BACKGROUND: As part of the Reengineering Primary Health Care initiative, the South African National Department of Health (NDoH) has committed to expanding access to home-based care provided by community health workers. The NDOH also prioritised Community Health Workers (CHWs) in their agenda to improve child development outcomes in South Africa. However, there is limited research on CHWs' experiences and knowledge of early childhood development AIM: To explore CHWs' motivation for work, their background, training and scope of work around Early Child Development (ECD SETTING: The study was conducted in Mopani District, Limpopo province, South Africa, in 2017 METHODS: Five focus group discussions (FGDs) were conducted with 41 CHWs participating within a large cluster-randomised study. Data were analysed thematically using an inductive approach RESULTS: Community health workers' motivation to work was influenced by personal experiences, community needs and community service. In terms of knowledge, CHWs indicated that a nutritious diet with extended breastfeeding, immunisations and preschool education is imperative for a child to thrive. The Road to Health Booklet, weighing scales and the mid-upper arm circumference tape were used as screening tools for ECD. Community health workers perceived their knowledge around ECD to be insufficient CONCLUSION: Community health workers play a crucial role in healthcare; therefore, capacity development on ECD and the provision of ECD screening tools to optimise their under-five child visits are necessary CONTRIBUTION: This study will potentially contribute to the improvement of the CHW programme in ensuring that children under 5 years of age are holistically cared for to ensure that they thrive

ABSTRACT Objective. To assess the legislative frameworks concerning childhood vaccination in the English- and Dutch-speaking Caribbean and propose a model legislative framework for Caribbean countries. Methods. This study included a survey of 22 countries and territories in the Caribbean regarding legal vaccination mandates for school entry, budget allocations, sanctions, or exemptions. A legal consultant conducted a comprehensive search and analysis of legislation regarding vaccination among 13 Caribbean countries/territories. A comparative analysis of the legislation under five themes—legislative structure, mandatory vaccination, national immunization schedule, sanctions, and exemptions—formed the basis for the proposed model legislation. Results. Among the 22 Caribbean countries/territories, 17 (77%) had legislation mandating vaccination, 16 (94%) mandated vaccination for school entry, 8 (47%) had a dedicated budget for immunization programs, and 13 (76%) had no legislated national schedules. The source of legislation includes six (35%) using the Education Act, eight (47%) the Public Health Act, and five (29%) a free-standing Vaccination Act. Three countries/territories—Jamaica, Montserrat, and Saint Lucia—had immunization regulations. In 12 (71%) of the 17 countries with legislation, sanctions were included, and 10 (59%) permitted exemptions for medical or religious/philosophical beliefs. Conclusions. Several countries in the Caribbean have made failure to vaccinate a child an offense. By summarizing the existing legislative frameworks and approaches to immunization in the Caribbean, the analysis guides policymakers in making effective changes to immunization legislation in their own countries.

RESUMO Objetivo. Avaliar as estruturas da legislação relativas à vacinação em crianças no Caribe de língua inglesa e holandesa e propor um modelo de legislação para os países caribenhos. Métodos. Este estudo incluiu uma pesquisa relativa à exigência legal em 22 países e territórios do Caribe de vacinação para admissão em escolas, alocações orçamentárias, sanções ou isenções. Um consultor jurídico realizou ampla pesquisa e análise da legislação relativa à vacinação em 13 países/territórios do Caribe. Uma análise comparativa da legislação referente a cinco temas – estrutura legislativa, vacinação obrigatória, cronograma nacional de imunização, sanções e isenções – formou a base para o modelo de legislação proposto. Resultados. Entre os 22 países/territórios caribenhos, 17 (77%) tinham legislação que exigia a vacinação; em 16 (94%), a vacinação era obrigatória para admissão na escola; 8 (47%) tinham orçamento exclusivo para programas de imunização; e em 13 (76%), a legislação não contemplava cronogramas nacionais. Com relação à fonte da legislação, seis (35%) países usavam a legislação de educação; oito, (47%) a Legislação de Saúde Pública; e cinco (29%), legislação de vacinação independente. Três países/territórios - Jamaica, Montserrat e Santa Lúcia - tinham regulamentações para imunização. Dos 17 países com legislação, 12 (71%) incluíam sanções e 10 (59%) permitiam isenções por crenças médicas ou religiosas/filosóficas. Conclusões. Diversos países do Caribe estabelecem que não vacinar uma criança é violação da lei. Ao resumir as estruturas de legislação existentes e as abordagens da imunização no Caribe, a análise orienta os formuladores de políticas a realizar mudanças efetivas na legislação de imunização em seus próprios países.

