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twitter account. now next year for the sprinkle system to go off. none of us will ever forget where we were when the power went off. probably because most of us were in the same place. >> i was on the couch. >> i was on the couch. >> reporter: we in the mead ucouldn't resist lowering our own lights to simulate super bowl conditions on the "view." the lights dipped. >> come on, now. >> then came up to reveal joy behar and guest host alley wentworth pretending to make out. the blackout ignited conspiracy theories. >> i call shenanigans on the power outages. somebody had a lot of money on the niners and there was a mysterious power surge. >> boomer aasighson cast suspicion on beyonce. >> by the way, beyonce blew the electric in the superdome twice in rehearsals.
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>> officials say beyonce was on her own power, not the superdome's grid. >> there's no indication at all this was caused by the half time show. >> jay-z tweeted a teasing, lights out! any questions? bane from batman has denied any role. human fans weren't the only ones featured on youtube reacting with wide-eyed wonder to the blackout. the scene from airplane when runway lights go out in an emergency landing. the runway has been replaced by the super bowl on an endless loop. as for beyonce, if she didn't cause it, maybe she could fix it. just plug a generator into beyonce's hips. problem solved. jeanne moos, cnn, new york. erin burnett "outfront" starts right now.
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"outfront" next, the hostage situation in alabama came to a violent end. we have an update on the gunman and the 5-year-old boy that was beeld held hostage. >> plus, last months, we brought you a story about the catholic hospital that said a fetus almost ready to be born is not a person, and today, there's a dramatic development in that story. and ted nugent, one of the nra's most vocal supporters promises to bring massive truth to cnn tonight. he gives us an exclusive look at his ranch, the guns he owns, and why he believes guns are crucial for america. let's go "outfront." good evening, everyone. i'm erin burnett. "outfront" tonight, breaking news on the alabama hostin crisis. it is now over. 5-year-old ethan, the little boy's name, he's at a hospital. we found that out a few seconds ago. he's with his family. there's heavy security there as
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well, and the big headline, he's safe. he was abducted from his school bus and held in an underground bunker for six days. we can also report that the kidnapper, 65-year-old jimmy lee dykes is dead. i want to get straight to martin savidge who is covering this story in midland city, alabama, about 100 miles south of montgomery. what more can you tell us about this little boy ethan and where he is and how he is tonight? >> we know he's surrounded by a very happy family. that would be his mother, his siblings, and extended family and we have been told that he is in good shape physically. of course, what's got to be determined is how is he doing mentally after this long ordeal. >> i know thatsd going to be a big question. there have been reports that the little boy may have had some sort of autism. that he really could have some psychological challenges to deal with. what do you know, martin, about how this rescue happened. why it happened today, and not three days ago? >> yeah, well, i guess the
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reason that authorities said to us is they noted in the last 24 hours, there had been a brackdown in the attitude of mr. dykes. they had been in constant contact, but they noticed he had deteriorated. they also said they saw him with a weapon in such a way they thought he was threatening and the biggest fear was for the 5-year-old boy. that's when they decided to act. there was an explosion, gunfire. we didn't hear it here,ut i got calls from people in the area saying did you hear? something is up? and of course, something was up. >> just to belabor the point, they who killed him as opposed to jimmy lee dykes killing himself? >> that point, erin, is a good one, but it has not been fully clarified. we believe that is the way it went down. we're expecting a further update tonight, where they will go into details and take questions. we also note there were some assets of the u.s. military that were brought to bare. leon panetta personally approved the use of special equipment that apparently could be used
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like, say, for detecting ieds overseas. it was allowed to be used here. there were soldiers here. soldiers only used to operate the equipment, not in any way to go in with law enforcement. >> how unusual is that, martin, that leon panetta of the defense department, that's the highest level of the american military system, would be volved in this? >> that's extremely usual, you're right, erin. there were also reports of unmanned surveillance, drones, that have been used. that hasn't been concerned. but it gives you a sense there was from the highest levels a very strong commitment and feeling of sympathy for the little boy and trying to get it rezauchbled in a way where he was safe and that's what happened. >> martin savidge, thank you very much. everyone i know has been talking about the little boy and what it was like for him down in the darkness in that bunker. i want to bring in a psychiatrist and director of
