In the discipline of practical theology, one finds a long history of linking the name of the field to diaconiology, in which you find the Greek word diaconia, directly translated as 'service'. For good and scientific reasons, the field changed its name to practical theology in some Faculties of Theology but that does not take away the fact that this field of research is still very much engaged in the broad area of 'service of all kinds'. The purpose (...) of this article was to do a descriptive investigation into the problems and challenges of service delivery in the suburb of Belhar (Cape Town), specifically looking at the role of leadership during a (new) time of struggle. As part of the normative task, the researcher took a closer look at the Belhar Confession as a prophetic stance in this regard. In an ironic twist, we see in these events the struggle between the real and the ideal that is typical of many places in the country facing problems with service delivery. The Church often thinks it knows what the world wants from it - inspiration, 'leadership,' clear teaching. But surely what the world is most hungry for is the simple knowledge that healing is possible - not by forgetting or minimizing outrages and sufferings but by sheer, obstinate, costly commitment to work with the grain of grace. (Rowan Williams, Archbishop of Canterbury, in Lapsley 2012:i). (shrink)

ABSTRACT Although dominant discourses of various kinds are frequently reproduced on talk radio, the fundamentally collaborative nature of the medium also means that it is able to serve as a channel through which to challenge these discourses. Using Critical Discourse Analysis, this article examines how neoliberal ideology structures discussions around ‘service delivery protest’ on South African talk radio, and explores some of the roles that talk radio is, and is not, able to play in constructing resistance to neoliberal (...) ideology. Our analysis yielded two discourses, namely: naturalisation of the commodification of everyday life, and market over welfare – both of which seemed to cohere with neoliberal frameworks and rationalities in different ways. We conclude by suggesting how radio can be used to denaturalise neoliberalism’s impulse towards making common sense conditions that enable economic oppression and exploitation. (shrink)

This article proceeded from the assumption that the theme of service delivery in present-day South Africa could well be qualified by the notion of 'crisis', to the extent that this qualification, from a theological perspective and on the basis of comparative social analysis, well recalls the statements in such critical and profound theological documents as The Kairos Document and Evangelical Witness in South Africa on the 'crisis' in the latter years of apartheid. The further recognition that the theme (...) of service delivery constitutes an essentially new focus for practical-theological scholarship in South Africa led the author, who has a pertinent interest in the field of Christian diaconia, to thereupon go the full circle of practical-theological interpretation in developing such a focus. This was done by, firstly, attempting to develop a deeper contextual understanding of the problem of service delivery in the country on the basis of the prevailing debate on service delivery in South Africa, after which the ideas from conceptualisations of two different modes of diaconal practice within contexts of endemic poverty in the practical-theological literature were explored. The discussion concluded with a more pertinent consideration of the extent to which these two conceptualisations could be taken as providing direction in conceptualising a transformational diaconal response to the current service-delivery problem. (shrink)

ABSTRACTAlthough dominant discourses of various kinds are frequently reproduced on talk radio, the fundamentally collaborative nature of the medium also means that it is able to serve as a channel...

A rising number of patients require continuing or palliative services and this means that they will need to transition from one model of healthcare delivery to another. If it is generally recognised that patient vulnerability to inadequate services increases when the setting in which patient receives care changes, it is usually taken to be the result of poor coordination of services or personnel. Recognising that an integrated system is essential to adequate access, the point that I put forward in (...) this paper is that the centrality of acute care services affects the way in which chronic and palliative services are structured and, consequently, their availability. I argue that the problem originates in the manner in which some of the foundational concepts of the acute care model are imported into the other models of care delivery. In order to make this case, I review the three main models of healthcare service delivery by focusing my analysis along three axes: the goal of the care model; the predominant understanding of autonomy implicit in the model; and, the main actors in the care relationship. By examining how the various concepts translate from one model to the next, I discuss what I identify to be one of the main conceptual obstacles to less problematic transitioning, the notion of autonomy and the corresponding view of the patient as an isolated agent. (shrink)