RESUMEN Objetivo. Evaluar los marcos legislativos relativos a la vacunación infantil en el Caribe de habla inglesa y neerlandesa y proponer un modelo de marco legislativo para los países del Caribe. Métodos. En este estudio se incluyó una encuesta en 22 países y territorios del Caribe sobre los requisitos legales de vacunación para el ingreso escolar, asignaciones presupuestarias, sanciones o exenciones. Un consultor jurídico realizó una búsqueda y un análisis exhaustivos de la legislación relativa a la vacunación en 13 países y territorios del Caribe. Un análisis comparativo de la legislación dividido en cinco temas (estructura legislativa, vacunación obligatoria, calendario nacional de vacunación, sanciones y exenciones) formó la base del modelo de legislación propuesto. Resultados. Entre los 22 países y territorios del Caribe, 17 (77%) contaban con leyes sobre vacunación obligatoria, 16 (94%) exigían la vacunación para el ingreso escolar, 8 (47%) tenían un presupuesto dedicado a los programas de vacunación y 13 (76%) no disponían de calendarios nacionales estipulados por ley. Entre las fuentes de la legislación, seis países y territorios (35%) empleaban la ley de educación, ocho (47%) la ley de salud pública y cinco (29%) una ley independiente de vacunación. Tres países y territorios —Jamaica, Montserrat y Santa Lucía— disponían de regulaciones sobre vacunación. Doce (71%) de los 17 países con legislación tenían sanciones y 10 (59%) permitían exenciones por creencias médicas o religiosas o filosóficas. Conclusiones. Varios países del Caribe han tipificado como delito el no vacunar a un niño o niña. Al resumir los enfoques y marcos legislativos existentes para la vacunación en el Caribe, este análisis ofrece orientaciones a los responsables de formular las políticas para que realicen modificaciones efectivas en la legislación relativa a la vacunación en sus propios países.

BACKGROUND: The South African National Policy Framework and Strategy on Palliative Care (NPFSPC) recommends that when integrating palliative care (PC) into the health system, a PC indicators tool should be used to guide clinicians to recognise a patient who should receive PC. The policy document recommends 'a simple screening tool developed for use in South Africa that would assist healthcare professionals (HCPs) to recognise patients who may have unmet palliative care needs' AIM: This research study sought to develop South African consensus on indicators for PC to assist clinicians to recognise a patient in need of PC SETTING: The South African healthcare setting METHODS: A Delphi study was considered suitable as a methodology to develop consensus. The methodology was based on the Conducting and REporting of DElphi studies (CREDES) guidance on Delphi studies to ensure rigour and transparency in conducting and reporting. Six different Delphi rounds were used to develop consensus. Each round allowed participants to anonymously rate statements with predefined rating scales RESULTS: Cognisant of the disparities in healthcare provision and access to equitable healthcare in South Africa, the expert advisory group recommended, especially for South Africa, that 'this tool is for deteriorating patients with an advanced life-limiting illness where all available and appropriate management for underlying illnesses and reversible complications has been offered'. The expert advisory group felt that disease-specific indicators should be described before the general indicators in the South African indicators tool, so all users of the tool orientate themselves to the disease categories first. This study included three new domains to address the South African context: trauma, infectious diseases and haematological diseases. General indicators for PC aligned with the original Supportive and Palliative Care Indicators Tool (SPICT) tool CONCLUSION: The Supportive and Palliative Care Indicators Tool for South Africa (SPICT TM-SA) is a simple screening tool for South Africa that may assist HCPs to recognise patients who may have unmet PC needs