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children's services along with tom fuentes. we know the ending here now. at least before the child begins his healing process, the child is physically safe. the kidnapper is dead. how could investigators have accomplished this without harming the child in. >> it would have taken a great deal of planning and still. in the case of the fbi hostage team, they plan full time for these kinds of events. they worked with negotiators. the team came in with the hostage team. they have worked together many times. they know what the capabilities are for each of their teams. and this planning would have begun from the first minute they arrived on the scene. because at the time, even from the beginning, the negotiators when they're establishing that line of communication, which they hope to be able to do as soon as possible, but when they establish that communication, the s.w.a.t. team has to immediately be prepared to do an assault and prepared to do a rescue in the event harm is happening to that boy. they don't have the luxury of sitting around for seven days
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and waiting until somebody decides. they have to be prepared from the first minute, 24 hours a day. that planning would have already gone on for a long time. from what i heard, the negotiations were starting to deteriorate. the mental attitude of dykes was starting to really get worse over the last couple of days. and the negotiators were becoming increasingly fearful that he saw no way out of this. that he knew he had committed a murder. he knows he's an old man and that he felt that he had no way to come out of this. and the fear would be, as we have seen in so many other situations, oftentimes the person commits suicide but then kills everybody around them in the process. that would have been the fear here, he might in the process of deciding to take his own life, take the boy's life first and then take his own. they just couldn't have that. >> i want to ask you something more about that in a moment. first, doctor, i want to ask you about ethan. obviously, he's physically okay, but he's 5 years old. he's going to have his 6th
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birthday on wednesday of this week. he's a little boy. he has asperger's syndrome. we are also told he has attention deficit disorder. psychologically, how is this going to affect the little boy over the longterm? >> i think any ability in any trauma that happens to a child, whether they have a psychiatric or mental health problemo ornot is going to fall heavily on them. the biggest message we can send to this child by his mother and father is he is safe and he is protected because he didn't feel safe and he wasn't protected and he ended up in this situation. that's the biggest impact on a child, especially after something is resolved. luckily, this is successfully resolved. >> and of course, we don't know at this point what happened? we don't know whether there was sexual abuse or physical abuse or what happened in the bunker. >> right, and the tendency is going to be to swarm around him to get information, both to help him and to understand what went
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down down under that ground, but the bottom line is right now, these next few days are critical for this boy to bond with his family, to feel safe and feel protected. >> so tom, i wanted to ask you a question when you were talking about the negotiators must have felt this was possibly going to end terribly, that the kidnapper could have killed the child and then killed himself, so they decided to intervene today. given that, how do you think this happened? as we're still trying to figure out whether jimmy lee dykes killed himself or whether law enforcement were able to successfully kill him before he could kill the child. >> the fact that you have so many witness accounts of hearing a loud explosion followed by multiple shots or some type of gunfire would indicate he didn't commit suicide. i don't think he would be able to kill himself too many times. so the standard procedure in an operation like this would be for the assault team to introduce a grenade simulator, commonly called a flash bang, and what that does is puts in a confined area like a bricked in bunker,
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that bank is so loud that it literally just freezes the nervous system of somebody so for a second or more they can't move, they're frozen, and during that time, the assault team rushes in. by the time he's recovering from the noise, if he has a weapon in his hand or turned with a weapon they would take him out. >> in a nutshell, i don't understand. if that's possible, why not do that right away? why wait six days? who cares? i'm sorry, who cares if you get the guy alive? you want to save the child from the trauma. >> well, they do care if they get him alive. what they want to do is try to resolve this where everybody comes out of this alive, and the other thing that would be assessed and the s.w.a.t. team leader would be informed the on-scene commander from the beginning, they have formulated a plan, but what are the odds the plan would be successful. i can tell you having been a s.w.a.t. team member and a commander, the commander as well, that looking at pictures of that bunker, that was an extreme challenge. if i was the s.w.a.t. team
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leader making that plan, i would have informed the commander that this is going to be very difficult. the odds are not great. they're not up above 90% success. they're going to be somewhat lower than that, and who knows how low. if that commander on the first, second, third day decides that oh, we're going to go ahead. who cares if he dies? and the odds are that that boy ends up dead. you can't try to end this any sooner than you absolutely have to because of those risks to ethan. >> i understand, not as simple as i thought. thanks so much to both of you. we're going to have much more on the story later in the show. we'll be speaking to a woman who lived through a similar ordeal, taken on a school bus, buried underground 36 years ago, she and five other children were abducted and held captive in that way. >> plus, president obama says he goes skeet shooting all the time, and the white house has released one photo. did it do more damage than good?
