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UnderstandingUnderstanding
Fundamental ConceptsFundamental Concepts
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Sy stemsSy stems
AA s ystemsystem isis thethe combinationcombination of of interactinginteractingcomponentscomponents operatingoperating withinwithin aa boundar yboundar y
forfor aa specifiedspecified purposepurpose
ItIt receivesreceives inputsinputs fromfrom thethe environment,environment,transformstransforms themthem andand sendssends themthem back back intointothethe environmentenvironment as as itsits outputsoutputs
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H ard Sy stemsH ard Sy stems
AA H H ardard Sy stemSy stem cancan bebe describeddescribed withwithprecisionprecision inin aa quantitativequantitative wa ywa y andand itsitsfunctioningfunctioning is is highl yhighl y predictablepredictable: :mechanicalmechanical oror electronicelectronic s ystemssystems
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Soft Sy stemsSoft Sy stemsSoftSoft SystemsSystems cannotcannot alwa ysalwa ys bebe describeddescribedthoroughl ythoroughl y andand precisel yprecisel y
T heirT heir descriptiondescription is,is, often,often, moremore of of aa qualitativequalitativethanthan of of aa quantitativequantitative naturenature andand isis filteredfilteredthroughthrough differentdifferent valuesvalues andand expectationsexpectations
T heT he functioningfunctioning of of aa softsoft s ystemsystem isis notnot predictablepredictablewithwith precisionprecision
H umanH uman activit yactivit y systemssystems areare softsoft s ystemssystems b ybydefinitiondefinition
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Sy stem thinkingSy stem thinking
An yAn y givengiven s ystemsystem cannotcannot bebe understoodunderstood b ybythethe separateseparate knowledgeknowledge of of itsits singlesingle
componentscomponents
SystemsSystems cancan onl yonl y bebe understoodunderstood throughthrough thetheknowledgeknowledge of of allall thethe componentscomponents and,and, evenevenmoremore important,important, of of theirtheir interactionsinteractions
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Sy stem thinkingSy stem thinking
Ever ything affects ever ything elseEver ything affects ever ything else
NothingNothing cancan standstand onon itsits ownown oror bebe understoodunderstood ononitsits ownown
Ever ythingEver ything isis partpart of of aa greatergreater entit yentit y
An yAn y actionaction affectingaffecting oneone component,component, affectsaffects allallotherother componentscomponents of of thethe s ystemsystem (although(although withwithdifferentdifferent degreesdegrees of of importance)importance)
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H ealth Sy stems & H ealth ActionsH ealth Sy stems & H ealth Actions
AA H ealthH ealth SystemSystem isis thethe combinationcombination of of allallthethe organisations,organisations, institutions,institutions, individuals,individuals,
devoteddevoted toto producingproducing healthhealth actionsactions
AA H ealthH ealth ActionAction isis an yan y effort,effort, whetherwhether ininpersonalpersonal healthhealth care,care, publicpublic healthhealth services,services,oror throughthrough interinter- -sectoralsectoral initiatives,initiatives, whosewhoseprimar yprimar y purposepurpose isis toto improveimprove healthhealth(W HO , H ealth Sy stems, Improving Performance, 2000)(W HO , H ealth Sy stems, Improving Performance, 2000)
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H ealth Sy stem in man y European CountriesH ealth Sy stem in man y European Countries
NationalH ealth
Sy stem Private For ProfitH ealth Sub-s ystem
PNFP
Alternative Medicine
???
???
PNFP = Private Non For Profit
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H ealth System in man y African CountriesH ealth System in man y African Countries
NationalH ealthSy stem
Private Non ForProfitH ealth Sub-s ystem
PFPTraditional Medicine
???
??????
???
