institutions, and public hospitals) were interviewed. The interview transcripts were analyzed using a deductive analytic approach. Nvivo 10 was used to for data processing prior to thematic analysis. Results: The key factors contributing to the under-reporting of patient safety incidents were categorized as hospital related and nonhospital related (government or independent agency). The hospital-related factors were: lack of understanding, knowledge, and responsibility for reporting; lack of leadership and institutional culture of reporting incidents; perception of reporting as an additional burden. The nonhospital-related factors were: lack of feedback and training; lack of confidentiality mechanisms in the system; absence of policy safeguards to prevent any punitive measures against the reporting hospital; lack of leadership. Conclusion: Our study identified factors contributing to the under-reporting of patient safety incidents in Indonesia. The lack of government support and absence of political will to improve patient safety incident reporting appear to be the root causes of under-reporting. Our findings call for concerted efforts involving government, independent agencies, hospitals, and other stakeholders for instituting reforms in the patient safety incident reporting system.

OBJECTIVES:Incident reporting is one of the tools used to improve patient safety that has been widely used in health facilities in many countries. Incident reporting systems provide functionality to collect, analyze, and disseminate lessons learned to the wider community, whether at the hospital or national level. The aim of this study was to compare the patient safety incident reporting systems of Taiwan, Malaysia, and Indonesia to identify similarities, differences, and areas for improvement.METHODS:We searched the official Web sites and homepages of the responsible leading patient safety agencies of the three countries. We reviewed all publicly available guidelines, regulatory documents, government reports that included policies, guidelines, strategy papers, reports, evaluation programs, as well as scientific articles and gray literature related to the incident reporting system. We used the World Health Organization components of patient safety reporting system as the guidelines for comparison and analyzed the documents using descriptive comparative analysis.RESULTS:Taiwan had the most incidents reported, followed by Malaysia and Indonesia. Taiwan Patient Safety Reporting (TPR) and the Malaysian Reporting and Learning System had similar attributes and followed the World Health Organization components for incident reporting. We found differences between the Indonesian system and both of TPR and the Malaysian system. Indonesia did not have an external reporting deadline, analysis and learning were conducted at the national level, and there was a lack of transparency and public access to data and reports. All systems need to establish a clear and structured incident reporting evaluation framework if they are to be successful.CONCLUSIONS:Compared with TPR and Malaysian system, the Indonesian patient safety incident reporting system seemed to be ineffective because it failed to acquire adequate national incident reporting data and lacked transparency; these deficiencies inhibited learning at the national level. We suggest further research on the implementation at the hospital level to see how far national guidelines and policy have been implemented in each country.

PURPOSE:This study investigated the practical and cultural barriers of reporting patient safety incidents in three accredited public hospitals in East Java, Indonesia. METHODS:This study employed a mixed methods approach using a convergent parallel design. We surveyed 1121 health workers and interviewed 27 managerial staff members from the sampled hospitals. A chi-square analysis was performed to evaluate differences in demographic factors, barriers to reporting, and practices of reporting between those who had reported an incident and those who had witnessed an incident but had not reported it. NVivo 11 software was used to perform the qualitative data analysis. RESULTS:This study had a 76.53% response rate. The quantitative evaluation identified significant differences in professions and work units and in participation in quality and safety training between the reporting group and the non-reporting group. The analysis of practical barriers displayed significant differences between the groups with the following responses: "did not know how to report," "did not know where to report," and "lack of feedback". For cultural barriers, a significant difference was shown only for the response "did not want conflict." In the qualitative assessment, most of the interview participants reported lack of knowledge and lack of socialization or training as practical barriers in reporting incidents. Furthermore, reluctance and fear to report were mentioned as cultural barriers by most of the interviewees. CONCLUSION:Because there were conflicting findings in the barriers of reporting incidents, these barriers must be identified, discussed, and resolved by health workers and their managers or supervisors to improve incident reporting. Managers must foster open communication and build positive connections with health workers. Further research is necessary to focus on possible ways of addressing the barriers to reporting.