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>> and the mystery of why this happened at the super bowl last night. we shed some light on the subject later in the show. she knows you like no one else. and you wouldn't have it any other way. but your erectile dysfunction - you know, that could be a question of blood flow. cialis tadalafil for daily use helps you be ready anytime the moment's right. you can be more confident in your ability to be ready. and the same cialis is the only daily ed tablet approved to treat ed and symptoms of bph,
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officewith an online package new colincluding: domain name,y! thanks. website builder with five pages and basic email just $49.99! that's up to 76 percent below online providers and only at officemax stores! how do you keep an older car running like new? you ask a ford customer. when they tell you that you need your oil changed you got to bring it in. if your tires need to be rotated, you have to get that done as well. jackie, tell me why somebody should bring they're car here to the ford dealership for service instead of any one of those other places out there. they are going to take care of my car because this is where it came from. price is right no problem, they make you feel like you're a family. get a synthetic blend oil change, tire rotation and much more, $29.95 after $10.00 rebate. if you take care of your car your car will take care of you. our second story "outfront," a picture is worth 1,000 words, or is it?
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the white house released this picture of president obama shooting skeet at camp david on his birthday in august. it was released nearly a week after his interview with the new republican in which he declared, quote, at camp david, we do skeet shooting all the time. that was met with skepticism, so the white house put out one photo, but it is too little too late. >> i don't understand. they should have put the picture out earlier. i don't know why they waited five days to put that out because it just rekindled the whole story. >> "outfront," cnn contributor david frahm and michael waldman. maybe president obama was hoping you both could help write his answers to the article. why do this? jay carney had to answer questions about this again. he told reporters the president made it clear, he grew up in hawaii, he spent time in california, chicago. this is not -- he never pretended to or suggested that he had grown up as a hunter.
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what is your reaction to that? it kind of brings it all back again. >> he was not hunting at harvard law. look, he kind of can't win or can't lose with this. he said, i think, very off the cuff, and honestly, yeah, we do skeet shooting. then people got hysterical, aha, he's lying, trying to pull a fast one. they released the photo. which is kind of funny, he looks really great doing the shooting, so that, of course, once again, he manages to look very cool in what he's doing. i don't think this is going to be -- >> he looks cool in everything he does. he's got that way about him. >> i don't think this is going to make that big of a difference. i fink if he were seriously thinking about it in political terms, it's a signal of reassurance that he's not against all guns. he's culturally understanding that a lot of people in america hunt and use sporting rifles. but i don't think that's why they released the photo. i think they were just trying to be responsive, and you know, no good deed goes unpunished. >> david, what is interesting
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about this is so you have people on both sides who aren't satisfied. on the left, let me play what jon stewart had to say because i thought he said it pretty darn well. here he is. >> the point is, mr. president, what are you doing? why try? as far as your opponents go, no measure of detaunts will ingreigeiate you to your opponent, which was probably summed up best in the dr. seuss classic, quote, oh, they hate you." they don't like you shooting deer or even if you roped a steer. >> now we have his base is upset. why would you even think to put out this picture? >> jon stewart loves the president. look, 5% of americans over age 16 have a hunting license. hunting is a very minority and dwindling activity. it's an honored activity.