PFP = Private For Profit
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Sustainabilit ySustainabilit y
T heT he capacit ycapacit y of of aa s ystemsystem toto remainremain operationaloperational afterafter thethewithdrawalwithdrawal of of externalexternal supportsupport
T heT he capacit ycapacit y of of aa s ystemsystem toto functionfunction effectivel yeffectivel y overover timetimewithwith aa minimumminimum of of externalexternal inputinput ( SCF)(SCF)
T hereT here areare differentdifferent aspectsaspects of of sustainabilit ysustainabilit y::
FinancialFinancialPoliticalPolitical
T echnicalT echnicalO thersO thers
At At thethe e nd end of of thethe dayday sus t ainabl esus t ainabl e isis wha t wha t wewe d ec id ed ec id e t ot osus t ainsus t ain
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R egulationR egulation
T heT he impositionimposition of of externalexternal constraintsconstraints uponuponthethe behaviourbehaviour of of individualsindividuals orororganizationsorganizations
AsAs such,such, itit isis thethe exerciseexercise of of authorit yauthorit y bybysomesome entit yentit y overover thosethose individualsindividuals orororganizations,organizations, forcingforcing aa changechange fromfrom theirtheirpreferredpreferred behaviourbehaviour
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O pportunit y costO pportunit y cost
T heT he valuevalue of of thethe nextnext bestbest alternativealternative oror
opportunit yopportunit y whichwhich hashas toto bebe foregoneforegone ininorderorder toto achieveachieve aa particularparticular objective,objective,produceproduce oror purchasepurchase a a givengiven goodgood oror serviceservice
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Equalit yEqualit y
T heT he absenceabsence of of differencesdifferences inin conditions,conditions, orortreatmenttreatment amongamong populationspopulations oror groupsgroups defineddefined
Sociall ySociall y
Economicall yEconomicall y
Demographicall yDemographicall y
G eographicall yG eographicall y
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Equit yEquit yT heT he absenceabsence of of avoidableavoidable oror remediableremediabledifferencesdifferences amongamong populationspopulations oror groupsgroups defineddefined
Sociall ySociall y
Economicall yEconomicall y
Demographicall yDemographicall y
G eographicall yG eographicall y((W orld W orld H eal th H eal th O rganiza t ionOrganiza t ion ))
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H ealth Sector R eformsH ealth Sector R eformsAA processprocess of of reformreform broughtbrought aboutabout b yby thethewidespreadwidespread perceptionperception that,that, inin man yman ycountries,countries, thethe healthhealth sectorsector waswas tootoocentralisedcentralised, , inertinert, , inefficientinefficient, , inequitableinequitableandand ineffectiveineffective
AA processprocess concernedconcerned withwith definingdefining
prioritiespriorities, , refiningrefining policiespolicies andand reformingreformingthethe institutionsinstitutions throughthrough whichwhich thosethose policiespoliciesareare implementedimplemented (Cassels,(Cassels, 19951995))
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H ealth Sector R eformsH ealth Sector R eforms
AA sustainedsustained processprocess of of fundamentalfundamental changechangeinin polic ypolic y andand institutionalinstitutional arrangementsarrangements, ,guidedguided b yby governmentgovernment, , designeddesigned toto improveimprovethethe functioningfunctioning andand performanceperformance of of thethe
healthhealth sectorsector and,and, ultimatel y,ultimatel y, thethe healthhealthstatusstatus of of thethe populationpopulation ( Sikosana,(Sikosana, 19971997))
AA sustainedsustained andand purposefulpurposeful changechange totoimproveimprove thethe efficienc yefficienc y,, equit yequit y andandeffectivenesseffectiveness of of thethe healthhealth sectorsector (Berman,(Berman,19951995))
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Allocative Efficienc yAllocative Efficienc yT heT he capacit ycapacit y of of aa s ystemsystem toto distributedistribute resourcesresources amongamongcompetingcompeting activities,activities, inin aa wa ywa y thatthat nono alternativealternative reallocationreallocationoffersoffers improvementsimprovements in in returnsreturns
R elatedR elated toto comparativecomparative efficac yefficac y of of interventionsinterventions andand priorit ypriorit y
settingsetting
AnAn aggregateaggregate concept,concept, referringreferring toto competingcompeting options,options, insideinsideoror outsideoutside thethe healthhealth sector,sector, andand toto thethe scalescale of of programmesprogrammes
AllocativeAllocative efficienc yefficienc y assumesassumes thatthat competingcompeting optionsoptions work work atatthethe samesame levellevel of of technicaltechnical efficienc yefficienc y
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T echnical efficienc yT echnical efficienc y
MaximisingMaximising outputoutput forfor aa givengiven setset of of ph ysicalph ysical inputsinputs, , oror minimizingminimizing thethe ph ysicalph ysicalinputsinputs requiredrequired toto produceproduce a a givengiven outputoutput
(H ensher(H ensher MM.. F inan cing F inan cing H eal th H eal th S ystems S ystemsth roug hth roug h E ffi ci enc y E ffi ci enc y GainsGains .. CM HCM H WorkingWorkingPapersPapers SeriesSeries.. PaperPaper NoNo.. W GW G33:: 22.. 20012001))
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IndicatorIndicatorAA ((quantitativequantitative )) variablevariable measuringmeasuring thethe amountamount of of work work donedone, ,oror thethe amountamount of of changechange producedproduced inin aa givengiven situationsituation