Abstract Background: Though gout is more prevalent in men than women, it remains unclear whether gender influences risk factors for incident gout. We aimed to systematically review all cohort studies examining risk factors for the development of gout by gender. Methods: MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched from inception to March 2019. Risk factors for gout examined were: age, ethnicity, consumption of alcohol, meat, seafood, dairy products, purine-rich vegetables, coffee and fructose, vitamin C intake, the Dietary Approaches to Stop Hypertension (DASH) diet, metabolic syndrome, BMI, waist and chest circumference, waist-to-hip ratio, weight change, diabetes mellitus, dyslipidaemias, renal disease, psoriasis, hypertension, diuretic use and anti-diabetic medication. Cohort studies were included if examining (at least) one of these risk factors for gout in either gender in the general population or primary care. Sample characteristics from included articles and their reported risk estimates were described using narrative synthesis. Results: Thirty-three articles were included, 20 (60.6%)directly compared risk factors by gender, 10 (30.3%) used men-only samples, 3 (9.1%) used women-only samples. Articles comparing risk across genders found similar increases in most risk factors. However, in men, metabolic syndrome (Hazard Ratio (95% CI) 1.37(1.20-1.58)) presented a risk of incident gout compared to none in women (> 50 years 1.15(0.85-1.54); ≤50 years 1.29(0.76-2.17)). Compared to men, women showed greater associated risk with higher consumption of fish and shellfish (HR (95% CI) Men: 1.02 (0.86-1.22); Women 1.36 (1.12-1.65)). Conclusions: Risk factors for developing gout did not typically differ between genders and therefore similar preventative advice can be provided. Exceptions were metabolic syndrome in men and excessive seafood consumption in women, but these singular articles need further examination and in general more research into the risk factors for gout which includes women is required.

Resumo Em uma era em que as prioridades da política social estão subordinadas a agendas capitalistas regressivas, sustentar compromissos coletivos com a proteção e a provisão social define a linha de frente da batalha para a “boa sociedade”. O conflito se manifesta em uma série de arenas, mas a saúde é um arquétipo analítico. O artigo, de caráter introdutório ao número especial, assume a dinâmica da contradição entre o caráter inerentemente coletivo da provisão em saúde e a insistência capitalista em usar o consumo individual valorado em preços de mercado para medir o sucesso de uma sociedade. Deixado sem controle, o bloco de elite cuja agenda é definida pela busca dos interesses do capital destruirá a proteção e a provisão social existentes, tornando as sociedades, especialmente no Sul Global, lugares ruins para os cidadãos comuns viverem. Os artigos deste volume deixam um desafio: como construir a agência necessária para expandir e fortalecer a proteção e provisão social em uma era de dominação capitalista regressiva?

Abstract In an era when social policy priorities are subordinated to regressive capitalist agendas, sustaining collective commitments to social protection and social provision defines the front line of the battle for the good society. The conflict manifests itself across a range of arenas, but health is analytically archetypal. This introductory article for the special issue assumes the dynamics of the contradiction between the inherently collective character of health provision and capitalist insistence on using individual consumption valued in market prices to measure societal success. Left unchecked, the elite bloc whose agenda is defined by pursuit of the interests of capital will destroy existing social provision and protection, making societies, especially in the Global South, ugly places to live for ordinary citizens. The articles in this volume leave us with a challenge: how can we construct the oppositional agency necessary to expand and strengthen social provision and protection in an era of regressive capitalist domination?