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it connects us deep to the american past. it's not what the gun debate is about. what the gun debate is about is the anxieties of middle-class, middle-aged americans about crime and insecurity. that's what the debate is about. so the president could -- he could disdissembowel a dear on naval television. it wouldn't make a difference. it's about fears and mayhem and crime. those who argue for more gun restrictions will say those fears are exaggerated. crime statistics are down. a gun in your house doesn't make your safe. it actually exposes your loved ones to greater harm of accident or suicide. if you're gone to engage the debate, you have to engage the debate where it is, and it is not about hunting deer or ducks. >> that's a fair point. >> it's interesting, when these debates happened 10 or 20 years ago, david is exactly wright. it was very much about the culture of the rural south being
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threatened. now it's about, as he says, a lot of these fears. but that's what's so interesting about the background check issue. back then, the nra said, no, no, no. don't ban assault weapons. let's just check and make sure that only law abided citizens get guns. now that's what the white house or the president is proposing and all of a sudden, the nra is saying, no, no, no, it's a terrible idea. it's an interesting time. crime is so down, not just in new york but all over the country. it really has opened up a possibility for a little bit less emotion and a little more common sense on criminal justice laws generally, but this kind of rips the band aid off a lot of people's fears, a lot of which are pretty iralgz. >> i want to play one quick sound bite and talk about whether the nra has gone too far on their side. and first, how did you say it. >> >> inco hnt. >> i am never sure how to say
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it. i'm so glad we have speechwriters on the show. let me explain the difference between the nra and chris wallace on fox news this weekend. >> the president's kids are safe, and we're all thankful for it. the point of thad ad -- >> they don't have to face a threat that most children do nod face. >> tell that to children in newtown. >> you really think the president's children are the same kind of target as every school child in america. that's ridiculous and you know it, sir. >> david, chris wallace tells the nra you're ridiculous and you know it, you might have jumped the shark of the nr ark. >> that's not what the polls are showing. there is tremendous sympathy for the nra and tremendous and rising, rising support for the most expansive vision of gun rights. that's the paradox. as americans become safer, as crime becomes less of a threat, americans seem to become more afraid and they turn to guns to make them safe. when they do that, they put their own children at riv of suicide and gun accidents. >> thanks very much to both of
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you. still to come, one of the nra's most vocal supporters come s "outfront." ted nugent takes on gun critics. >> plus, a story we have been following closely. >> determination will determine how many bullets i need to protect my family. >> tonight, a major development. ] surprise -- your house was built on an ancient burial ground. [ ghosts moaning ] surprise -- your car needs a new transmission. [ coyote howls ] how about no more surprises? now you can get all the online trading tools you need without any surprise fees. ♪ it's not rocket science. it's just common sense. from td ameritrade. in the middle of the night it can be frustrating. it's hard to turn off and go back to sleep. intermezzo is the first and only prescription sleep aid approved for use as needed in the middle of the night when you can't get back to sleep.