China has undergone a profound paradigm shift in its approach to economic development since its policy of 'opening and reform' was first implemented in 1978. It has shifted rapidly from a centrally planned economy to a market-oriented one, speeding up its economic development through foreign investment, a more open market, access to advanced technologies and management experience. It is notable that its economic growth, marked by annual double-digit rises in GDP over two decades, has lifted more than 400 million people (...) out of extreme poverty. Today, the number of Chinese billionaires has ballooned, but so has the rich-poor gap. China's 'development' has to address this urgent issue. This article examines, based on the experience of Amity Foundation, one of China's largest faith-based organisations, how religious organisations are being harnessed by the state to redress the wealth gap arising from 'development'. The process of social engagement has empowered FBOs, made their presence more accepted and appreciated in Chinese society and contributed to the creation of more social and political space for a nascent civil society. The author argues that FBOs must provide visible, viable and replicable alternatives in their social practices that are firmly rooted in their faith, if they are to make any sustainable impact on the development debate. (shrink)

An important factor that leads governments to engage in public service contracts with nonprofit organizations is the belief that they share similar ethical and value orientations that will allow governments to reduce monitoring costs. However the notion of the existence of similarities in ethical climate has not been systematically examined. The purpose of this paper is to investigate the ethical climate in government and nonprofit sectors and to determine the extent to which similarities (and differences) exist in ethical climate (...) dimensions. Using survey data and structural equation modeling technique, the factor structure equivalence and measurement invariance of the ethical climate in the two sectors are tested. Results indicate that while there is a significant overlap in shared perception of ethical climate dimensions, there are also key differences between the two sectors. The outcome of this research provides important preliminary insights for public policy makers in government to better understand the implications of using the nonprofit sector for service delivery. (shrink)

An important factor that leads governments to engage in public service contracts with nonprofit organizations is the belief that they share similar ethical and value orientations that will allow governments to reduce monitoring costs. However the notion of the existence of similarities in ethical climate has not been systematically examined. The purpose of this paper is to investigate the ethical climate in government and nonprofit sectors and to determine the extent to which similarities (and differences) exist in ethical climate (...) dimensions. Using survey data and structural equation modeling technique, the factor structure equivalence and measurement invariance of the ethical climate in the two sectors are tested. Results indicate that while there is a significant overlap in shared perception of ethical climate dimensions, there are also key differences between the two sectors. The outcome of this research provides important preliminary insights for public policy makers in government to better understand the implications of using the nonprofit sector for service delivery. (shrink)

Task shifting is increasingly used to address human resource shortages impacting HIV service delivery in low- and middle-income countries. By shifting basic tasks from higher- to lower-trained cadres, such as Community Health Workers, task shifting can reduce overhead costs, improve community outreach, and provide efficient scale-up of essential treatments like antiretroviral therapies. Although there is rich evidence outlining positive outcomes that CHWs bring into HIV programs, important questions remain over their place in service delivery. These challenges (...) often reflect concerns over whether CHWs can mitigate HIV through a means that does not overlook the ethical and practical constraints that undergird their work. Ethical and practical guidance thus needs to become the cornerstone of CHW deployment. This paper analyzes such challenges through the lens of Ethical Principlism. We examined papers identifying substantive and ethical challenges impacting CHWs as they provide HIV services in low- and middle-income contexts. To do this, we analyzed papers written in English and published from year 2000 or later. These articles were identified using MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar databases. In total, 465 articles were identified, 78 of which met our inclusion criteria. Article reference lists and grey literature were also examined. CHWs experience specific challenges while carrying out their duties, such as conducting emotionally- and physically-demanding tasks with often inadequate training, supervision and compensation. CHWs have also been poorly integrated into health systems, which not only impacts quality of care, but can hinder their prospects for promotion and lead to CHW disempowerment. As we argue, these challenges can be addressed if a set of ethical principles is prioritized, which specifically entail the principles of respect for persons, justice, beneficence, proportionality and cultural humility. CHWs play a crucial role in HIV service delivery, yet the ethical challenges that can accompany their work cannot be overlooked. By prioritizing ethical principles, policymakers and program implementers can better ensure that CHWs are combatting HIV through a means that does not exploit or take their critical role within service delivery for granted. (shrink)