IndicatorsIndicators helphelp toto assessassess thethe degreedegree of of achievementachievement of of aa givengivenobjectiveobjective
DifferentDifferent indicatorsindicators areare setset toto tr ytr y andand measuremeasure efficienc yefficienc y,,effectivenesseffectiveness, , outcomesoutcomes andand impactimpact
IndicatorsIndicators forfor monitoringmonitoring andand evaluationevaluation shouldshould alwa ysalwa ys bebe setsetatat thethe initialinitial stagesstages of of an yan y planningplanning processprocess
I ndi ca t ors I ndi ca t ors ar ear e aa wayway of of see ing see ing thethe big big pi ct ur e pi ct ur e byby looking looking a t a t aa small small pi ece pi ece of of i t i t ((quo ted quo ted inin Sch irnding, Sch irnding, 20022002 ))
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DataData
R awR aw andand unprocessedunprocessed observationsobservations: : thetheoriginorigin of of informationinformation
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InformationInformation
FactsFacts oror datadata organisedorganised inin aa meaningfulmeaningfulformform allowingallowing
1.1. KnowledgeKnowledge toto bebe gainedgained2.2. UnderstandingUnderstanding to to bebe deepeneddeepened3.3. ConclusionsConclusions toto bebe drawn,drawn,
4.4. DecisionsDecisions toto bebe mademade5.5. ActionsActions toto bebe takentaken
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DistrictDistrictAA clearl yclearl y defineddefined administrativeadministrative areaarea which,which,commonl y,commonl y, hashas aa populationpopulation of of betweenbetween5050..000000 andand 500500..000000 peoplepeople
SomeSome formform of of locallocal governmentgovernment ororadministrationadministration takestakes overover man yman yresponsibilitiesresponsibilities fromfrom thethe centralcentral governmentgovernment
T hereT here usuall yusuall y isis aa generalgeneral hospitalhospital forforreferralreferral supportsupport
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District H ealth Sy stemDistrict H ealth Sy stemAA DistrictDistrict H ealthH ealth SystemSystem basedbased onon Primar yPrimar y H ealthH ealthCareCare isis aa moremore oror lessless self self containedcontained segmentsegment of of thethe NationalNational H ealthH ealth SystemSystem
ItIt comprises,comprises, firstfirst andand foremost,foremost, a a wellwell defineddefined
populationpopulation livingliving withinwithin aa clearl yclearl y identifiedidentifiedadministrativeadministrative andand geographicalgeographical areaarea, , whetherwhetherurbanurban oror ruralrural
ItIt includesincludes allall thethe institutionsinstitutions andand individualsindividualsprovidingproviding healthhealth carecare inin thethe district,district, whetherwhethergovernmentalgovernmental, , nonnon governmentalgovernmental, , socialsocial securit ysecurit y,,privateprivate oror traditionaltraditional
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O rganizationO rganization
AA groupgroup of of peoplepeople sharingsharing objectivesobjectives andandworkingworking togethertogether toto achieveachieve themthem
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DecentralizationDecentralization
T heT he transfertransfer of of authorit y,authorit y, responsibilit y,responsibilit y,powerpower andand resourcesresources fromfrom centralcentral totoperipheralperipheral level,level, fromfrom thethe centralcentralgovernmentgovernment to to locallocal governmentsgovernments
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DeconcentrationDeconcentration
T heT he partialpartial transfertransfer of of administrativeadministrativefunctionsfunctions (not(not politicalpolitical power)power) fromfrom centralcentraltoto locallocal levellevel
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DevolutionDevolution
T heT he transfertransfer of of administrativeadministrative authorit yauthorit y
fromfrom centralcentral toto peripheralperipheral levellevel
MoreMore pushedpushed thanthan deconcentrationdeconcentration butbut stillstill
limitedlimited toto administrativeadministrative functionsfunctions
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PrivatizationPrivatization
T heT he transfertransfer of of somesome administrativeadministrativefunctionsfunctions toto privateprivate firmsfirms oror organisationsorganisations(for(for profitprofit oror notnot forfor profit),profit), withinwithin thetheframework framework of of preciseprecise guidelines,guidelines, rulesrules andandregulationsregulations
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MissionMission
T heT he purposepurpose andand philosph yphilosph y of of aa givengiven organisationorganisation
T heT he reasonreason wh ywh y itit existsexists
ee..gg..,, thethe statedstated missionmission of of thethe Ministr yMinistr y of of H ealthH ealth isistoto improveimprove thethe healthhealth statusstatus of of thethe populationpopulation
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Ideolog yIdeolog y
A set of assumptions and ideas about socialA set of assumptions and ideas about socialbehaviour, social and political s ystemsbehaviour, social and political s ystems
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Polic yPolic y
AA setset of of principlesprinciples selectedselected toto guideguidedecisionsdecisions andand actionsactions towardstowards thethe particularparticulargoalgoal of of anan organisationorganisation
ForFor instance,instance, it it isis aa polic ypolic y inin mostmost countriescountriestoto givegive priorit ypriorit y toto womenwomen andand children,children, orortoto pursuepursue equit y,equit y, etcetc..