Resumo Em uma era em que as prioridades da política social estão subordinadas a agendas capitalistas regressivas, sustentar compromissos coletivos com a proteção e a provisão social define a linha de frente da batalha para a “boa sociedade”. O conflito se manifesta em uma série de arenas, mas a saúde é um arquétipo analítico. O artigo, de caráter introdutório ao número especial, assume a dinâmica da contradição entre o caráter inerentemente coletivo da provisão em saúde e a insistência capitalista em usar o consumo individual valorado em preços de mercado para medir o sucesso de uma sociedade. Deixado sem controle, o bloco de elite cuja agenda é definida pela busca dos interesses do capital destruirá a proteção e a provisão social existentes, tornando as sociedades, especialmente no Sul Global, lugares ruins para os cidadãos comuns viverem. Os artigos deste volume deixam um desafio: como construir a agência necessária para expandir e fortalecer a proteção e provisão social em uma era de dominação capitalista regressiva?

Abstract In an era when social policy priorities are subordinated to regressive capitalist agendas, sustaining collective commitments to social protection and social provision defines the front line of the battle for the good society. The conflict manifests itself across a range of arenas, but health is analytically archetypal. This introductory article for the special issue assumes the dynamics of the contradiction between the inherently collective character of health provision and capitalist insistence on using individual consumption valued in market prices to measure societal success. Left unchecked, the elite bloc whose agenda is defined by pursuit of the interests of capital will destroy existing social provision and protection, making societies, especially in the Global South, ugly places to live for ordinary citizens. The articles in this volume leave us with a challenge: how can we construct the oppositional agency necessary to expand and strengthen social provision and protection in an era of regressive capitalist domination?

A era neoliberal minou os direitos dos trabalhadores e o poder das forças sociais do trabalho a nível nacional, mas foi caracterizada, também, como uma era do novo “transnacionalismo do movimento dos trabalhadores”. Mudanças conjunturais a nível nacional foram fundamentais para aumentar a abertura às alianças transnacionais. Uma análise das campanhas evidencia isso. Avaliar as conexões entre movimentos nacionais de trabalhadores e a nova infraestrutura organizacional que emergiu no neoliberalismo é um ponto de partida necessário para construir teorias mais apuradas sobre as dinâmicas das contestações das forças sociais do trabalho ao capital global.

The neoliberal era has undermined worker’s rights and labor’s power at the national level, but has also been characterized as an era of “the new labor transnationalism”. Shifting fortunes at the national level have been fundamental to expanding openness to transnational alliances. An analysis of campaigns displays that. Assessing the connections among national labor movements and the new global organizational infrastructure that have emerged under neoliberalism is a necessary foundation for building better theories of labor’s evolving contestation with global capital.

L’ère néolibérale a miné les droits des travailleurs et le pouvoir des forces sociales du travail au niveau national mais a aussi été caractérisée comme l’ère d’un nouveau “transnationalisme du mouvement des travailleurs”. Les changements conjoncturels au niveau national ont joué un rôle fondamental pour amplifier l’ouverture à des alliances transnationales. Une analyse des campagnes permet de le mettre en évidence. Faire l’évaluation des liens existants entre les mouvements nationaux des travailleurs et la nouvelle infrastructure organisationnelle qui a surgi au sein du néolibéralisme est un point de départ nécessaire à la construction de théories plus précises concernant les dynamiques de contestation des forces sociales du travail envers le capital mondial.

O estudo tem como objetivo analisar a compreensão da composição aditiva dos números em crianças surdas. Este artigo descreve dois estudos que utilizaram a Tarefa de Compra de Nunes e Schliemann (1990) para investigar a compreensão da composição aditiva em crianças no contexto de contar dinheiro. No primeiro estudo, comparamos a compreensão da composição aditiva em crianças surdas à de crianças ouvintes da mesma idade. No segundo estudo, realizamos uma breve intervenção para avaliar a possibilidade de melhorar sua compreensão de composição aditiva. Concluímos que intervenções ainda que breves, mas teoricamente significativas e claramente direcionadas, podem ser usadas para melhorar o desempenho das crianças surdas nas tarefas que avaliam a composição aditiva.