This research addresses equity in geographic access to financial services. As financial products and services continue to become more accessible and affordable, many low‐ to moderate‐income Americans remain unbanked and underbanked, relying instead upon informal, alternative financial service providers, including check cashing outlets and payday lenders. While geographic access to affordable financial products and services assists in the successful asset building strategies of economically vulnerable households, concerns that access to financial services is uneven persist. This article uses geographic information (...) systems and spatial binary logistic regression analysis to test the hypothesis that sociodemographic characteristics and mortgage lending variables have a predictive relationship on the presence of financial deserts—census tracts where check cashing outlets are more prevalent than banks—in southeastern Pennsylvania. Results of comparison of means and regression analysis reveal that these tracts are associated with higher than average population density, lower levels of median household income, a higher proportion of Black and Latinx residents, and higher levels of mortgage application denial. This article contributes to the ongoing debate over the emergence of a two‐tiered or dual financial service delivery system, whereby financial products and services are bifurcated based on socioeconomic status and geography. (shrink)

With an upsurge of interest and investment in new legal technologies comes consideration of who is making them and whether these individuals or entities should be subject to regulation. This article looks at how such regulation might function in light of the existing regulatory regimes governing lawyers and the capacities of legal regulators. It considers the ramifications both of maintaining the existing system, or in extending some form of regulation to these new entrants to the legal services market.

With an upsurge of interest and investment in new legal technologies comes consideration of who is making them and whether these individuals or entities should be subject to regulation. This article looks at how such regulation might function in light of the existing regulatory regimes governing lawyers and the capacities of legal regulators. It considers the ramifications both of maintaining the existing system, or in extending some form of regulation to these new entrants to the legal services market.

For the last thirty years, the nation's mental health and social service systems have been under relentless assault, with dramatically rising costs and the fragmentation of service delivery rendering them incapable of ensuring the safety, security, and recovery of their clients. The resulting organizational trauma both mirrors and magnifies the trauma-related problems their clients seek relief from. Just as the lives of people exposed to chronic trauma and abuse become organized around the traumatic experience, so too have (...) our social service systems become organized around the recurrent stress of trying to do more under greater pressure: they become crisis-oriented, authoritarian, disempowered, and demoralized, often living in the present moment, haunted by the past, and unable to plan for the future.Complex interactions among traumatized clients, stressed staff, pressured organizations, and a social and economic climate that is often hostile to recovery efforts recreate the very experiences that have proven so toxic to clients in the first place. Healing is possible for these clients if they enter helping, protective environments, yet toxic stress has destroyed the sanctuary that our systems are designed to provide.This thoughtful, impassioned critique of business as usual begins to outline a vision for transforming our mental health and social service systems. Linking trauma theory to organizational function, Destroying Sanctuary provides a framework for creating truly trauma-informed services. The organizational change method that has become known as the Sanctuary Model lays the groundwork for establishing safe havens for individual and organizational recovery. The goals are practical: improve clinical outcomes, increase staff satisfaction and health, increase leadership competence, and develop a technology for creating and sustaining healthier systems. Only in this way can our mental health and social service systems become empowered to make a more effective contribution to the overall health of the nation.Destroying Sanctuary is a stirring call for reform and recovery, required reading for anyone concerned with removing the formidable barriers to mental health and social services, from clinicians and administrators to consumer advocates. (shrink)

Reason and Rationality in Health and Human Services Delivery is the first book to discuss the topic of decisionmaking and services from a multidisciplinary approach. It uses theory and social considerations, not just technology, as a basis for improved services. Health and human service students and professionals will learn how to form rational and reasonable decisions that take their clients'cultural backgrounds into consideration when identifying an illness or appropriating any kind of intervention. With a particular emphasis on theories, (...) models, organizational settings, technologies, and practitioner training methods that lead to culturally sensitive decisions, Reason and Rationality will help you deliver efficient and improved medical and social services to clients from all ethnic backgrounds. Recognizing reason as the centerpiece of most of Western philosophy, this text reveals how our idea of truth, fact, and order are wrongly thought to be universal; yet, Western principles are continually used in the decision-making process for health and social services. Focusing on the policy implications of decisionmaking in medical and social service settings, this text works to incorporate a broad range of factors into the reasoning process, such as cultural traditions and beliefs, that will result in better treatment for patients. Giving you suggestions and strategies for upgrading reasoning and decision-making processes and applying them to every area of service, Reason and Rationality discusses different themes that will help you improve services to patients, such as: the rationale currently used to justify decision-making strategies concerning medical and human services using computer technology to make clinical assessments revising administrative structure, management theories, and organizational strategies so that decision-making processes enhance the overall quality of service delivery how the practitioner/patient relationship is important in choosing the proper treatment soliciting community-based input to assess the public's health and human service needs in order to lessen political involvement in decision-making stages In addition, Reason and Rationality provides information and examples that show why you should consider the "life-world"--the values, beliefs, and commitments of a culture's history-- as the key to understanding the powers of reasoning that specify parameters of health and illness. (shrink)