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AimAim
T heT he broadbroad statementstatement of of aa desireddesiredachievementachievement in in relationrelation toto aa givengiven goalgoal andandspecificspecific toto aa particularparticular problemproblem (for(forinstance,instance, toto improveimprove thethe nutritionalnutritional statusstatus of of
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O bjectiveO bjectiveA measurable amount of progress contributing toA measurable amount of progress contributing to
the achievement of a given goalthe achievement of a given goal
Some authors introduced the acron ym SMA R T toSome authors introduced the acron ym SMA R T tostress the main characteristics of well formulatedstress the main characteristics of well formulatedobjectives:objectives:
S pecificS pecificM easurableM easurableA ttainableA ttainableR elevantR elevantT imeT ime--boundbound
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Strateg yStrateg yAA broadbroad approachapproach adoptedadopted toto achieveachieve goalsgoals andandobjectivesobjectives
ForFor instance,instance, toto increaseincrease immunisationimmunisation coverage,coverage,
oneone cancan adoptadopt thethe strateg ystrateg y of of mobilemobile servicesservices
toto improveimprove thethe nutritionalnutritional statusstatus of of aa givengivenpopulationpopulation onon cancan adoptadopt thethe strateg ystrateg y of of healthhealtheducationeducation oror promotionpromotion of of incomeincome generatinggeneratingactivitiesactivities
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Allocative PlanningAllocative Planning
DecidingDeciding onon howhow toto allocateallocate scarcescarce resourcesresources
toto differentdifferent sectors,sectors, activities,activities, departments,departments,etcetc..,, accordingaccording toto clear,clear, clarified,clarified,transparenttransparent criteriacriteria
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PlanPlanDescriptionDescription of of::
objectivesobjectives, ,
activitiesactivities designeddesigned toto achieveachieve them,them,
peoplepeople responsibleresponsible forfor theirtheir implementationimplementation
timetime--spanspan withinwithin whichwhich the ythe y havehave toto bebe implementedimplemented
thethe resourcesresources neededneeded andand theirtheir sourcessources
indicatorsindicators forfor monitoringmonitoring andand evaluationevaluation
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Business PlanBusiness Plan
AA strategicstrategic planplan indicatingindicating thethe directiondirection a agivengiven organisationorganisation intendsintends toto followfollow andandprovidingproviding incomeincome andand expenditureexpenditureprojectionsprojections
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O perational PlanO perational Plan
An activit y plan detailing precise timing andAn activit y plan detailing precise timing andmode of implementationmode of implementation
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WorkplanWorkplanAnAn operationaloperational planplan referringreferring toto aa smallsmall unitunit
T heT he organisedorganised andand detaileddetailed descriptiondescription of of activitiesactivities toto bebecarriedcarried outout toto achieveachieve predeterminedpredetermined objectivesobjectives inin thethe shortshorttermterm (for(for exampleexample oneone yearyear oror less)less)
ForFor eacheach activit y,activit y, thethe followingfollowing aspectsaspects shouldshould alwa ysalwa ys bebespecifiedspecified: :
1) T he objective (results) to be achieved1) T he objective (results) to be achieved2) When it should be carried out2) When it should be carried out
3) Where3) Where4) B y whom (who is responsible for what)4) B y whom (who is responsible for what)5) H ow much will it cost5) H ow much will it cost6) Where will the needed funds come from6) Where will the needed funds come from7) Monitoring and evaluation indicators7) Monitoring and evaluation indicators
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ProjectProject
AA setset of of plannedplanned actionsactions designeddesigned toto bringbringaboutabout desireddesired changeschanges inin aa previousl ypreviousl yanal ysedanal ysed situationsituation b yby achievingachieving wellwellidentifiedidentified objectivesobjectives usingusing wellwell identifiedidentified
identifiedidentified resourcesresources inin aa defineddefined periodperiod of of timetime
AchievementsAchievements andand setbackssetbacks shouldshould bebeassessedassessed b yby usingusing aa setset of of wellwell defineddefinedindicatorsindicators forfor monitoringmonitoring andand evaluationevaluation