This study aims at analyzing the comprehension of additive composition of number by deaf children. This article describes two studies that use the Purchasing Task from Nunes and Schliemann (1990) to investigate the perception of additive composition by children in the context of counting money. In the first study, we compared the comprehension of the concept by deaf children and hearing children of the same age. In the second study, we carried out a brief intervention to evaluate the possibility of enhancing deaf children's apprehension of the concept. We concluded that the interventions, even brief ones, but theoretically meaningful and clearly directed, can be used to improve the performance of deaf children in tasks that evaluate additive composition.

Objective To directly estimate how much smoking contributes to cause-specific mortality in Bangladesh. Methods A case–control study was conducted with surveillance data from Matlab, a rural subdistrict. Cases (n = 2213) and controls (n = 261) were men aged 25 to 69 years who had died between 2003 and 2010 from smoking-related and non-smoking-related causes, respectively. Cause-specific odds ratios (ORs) were calculated for “ever-smokers” versus “never-smokers”, with adjustment for education, tobacco chewing status and age. Smoking-attributable deaths among cases, national attributable fractions and cumulative probability of surviving from 25 to 69 years of age among ever-smokers and never-smokers were also calculated. Findings The fraction of ever-smokers was about 84% among cases and 73% among controls (OR: 1.7; 99% confidence interval, CI: 1.1–2.5). ORs were highest for cancers and lower for respiratory, vascular and other diseases. A dose–response relationship was noted between age at smoking initiation and daily number of cigarettes or bidis smoked and the risk of death. Among 25-year-old Bangladeshi men, 32% of ever-smokers will die before reaching 70 years of age, compared with 19% of never-smokers. In 2010, about 25% of all deaths observed in Bangladeshi men aged 25 to 69 years (i.e. 42 000 deaths) were attributable to smoking. Conclusion Smoking causes about 25% of all deaths in Bangladeshi men aged 25 to 69 years and an average loss of seven years of life per smoker. Without a substantial increase in smoking cessation rates, which are low among Bangladeshi men, smoking-attributable deaths in Bangladesh are likely to increase.

Resumen Objetivo Estimar directamente la medida en la que el tabaquismo contribuye a la mortalidad por causa específica en Bangladesh. Métodos Se realizó un estudio de casos y controles con datos de vigilancia de Matlab, un subdistrito rural. Los casos (n = 2213) y los controles (n = 261) se trataron de hombres de edades entre 25 y 69 años que habían fallecido entre 2003 y 2010 por causas relacionadas y no relacionadas con el tabaquismo, respectivamente. Las razones de posibilidades por causa específica se calcularon para los «fumadores de siempre» frente a los «nunca fumadores», ajustando la educación, el consumo de tabaco de mascar y la edad. También se calcularon las muertes atribuibles al tabaquismo entre los casos, las fracciones nacionales atribuibles y la probabilidad acumulada de sobrevivir de los 25 a los 69 años de edad entre los fumadores de siempre y los nunca fumadores. Resultados La fracción de fumadores de siempre fue de aproximadamente el 84% entre los casos y el 73% entre los controles (razón de posibilidades: 1,7; intervalo de confianza 99%: 1,1–2,5). Las razones de posibilidades fueron las mayores en casos de cánceres y menores en casos de enfermedades vasculares, respiratorias y de otros tipos. Se señaló una relación dosis-respuesta entre la edad de la iniciación en el tabaquismo y el número diario de cigarrillos o bidis fumados y el riesgo de muerte. Entre los hombres de Bangladesh de 25 años, el 32% de los fumadores de siempre fallecerán antes de alcanzar los 70 años, comparado con el 19% de los nunca fumadores. En 2010, aproximadamente el 25% de las muertes observadas en los hombres de Bangladesh de entre 25 y 69 años (42 000 muertes) fueron atribuibles al tabaquismo. Conclusión El tabaquismo causa aproximadamente el 25% de todas las muertes en los hombres de Bangladesh de entre 25 y 69 años y una pérdida media de siete años de vida en cada fumador. Sin un aumento significativo en las tasas de abandono del tabaquismo, que son bajas entre los hombres de Bangladesh, es probable que aumenten las muertes atribuibles al tabaquismo en Bangladesh.