This practical-theological study aims to develop a contextual theology in the areas of business and government that will aid a successful intervention by the church in diminishing the corrupt practices prevalent in South Africa. It seeks to prove that corruption is a major factor in causing the delays experienced in the implementation of service delivery, and that this is causing much anger and increasing disillusionment with the present system of democratic government. At the moment the church has a (...) window of opportunity for this intervention to take place, since many of those responsible for supporting, organising and implementing service delivery, both in government and industry, worship regularly, as committed members, in local Christian congregations. A modified application of the Asset-Based Community Development (ABCD) approach using focus groups is suggested as both a tool for intervention and for further research. (shrink)

Stakeholder management is an important method for reducing business risk. Recent decades have seen the growth of a new type of stakeholder: social protest stakeholders, individuals engaging in protest action which is directed at other unrelated parties, often the government. However, the actions of social protest stakeholders may negatively affect companies located nearby. This stakeholder category has not received any formal attention in the literature, and this article addresses the knowledge gap by exploring the effects of community-driven protest action in (...) South Africa and the strategies that firms adopt to mitigate the negative consequences of such protests. A multiple case study analysis was used to describe this type of stakeholder group and the management of the consequences of social protest action. Eight manufacturing companies in the Gauteng province participated in the study, the companies varied in size and industry. Among the key findings are that companies need to be highly adaptable if they are to mitigate the impact of protest action. We make practical suggestions about how companies may manage these risks, including the recommendation that companies engage more directly with social protestors to manage risks. The study makes an important contribution to the literature by identifying an additional key category of stakeholder and proposing a risk management approach to avert or minimize loss and damage. (shrink)

Climate change, energy price spikes, and concerns about energy security have reignited interest in state and local efforts to promote end-use energy efficiency, customer-sited renewable energy, and energy conservation. Government agencies and utilities have historically designed and administered such demand-side measures, but innovative third-party administrative models present new options to finance, market, and deliver sustainable energy services to energy end-users. This study outlines the concept of a new third-party administrative model, a sustainable energy utility (SEU), with the potential to achieve (...) deep energy efficiency savings and a high penetration of customer-sited renewable energy. An SEU is characterized by central coordination, comprehensive programs, flexible incentives, financial self-sufficiency, competitive procurement, and a focus on delivering energy services rather than commodity energy. (shrink)

In Europe, a well-known problem is the coordination of interagency service delivery to independently living older persons, disabled persons or persons suffering from chronic illness. Coordination is necessary in order for the users to receive services at the appropriate time and place. Based on historical institutionalism, which focuses on the path dependency of the development of government policy and organizational and professional rules, it can be stated that coordination requires organizational models or other solutions that fit the characteristics (...) of the context (‘configuration’) for which the solution is intended. The western European countries have different configurations. Remarkably, across these countries, we see the emergence of multidisciplinary teams as a solution to the problem of coordination. Consequently, if we take the above statement to mean that a solution should fit all the configuration’s characteristics, we must reject the statement. However, when we assume that a solution should fit particular configurational characteristics, we must not. We take the second position and we argue that multidisciplinary teams have emerged because they fit one particular feature that is similar in the countries: professionalism and professional fragmentation. (shrink)