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T argetT arget
AA stepstep onon thethe wa ywa y toto achieveachieve anan objectiveobjective
ItIt measuresmeasures thethe amountamount of of outputoutput toto bebeobtainedobtained withwith aa givengiven activit yactivit y inin aa specificspecificperiodperiod of of timetime (usuall y(usuall y aa fractionfraction of of thethe timetimesetset toto achieveachieve thethe relatedrelated objective)objective)
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T ask T ask
Work Work toto bebe carriedcarried outout withinwithin aa certaincertain timetime
O neO ne elementelement of of anan activit yactivit y
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Logical Framework Anal ysis (Logframe)Logical Framework Anal ysis (Logframe)AA methodmethod of of projectproject oror programmeprogramme planningplanning usingusing aa
matrixmatrix of of thethe goalgoal,, purposepurpose, , expectedexpected resultsresults andand activitiesactivitiesonon thethe verticalvertical axisaxis andand thethe performancperformanc indicatorsindicators, , meansmeansof of verificationverification andand assumptionsassumptions onon thethe horizontalhorizontal axisaxis
T heT he approachapproach is is oftenoften conductedconducted inin aa groupgroup settingsetting withwithfacilitationfacilitation soso asas toto promoteteamwork promoteteamwork and and ownershipownership of of thethe planplan
T heT he matrixmatrix cancan alsoalso bebe usedused forfor monitoringmonitoring andand evaluationevaluationandand ma yma y bebe updatedupdated inin responseresponse toto changeschanges inin thethetimetable,timetable, performance,performance, or or feasibilit yfeasibilit y of of componentactivitiescomponentactivities
LogframeLogframe planningplanning isis favouredfavoured b yby somesome internationalinternationaldevelopmentdevelopment agenciesagencies ( ( L as t L as t 20012001, , modifi ed modifi ed ))
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MatrixMatrix
InIn epidemiolog yepidemiolog y andand biostatistics,biostatistics, a a displa ydispla yof of datadata inin columnscolumns andand rowsrows
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InputInput
R esourcesR esources usedused (or(or needed)needed) toto implementimplement a agivengiven activit yactivit y (human,(human, financial,financial, materialmaterialtime)time)
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Efficienc yEfficienc y
T heT he measuremeasure of of howhow economicall yeconomicall y resourcesresourcesareare utilisedutilised toto achieveachieve predeterminedpredeterminedobjectivesobjectives
T heT he ratioratio of of inputsinputs overover outputsoutputs
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EffectivenessEffectiveness
T he degree of attainment of predeterminedT he degree of attainment of predeterminedobjectivesobjectives
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MonitoringMonitoringT heT he continuouscontinuous observationobservation andand measurementmeasurement of of implementationimplementation to to makemake suresure thatthat itit isis goinggoingaccordingaccording toto plansplans
If If monitoringmonitoring revealsreveals thatthat therethere areare problemsproblems orordiscrepanciesdiscrepancies betweenbetween implementationimplementation andand plans,plans,correctivecorrective actionsactions mustmust bebe takentaken toto bringbring activitiesactivitiesback back onon track track
InIn somesome circumstances,circumstances, it it ma yma y bebe necessar ynecessar y totoreviserevise thethe plansplans
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EvaluationEvaluationT heT he attemptattempt toto determine,determine, asas s ystematicall ysystematicall yandand objectivel yobjectivel y asas possible,possible, thethe relevancerelevance, ,efficienc yefficienc y,, effectivenesseffectiveness, , outcomesoutcomes andandimpactimpact of of activitiesactivities inin thethe lightlight of of theirtheir
objectivesobjectives
ItIt mustmust considerconsider thethe inputsinputs, , thethe processprocess of of
theirtheir transformationtransformation in in outputsoutputs, , thetheoutcomeoutcome andand thethe impactimpact
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O utcomeO utcome
T heT he endend resultresult of of anan activit yactivit y oror aa setset of of activitiesactivities (for(for instance,instance, decreaseddecreased incidenceincidenceof of measlesmeasles afterafter anan immunisationimmunisationcampaign)campaign). .