Résumé Objectif Estimer la contribution directe du tabagisme à la mortalité par cause au Bangladesh. Méthodes Une étude cas-témoins a été menée avec les données de surveillance de Matlab, un sous-district rural. Les cas (n = 2213) et les contrôles (n = 261) étaient des hommes âgés de 25 à 69 ans décédés entre 2003 et 2010 des suites ou non du tabagisme, respectivement. Les rapports des cotes (RC) par cause ont été calculés pour les « fumeurs depuis toujours » par rapport aux « non-fumeurs », avec un ajustement pour l'éducation, la consommation de tabac à mâcher et l'âge. On a également calculé les décès attribuables au tabagisme parmi les cas, les fractions attribuables à la population nationale et la probabilité de survie de 25 à 69 ans chez les fumeurs depuis toujours et chez les non-fumeurs. Résultats La fraction des fumeurs depuis toujours était d'environ 84% chez les cas et de 73% chez les contrôles (RC: 1,7; intervalle de confiance de 99%, IC: 1,1–2,5). Les rapports de cotes étaient les plus élevés pour les cancers et plus bas pour les maladies respiratoires, vasculaires et autres. Une relation dose-réponse a été notée entre l'âge de l'initiation au tabagisme et le nombre de cigarettes ou de « bidi s» fumées chaque jour et le risque de mortalité. Chez les hommes du Bangladesh de 25 ans, 32% des fumeurs depuis toujours mourront avant l'âge de 70 ans, par rapport à 19% pour les non-fumeurs. En 2010, environ 25% de tous les décès observés chez les hommes du Bangladesh âgés de 25 à 69 ans (c'est-à-dire 42 000 décès) étaient attribuables au tabagisme. Conclusion Le tabagisme est à l'origine de 25% de tous les décès chez les hommes du Bangladesh âgés de 25 à 69 ans, et d'une perte moyenne de 7 années de vie pour les fumeurs. Sans une augmentation importante des taux d'abandon du tabac, qui sont faibles chez les hommes du Bangladesh, les décès attribuables au tabagisme augmenteront probablement dans ce pays.

A migração partidária no Parlamento Europeu (PE), fenómeno que define a mudança de um deputado ou de um conjunto de deputados para um grupo político diferente daquele em que inicia o mandato, contribui para a volatilidade do sistema partidário da única instituição europeia diretamente eleita pelos cidadãos. Neste estudo apresentamos os resultados de uma base de dados original e exaustiva sobre a evolução da filiação parlamentar de todos os deputados eleitos ao PE desde as primeiras eleições diretas em 1979 até ao final da sexta legislatura, em 2009. O estudo examina as características das migrações que ocorreram neste período, analisando em particular a direção dos fluxos, a sua variação no tempo, por nacionalidade, grupos parlamentares e famílias ideológico-partidárias.

Party group switching in the European Parliament (EP), where parliamentarians individually or collectively switch from one party group to the other is a well-known contributor to the volatility of the EP party system. We present a new dataset that contains party group in formation on all MEPs from 1979 to 2009. As a first step to a more comprehensive analysis of the phenomenon of party group switching in the EP we describe characteristics of all switches that have occurred in these six legislatures, with a focus on the trends across time, variety between member states party groups and ideological party families.