Inge Dhamanti 1–3 Sandra Leggat 3 Simon Barraclough Benny Tjahjono 4 1Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia; 2Center for Patient Safety Research, Universitas Airlangga, Surabaya, Indonesia; 3School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia; 4Centre for Business in Society, Coventry University, Coventry, UK Background: Incident reporting is widely acknowledged as one of the ways of improving patient safety and has been implemented in Indonesia for more than ten years. However, there was no significant increase in the number of reported incidents nationally. The study described in this paper aimed at assessing the extent to which Indonesia’s patient safety incident reporting system has adhered to the World Health Organization (WHO) characteristics for successful reporting. Methods: We interviewed officials from 16 organizations at national, provincial and district or city levels in Indonesia. We reviewed several policies, guidelines and regulations pertinent to incident reporting in Indonesia and examined whether the WHO characteristics were covered in these documents. We used NVivo version 9 to manage the interview data and applied thematic analysis to organize our findings. Results: Our study found that there was an increased need for a non-punitive system, confidentiality, expert-analysis and timeliness of reporting, system-orientation and responsiveness. The existing guidelines, policies and regulations in Indonesia, to a large extent, have not satisfied all the required WHO characteristics of incident reporting. Furthermore, awareness and understanding of the reporting system amongst officials at almost all levels were lacking. Conclusion: Despite being implemented for more than a decade, Indonesia’s patient safety incident reporting system has not fully adhered to the WHO guidelines. There is a pressing need for the Indonesian Government to improve the system, by putting specific regulations and by creating a robust infrastructure at all levels to support the incident reporting.

BACKGROUND:Incident reporting is widely acknowledged as one of the ways of improving patient safety and has been implemented in Indonesia for more than ten years. However, there was no significant increase in the number of reported incidents nationally. The study described in this paper aimed at assessing the extent to which Indonesia's patient safety incident reporting system has adhered to the World Health Organization (WHO) characteristics for successful reporting.METHODS:We interviewed officials from 16 organizations at national, provincial and district or city levels in Indonesia. We reviewed several policies, guidelines and regulations pertinent to incident reporting in Indonesia and examined whether the WHO characteristics were covered in these documents. We used NVivo version 9 to manage the interview data and applied thematic analysis to organize our findings.RESULTS:Our study found that there was an increased need for a non-punitive system, confidentiality, expert-analysis and timeliness of reporting, system-orientation and responsiveness. The existing guidelines, policies and regulations in Indonesia, to a large extent, have not satisfied all the required WHO characteristics of incident reporting. Furthermore, awareness and understanding of the reporting system amongst officials at almost all levels were lacking.CONCLUSION:Despite being implemented for more than a decade, Indonesia's patient safety incident reporting system has not fully adhered to the WHO guidelines. There is a pressing need for the Indonesian Government to improve the system, by putting specific regulations and by creating a robust infrastructure at all levels to support the incident reporting.

(1) Background: A patient safety incident reporting system was introduced in Indonesian hospitals in 2006; however, under-reporting of patient safety incidents is evident. The government plays a vital role in the implementation of a national system. Therefore, this study focuses on how the Indonesian government has been undertaking its role in patient safety at provincial and city/district levels, including incident reporting according to the National Guideline for Hospital Patient Safety. (2) Methods: This study employed a qualitative approach with interviews of 16 participants from seven organizations. The data were managed using NVivo and thematically analyzed. (3) Results: The findings revealed several problems at the macro-, meso-, and micro-level as the government was weak in monitoring and evaluation. The District Health Office (DHO) and Provincial Health Office (PHO) were not involved in incident reporting, and there was a lack of government support for the hospitals. (4) Conclusions: The DHO and PHO have not carried out their roles related to patient safety as mentioned in the national guidelines. Lack of commitment to and priority of patient safety, the complexity of the bureaucratic structure, and a lack of systematic partnership and collaboration are problems that need to be addressed by systematic improvement. To ensure effective and efficient national outcomes, the three levels of government need to work more closely.