Diabetes is a chronic and systemic disease that has reached epidemic proportions. An estimated 17 million Americans have diabetes, and an additional 16 million individuals are considered to have pre-diabetes. Studies have shown that timely screening and referral are necessary to maintain healthy blood glucose levels and slow the progression of diabetes-related complications. Furthermore, lifestyle changes can prevent or delay the onset of Type 2 diabetes for high-risk individuals.The Division of Diabetes Translation at the Centers for Disease Control and Prevention (...) undertook an analysis of diabetes-related legislation across the nation. More specifically, state laws, rules and regulations mandating health insurance coverage for diabetes-related supplies and services were examined according to Sample Purchasing Specifications for Services Related to Diabetes—an evidence-based model of standards of care for persons with diabetes. (shrink)

Diabetes is a chronic and systemic disease that has reached epidemic proportions. An estimated 17 million Americans have diabetes, and an additional 16 million individuals are considered to have pre-diabetes. Studies have shown that timely screening and referral are necessary to maintain healthy blood glucose levels and slow the progression of diabetes-related complications. Furthermore, lifestyle changes can prevent or delay the onset of Type 2 diabetes for high-risk individuals.The Division of Diabetes Translation at the Centers for Disease Control and Prevention (...) undertook an analysis of diabetes-related legislation across the nation. More specifically, state laws, rules and regulations mandating health insurance coverage for diabetes-related supplies and services were examined according to Sample Purchasing Specifications for Services Related to Diabetes—an evidence-based model of standards of care for persons with diabetes. (shrink)

The Alexandra District Ambulance Service is the only volunteer-based ambulance service in Victoria, Australia. It provides an opportunity to reflect on the ethical issues surrounding the delivery of ambulance service by volunteers, and its impact on the community.

In this article, I will argue that the delivery of healthcare could be an act of resistance, that is, day‐to‐day, routine and perhaps mundane acts, undertaken in the course of the delivery of health services, which for many could also be considered otherwise routine care. I first consider how resistance has been conceptualised. How we understand resistance will determine if we believe healthcare could be conceptualised this way. I will show how resistance has been applied to day‐to‐day struggles (...) elsewhere and argue that it can clearly encompass open, collective dissent and more subtle, day‐to‐day action that does not necessarily make clear political demands. I go on to introduce some examples, where the delivery of health services could be conceptualised as resistance. While I advocate for a broad understanding of resistance, clearly not every act could be considered resistance; I will consider some points of tension and contention in utilising resistance to describe the delivery of health services, in particular discussing the issue of intent and opposition as they relate to resistance. Finally, while I hope that I make a convincing case, one final issue remains, namely, why turn to resistance at all, when many of the examples that I provide could be labelled using concepts that are more widely utilised. I will offer some general reflections on this point, speaking to the benefits and potential of resistance. (shrink)

Cochran has argued that Catholic health care occupies a “unique place on the border of public and private life”. Catholic health care is accountable to both its religious and sacramental traditions and its public responsibilities. It is inevitable that “border skirmishes” will arise. Yet there is no single formula for suggesting what public-private collaboration should comprise or how conflicts between values ought to be resolved. It may be, as Cochran suggests, that increasingly bitter conflicts over widely valued services such as (...) sterilization, combined with market pressures to conform to for-profit trends in health care, will make divestiture of faith-based hospitals in favor of other types of church-community partnerships the best course for the future. (shrink)

Medical-legal partnership (MLP) embeds attorneys and paralegals into care delivery to help clinicians address root causes of health inequities. Notwithstanding decades of favorable outcomes, MLP is not as well-known as might be expected. In this essay, the authors explore ways in which strategic alignment of legal services with healthcare services in terms of professionalism, information collection and sharing, and financing might help the MLP movement become a more widespread, sustainable model for holistic care delivery.

Partially because of the high cost of developing and maintaining cold chains, systems needed to keep heat-labile vaccines under adequate refrigeration from their points of manufacture to their administration in the field, the Joint WHO/FAO Expert Committee on Zoonoses (i.e., the approximately four fifths of all described human infections that people share with other vertebrate animals) recommended in 1982 operation of common cold chains by health and veterinary services in rural areas. Following this recommendation, a 1984 pilot level initiative in (...) medical-veterinary intersectoral cooperation should be regarded as a practical way to deliver human primary health care to currently neglected African pastoralists, and as a potential core program for development efforts overall within arid and semiarid areas of the African continent. (shrink)