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ImpactImpact
LongLong termterm, , lastinglasting changechange producedproduced uponupon aagivengiven situationsituation b yby aa setset of of activitiesactivities oror eventsevents(for(for instance,instance, decreaseddecreased infantinfant mortalit y)mortalit y)
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Q ualit yQ ualit y
T heT he measuremeasure of of howhow goodgood somethingsomething is is
DoingDoing thethe rightright thingsthings right,right, atat thethe rightrighttime,time, inin thethe rightright place,place, withwith thethe rightrightresourcesresources
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StandardStandard
Criterion,Criterion, measure,measure, againstagainst whichwhich totocomparecompare weights,weights, lengths,lengths, qualit y,qualit y, purit y,purit y,etcetc..
R equired,R equired, expected,expected, acceptedaccepted levellevel of of qualit yqualit y
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Q ualit y AssuranceQ ualit y AssuranceT heT he continuous,continuous, s ystematicsystematic processprocess totoensureensure thatthatthe right things are donethe right things are doneto achieve the right objectivesto achieve the right objectivesat the right timeat the right timein the right placein the right placeby the right peopleby the right peoplein the right wa yin the right wa ywith the right resourceswith the right resources
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G ini CoefficientG ini CoefficientAA measuremeasure of of thethe extentextent toto whichwhich thethedistributiondistribution of of incomeincome (or,(or, inin somesome cases,cases,consumptionconsumption expenditures)expenditures) amongamongindividualsindividuals oror householdshouseholds withinwithin anan
econom yeconom y deviatesdeviates fromfrom aa perfectl yperfectl y equalequaldistributiondistribution
T heT he coefficientcoefficient rangesranges fromfrom 00 meaningmeaningperfectperfect equalit yequalit y toto 11 completecomplete inequalit yinequalit y
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G ross Domestic ProductG ross Domestic ProductG ross National ProductG ross National Product
G rossG ross domesticdomestic productproduct ( GD P)(GD P) isis thethe totaltotal outputoutput of of goodsgoodsandand servicesservices forfor finalfinal useuse producedproduced b yby anan econom yeconom y byby bothbothresidentsresidents andand nonnon--residents,residents, regardlessregardless of of thethe allocationallocation totodomesticdomestic andand foreignforeign claimsclaims
ItIt doesdoes notnot includeinclude deductionsdeductions forfor depreciadeprecia- - tiontion of of ph ysicalph ysicalcapitalcapital oror depletiondepletion andand degradationdegradation of of naturalnatural resourcesresources
G rossG ross nationalnational productproduct ( G NP)(G NP) ComprisesComprises GD PGD P plusplus netnetfactorfactor incomeincome fromfrom abroad,abroad, whichwhich isis thethe incomeincome residentsresidentsreceivereceive fromfrom abroadabroad forfor factorfactor servicesservices (labour(labour andandcapital),capital), lessless similarsimilar pa ymentspa yments mademade toto nonnon--residentsresidents whowhocontributecontribute to to thethe domesticdomestic econom yeconom y
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G lobalizationG lobalizationT heT he increasedincreased interconnectednessinterconnectedness andand interdependanceinterdependance of of peoplespeoples andand countries,countries, is is generall ygenerall y understoodunderstood to to includeincludetwotwo interrelatedinterrelated elementselements: :
thethe openingopening of of bordersborders toto increasingl yincreasingl y fastfast flowsflows of of goods,goods,services,services, finance,finance, peoplepeople andand ideasideas
thethe changeschanges inin institutionalinstitutional andand polic ypolic y regimesregimes atat thetheinternationalinternational andand nationalnational levelslevels thatthat facilitatefacilitate oror promotepromotesuchsuch flowsflows
ItIt isis recognizedrecognized thatthat globalizationglobalization hashas bothboth positivepositive andandnegativenegative impactsimpacts onon developmentdevelopment ( (W H OW H O GlossaryGlossary ))