This study analyses what British American Tobacco (BAT) and its 4 publicly listed Asian subsidiary companies have told their shareholders about the commercial value of tobacco packaging. The discourse on packaging in BAT annual reports was analyzed, revealing themes of modernization, rejuvenation, internationalism, heritage, innovation, value for money, and competitive edge. Packaging was credited with providing existing brands with a competitive edge and enabling the successful "launch" of new ones. Since advertising, sponsorship, and free samples were prohibited in many countries, packaging has become more important for advertising. New brands and brand variants have proliferated. BAT companies have allocated considerable resources to regularly altering packaging for marketing purposes. Clearly, restrictions on packaging will substantially detract from the promotion of the company's brands. The findings provide further evidence from industry sources of the vital function of packaging and further justify plain packaging as an essential part of any comprehensive tobacco control policy.

AIM This study explored factors that shaped the development of Australia's Health Star Rating system for front-of-pack labelling (FoPL) on packaged foods and whether insights could be drawn from this experience to inform the development of global FoPL standards. METHODS Ten individual semi-structured interviews were conducted with public health or consumer advocates, academics in the field of nutrition labelling and policy, a food industry employee, and Australian public servants. Thematic analysis was undertaken, guided by Kingdon's Multiple Streams Framework, to identify factors which shaped Australian and international FoPL policy processes. RESULTS Senior Australian bureaucrats played the policy entrepreneur role to facilitate the development of the Health Star Rating system. The public health and consumer advocacy groups formed an alliance to counter-balance the influence of the food industry in the Health Star Rating development process. Public health and consumer groups have less influence at Codex Alimentarius, where policy-making is constrained by political alliances and consensus voting structures. CONCLUSIONS Strong leadership, policy entrepreneurship and a coherent alliance between public health and consumer groups enabled the development of a FoPL system in Australia and could contribute to advancing FoPL standards at the international level.

Objectives: To identify the historical nexus between Malaysia's largest and politically dominant ethnic group and the political economy of tobacco, and to consider the implications of this connection for tobacco control.Design: Primary and secondary documentary sources in both English and Malay were analysed to illuminate key events and decisions, and the discourse of industry and government. Sources included: speeches by Malaysian political and industry actors; tobacco industry reports, press releases and websites; government documents; World Health Organization (WHO) tobacco control literature; and press reports.Results: Malays have the highest smoking prevalence among Malaysia's major ethnic groups. The tobacco industry has consistently been promoted as furthering Malay economic development. Malays play the major role in growing and curing. Government-owned Malay development trusts have been prominent investors in tobacco corporations, which have cultivated linkages with the Malay elite. The religious element of Malay ethnicity has also been significant. All Malays are Muslim, and the National Fatwa Council has declared smoking to be haram (forbidden); however, the Government has declined to implement this ruling.Conclusion: Exaggerated claims for the socio-economic benefits of tobacco production, government investment and close links between tobacco corporations and sections of the Malay elite have created a conflict of interest in public policy, limited the focus on tobacco as a health policy issue among Malays and retarded tobacco control policy. More recently, ratification of the WHO Framework Convention on Tobacco Control, regional free trade policies reducing the numbers of growers, concerns about smoking from an Islamic viewpoint, and anxieties about the effects of smoking upon youth have increasingly challenged the dominant discourse that tobacco furthers Malay interests. Nevertheless, the industry remains a formidable political and economic presence in Malaysia that is likely to continue to proclaim that its activities coincide with Malay socio-economic interests.

Sri Lanka has one of the fastest aging populations in the world. Measurement of quality of life (QoL) in the elderly needs instruments developed that encompass the sociocultural settings. An instrument was developed to measure QoL in the young elderly in Sri Lanka (QLI-YES), using accepted methods to generate and reduce items. The measure was validated using a community sample. Construct, criterion and predictive validity and reliability were tested. A first-order model of 24 items with 6 domains was found to have good fit indices (CMIN/df = 1.567, RMR = 0.05, CFI = 0.95, and RMSEA = 0.053). Both criterion and predictive validity were demonstrated. Good internal consistency reliability (Cronbach’s α = 0.93) was shown. The development of the QLI-YES using a societal perspective relevant to the social and cultural beliefs has resulted in a robust and valid instrument to measure QoL for the young elderly in Sri Lanka.