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our third story "outfront," a change of tune. there's a huge development tonight in a story we have been following. a catholic hospital's surprising defense in a wrongful death case involving unborn twin fetuses. laurie was seven months pregnant when she went into cardiac arrest. she died and the twins died. when her husband sued the catholic hospital argued that the fetuses were not people under colorado law. tonight, though, the hospital in a surprising about face called its own defense morally wrong. kyung lah has been out front on the story from the beginning, and what is the hospital saying? >> well, erin, the statement we received today from catholic health initiatives is a complete reversal from what its attorneys have argued in court for years. in court, catholic health initiatives have argued under colorado law that the twins do not count as people. that's a direct contradiction to
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theteachings. they didn't just argue this once. they have argued this repeatedly. the case is waiting to be heard in colorado's supreme court. after local newspapers and this program, "outfront," pointed out the hypocrisy, here is what catholic health initiatives or chi is saying today. chi representatives acknowledge it was, quote, morally wrong for attorneys representing st. thomas more hospital to cite the state's wrongful death act in defense of this lawsuit. the statement does go on to mention that the hospital also will not cite colorado's law that says fetuses are not people anymore. we also got a statement from the bishops of colorado. why now? the bishops say they weren't aware of what the lawyers were arguing. the bishops say chi's upper management didn't know what its own lawyers were arguing in court. after the news report, they say they became aware. they huddled and decided that
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the legal argument didn't align with church teachings. >> where does this leave the lawsuit, and i have to ask you because when you first aired the piece, i was so moved by the father jeremy talking when you visited the simitary with him at the wisite of his wife and children, what did he say? >> i talked to jeremy today. he didn't know about the statement. i read it to him over the phone. he said he was stunned, in shock, and he said wow. here is what his attorney is saying. quote, this is a self-serving document. it is inaccurate as to how it characterizes the decisions of the lower court and the petition in the supreme court. it does not appear to reflect a real investigation and does nothing to address the harm done to jeremy stodghill in this case. and jeremy has not heard from the hospital or the bishops of colorado and it doesn't change his lawsuit at all right now. >> thank you. we'll keep following that story. still to come, the
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kidnapping and haaseening story comes to an end in colorado. 36 years ago, school children were on a bus, they got taken, they got held hostage underground. they survived. one of them joins us tonight. plus, one of america's most celebrated snipers who served four tours was murdered by someone he brought to a gun range. one of his closest friends comes otd ott to explain why he thought that was a good idea. it's a hawk with night vision goggles. it's marching to the beat of a different drum. and where beauty meets brains. it's big ideas with smaller footprints. and knowing there's always more in the world to see. it's the all-new lincoln mkz. so if ydead battery,t tire, need a tow or lock your keys in the car, geico's emergency roadside assistance is there 24/7.
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welcome back to the second half of "outfront." we start with stories we care about where we focus on reporting from the front lines and we begin with the super bowl blackout. what caused half the lights in the new orleans superdome to go out for 34 minutes? according to the power company which serves the superdome and the smg, which is a company that managed the superdome, it's a machine that monitors electrical load detected an abnormality and did what it is supposed to do, which is shut off power. in case you were wondering, both smg and the commissioner said beyonce's halftime show had absolutely nothing to do with it. all right, in a press conference with french president
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francois hollande, vice president biden says he supports their efforts in mally. they have transported 610 people and 760 tons of equipment to french troops. france has been heavily involved in ousting the islamist rebels from key malian cities. today, ox fam said many food traders fled the region as the french troops advanced, causing food prices to rise as much as 20%. >> mahmoud ahmadinejad joked he would be willing to be the first man iranians sent into space. it came after their news agency said the country had successfully sent a monkey into orbit. you may remember that story, but john mccain got involved in this. he got onto the twitter and said, quote, so ahmadinejad wants to be the first iranian in space. wasn't he just there last week?
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i can warn you, calling people monkeys can be problematic. after receiving some criticism about the tweet, mccain tweeted again, clarifying it was a joke and telling people to lighten up. >> it has been 550 days since the u.s. lost its top credit rating. what are we doing to get it back? president obama signed an act that allows the house to pass a budget by mid-april or their pay will be weld. >> and today, the six-day hostage stand' off in alabama is over tonight. the 5-year-old boy named ethan is safe. the abductor is dead after authorities entered the underground bunker where the trauma played out. it brings back painful memories to the victims of another kidnapping 36 years ago. three men hijacked a bus load of 26 school children. they forced the driver and children to climb into a hole in the ground into a moving van
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which was buried underground in a quarry. the kidnappers then left their hostages buried for 16 hours, demanding $5 million in ransom. the hostages fortunately got out alive, and tonight, one of those victims is "outfront." thank you so much for joining us. i want to let everyone know, you're standing in forty-oront t school bus, the very school bus you were on, which has become a bit of a memorial for the horrific thing you went through. you were 10 years old. what do you still remember, even now, about that day? >> um, certain smells, and how edward was so brave for us. as their bus driver was for them. and how frightened all of us were. and -- oh. just how scared we all were.