Este artículo ilustra cómo es posible vincular el concepto de aprendizaje de Peter Senge con la idea de acción-decisión de Alfred Schutz y Darío Parra. Las inferencias presentadas argumentan por qué el proceso de toma de decisiones puede ser considerado como un espacio para el aprendizaje, en tanto transforma las experiencias obtenidas en un cambio de actitud del decisor/directivo. Se describen las etapas del proceso de toma de decisiones y su respectiva relación con el aprendizaje organizacional, a saber: plan mental, acto correspondiente y retroalimentación de bucle doble. Finalmente, se presentan inferencias teóricas que sintetizan por qué puede concebirse este aprendizaje como un ciclo descrito de la siguiente manera: experiencia inmediata y concreta se traduce en la base de la observación y la reflexión; observaciones se asimilan en una nueva teoría de la que se pueden deducir nuevas implicaciones para la decisión; implicaciones o hipótesis sirven de guías para la ejecución o creación de nuevas experiencias; y resultados exitosos o de fracaso se incorporan en nuevas decisiones, cambios de actitud.

This article shows how it is possible to link Peter Senge's concept of learning to Alfred Shutz's and Dario Parra's idea of action-decision. The conclusions explain why the process of decision making can be considered as a space for learning, for it transforms the acquired experiences into a change of attitude in the decision marker/executive. The article describes the phases of decision-making and its respective relation to the organizational learning as such: mental plan, corresponding action, and a double spin feedback. Finally, the article expounds theoretical inferences that synthesize why this learning can be conceived as a cycle that is described as follows: immediate concrete experience is translated into the basis of observation and reflection; observations that lead to a new theory from which one can deduce new implications for the decision; implications or hypothesis that act as a guideline for the execution or creation of new experiences; and successful or unsuccessful results that get incorporated into new decisions and changes of attitude.

A teoria econômica moderna foi além do "fundamentalismo do capital". Nas palavras de Hoff e Stiglitz (2001, p. 389), "o desenvolvimento não é mais visto primariamente como um processo de acúmulo de capital, mas antes como um processo de mudança organizacional". Essa percepção possibilitou uma "virada institucional" na teoria do desenvolvimento ao enfatizar o papel de idéias e das instituições enquanto determinantes das possibilidades para o acúmulo de capital, ao invés do oposto. Tanto a "nova teoria do crescimento" quanto o "novo institucionalismo" de Douglass North são exemplos dessa virada institucional. Infelizmente, a "virada institucional" tem sido utilizada de modo perverso por formadores de políticas globais. A visão globalmente dominante é a de que, por serem as instituições tão importantes, por conseguinte, um planejamento institucional baseado em versões idealizadas de instituições anglo-americanas deve ser uniformemente imposto aos países ao Sul do globo para que se desenvolvam. De forma não surpreendente, essa visão falhou na prática. Perspectivas alternativas propostas por Rodrik e Sen defendem que o desenvolvimento tem poucas possibilidades de ter êxito a menos que a mudança institucional esteja alicerçada na tomada de decisões local. Essa é a visão explorada neste trabalho. O estado de Kerala na Índia e a cidade de Porto Alegre no Brasil são utilizados como casos concretos.

Modern economic theory has moved beyond "capital fundamentalism." In the words of Hoff and Stiglitz, (2001, p. 389) "[d]evelopment is no longer seen primarily as a process of capital accumulation but rather as a process of organizational change." This realization has made possible an "institutional turn" in development theory that emphasizes the role of ideas and institutions as determinants of the possibilities for capital accumulation rather than the reverse. Both the "new growth theory" and Douglass North's "new institutionalism" are examples of the institutional turn. Unfortunately, the "institutional turn" has been used in a perverse way by global policy-makers. The globally dominant view is that because institutions are so important, therefore an institutional blueprint based idealized versions of Anglo-American institutions must be uniformly imposed on the countries of the global South in order for them to develop. Not surprisingly, this view has failed in practice. Alternative perspectives proposed by Rodrik and Sen argue that development is unlikely to succeed unless institutional change is grounded in local decision-making. That is the view that is explored in this paper. The State of Kerala in India and the city of Porto Alegre in Brazil are used as concrete cases.