Persuasion, a vital element in commercial marketing, is also an essential tool for the winning and maintenance of political power. Corporations seek to persuade customers to purchase their products and services but may also need to influence wider public opinion and political decision-makers in ways that serve their interests. In this article, we present an account of environmental-related conflict in Malaysia and the use of persuasion in the discourse of an Australian transnational mining corporation and its supporters. We analyse the strategies used by the corporation as it engages in intense conflict with environmental campaigners and concerned residents following its moves to establish the world's largest rare earth metals extraction plant in peninsular Malaysia. Following the political ecology perspective, we note that the efforts at persuasion used by the corporation have been actively backed by the Malaysian state itself. This is not simply a case of environmental conflict but strongly connected to the underlying political economy of Malaysia - a country with an authoritarian regime where corruption and 'crony capitalism' are rife, and public opinion is often ignored or consistently manipulated by government-controlled mass media.

Medical Journal of AustraliaVolume 203, Issue 2 p. 114-116 Reflection A French naval surgeon's account of disease, treatments and hospitals in colonial Sydney, 1873 Simon Barraclough BA(Hons), MA, PhD, Corresponding Author Simon Barraclough BA(Hons), MA, PhD [email protected] La Trobe University, Melbourne, VIC.Correspondence: [email protected]Search for more papers by this authorArnaud Gallois BA(Hons), DipEd, Arnaud Gallois BA(Hons), DipEd University of Melbourne, Melbourne, VIC.Search for more papers by this author Simon Barraclough BA(Hons), MA, PhD, Corresponding Author Simon Barraclough BA(Hons), MA, PhD [email protected] La Trobe University, Melbourne, VIC.Correspondence: [email protected]Search for more papers by this authorArnaud Gallois BA(Hons), DipEd, Arnaud Gallois BA(Hons), DipEd University of Melbourne, Melbourne, VIC.Search for more papers by this author First published: 20 July 2015 https://doi.org/10.5694/mja14.00721Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1Bourse F. [Contributions a la geographie medicale, Australie: Sydney] [French]. Archives de Medecine Navale Tome 25, Paris, 1876. 2 The French war steamer Atalante. Sydney Morning Herald 1873; 2 Sep: 5. 3 American & Australasian Photographic Company. Images of French warship ‘Atalante', Sydney, 1873. In: Manuscripts, oral history and pictures collection. Sydney: State Library of New South Wales. http://acmssearch.sl.nsw.gov.au/s/search.html?collection=slnsw&form=simple&query=atalante&type=1&meta_G_sand=&sort=&submit=Search (accessed Jun 2015). 4Social. Sydney Morning Herald 1873; 6 Sep: 5. 5Krefft G. The snakes of Australia: an illustrated and descriptive catalogue of all the known species. Sydney: T Richards, Government Printer, 1869. 6 St Vincent's Hospital annual report 1874. Sydney: St Vincent's Hospital, 1874: 4. Volume203, Issue2General practice issueJuly 2015Pages 114-116 ReferencesRelatedInformation

Funds to developing countries for HIV/AIDS programmes have noticeably increased. For civil society organisations (CSOs), one challenge of project implementation is the difficulty in assessing their interventions. A qualitative study was conducted in Malaysia and the Philippines with CSOs to identify the obstacles to HIV project evaluation. Twenty-five bodiesCSOs, donors, governments and the United Nationsin both countries were interviewed. The findings show that despite contrasting political and socio-economic contexts, both countries' CSOs share similar impediments to evaluation, including the lack of evaluation expertise, inadequate resources, onerous reporting obligations and constraints in evaluating interventions with marginalised groups. Copyright (c) 2013 John Wiley & Sons, Ltd.

SECTION 1: THE 'HEALTH SYSTEM' SECTION 2: THE 'HEALTH SECTOR': FINANCING, PURCHASING, PROVISION AND PERFORMANCE SECTION 3: HEALTH AND SYSTEMS IN THE WIDER CONTEXT SECTION 4: THE FUTURE OF HEALTH SYSTEMS