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>> i mean -- sorry, go ahead. >> um, i just remember that day being probably one of the worst days ever in my life and of my classmates'. >> i know you have been through years and years, jody, of therapy, of trying to come to terms with this. and i'm wondering what still is hardest for you, and what you would say to ethan's parents who are just beginning this process with that little boy? >> what i would say to them is to always let him be open to what he needs to say to them. and let him say it when he needs to say it. not to force it. and to make sure that they do seek out therapy for him with
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someone who is qualified. >> and in your case, jodi, i know you were driven around for 11 hours before you were then put underground into that quarry. and then another 16 hours before you were able to escape. what do you recall from those hours that might help us all understand a little bit of what ethan has been going through for the past week? >> well, for us, i at least had the other kids to comfort me or to be around me, even though right now our back then, i found it -- i couldn't stand them touching me. because they were, you know, urinating on us, and you know, the smell, and it was so hot. poor ethan only had this deranged man with a gun. and i can't imagine that poor
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boy being only 5, being alone with this deranged man with a gun. and at least the kids, the ones i was with, all of the children i was with, we had each other, and we had edward, our bus driver. the other children on the bus that ethan was on, they had to witness their bus driver be murdered and shot. and i can't imagine how horrific that was for them, and the pain that they still see and the nightmares they might have. and i just urge all the parents of all the children to allow those children to please let them talk about it. and be open to it. and maybe even let them all get together alone and speak about it with each other because you know, none of us ever really sat down and talked about it ever to each other until recently.
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a group of us girls did speak about it, and we never, ever, ever talked about it. as a matter of fact, as soon as this happened to us, there were some that told our parents, just pretend like it never happened. and that's the way it was treated for years and years and years. and i did seek help from a doctor, and she helped me tremendously. and i'm very thankful for her. and i did seek help from my pastor. so i believe that that's what helped me. >> right. >> but i also believe that us talking together was very healing for me, too, and i think it was healing for the other girls. and i wished we would have done it sooner. i think it would have helped us all with many problems that we experienced through our teens and our 20s that we may not have had. and i just urge all those parents to please let their children talk about it and get
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together without reporters and without anyone stopping them from what they feel and let them say it to each other. >> all right, jodi, thank you very much for taking the time to share that with us. and now we go to texas and the shooting murder of america's most lethal snipers. chris kyle. kyle was killed on saturday at a gun range, allegedly by a former marine who had been reportedly struggling with post traumatic stress disorder. with 160 confirmed killed, kyle was named the devil of ramadi and placed a bounty on his head. the first kill was a woman who held a baby in one hand and a grenade in the other. "outfront," a close friend who is also a former navy s.e.a.l. he knew chris kyle for 17 years. thank you for coming on and talking about your friend. i knew you had time today to spend time with kyle's family,
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and he was dedicated to helping soldiers coming home from war who were struggling with adjustment. was the shooting range a regular part of that to help them? >> it was part of it. from what i understand, he had talked to the kid, called him up and was like hey, do you want to get together? get out of the house? kind of clear your head out, let's go down to the shooting range and throw some rounds down range, and kind of a way to blow off a little steam, yeah. >> and i want to ask you more about that in a moment, but first, we were able to find some tape of chris talking. he was a very good speaker. he spoke at las vegas, at a gun show about the transition he went through from being a sniper who killed people. that's what he did, killed people, put them in his sights and killed people, to come home. here's a piece of what he said in that interview to guns.com. >> you know, we let our job identify who we are.
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you're honorable and you're doing it for the greater good. all of a sudden, you don't have an identity. you have to learn a whole new way to act because you can't act the same way we do in work out in public. people will think you're a savage or something, so it's hard to get your head around. it takes a while. >> did he ever talk to you about the difficults he had in adjusting? >> yes, ma'am, of course. as navy s.e.a.l.s, as frogmen, we were very rarely go to the psychiatrist and psychologist to talk about our problems. we would usually solve our problems in house. you're talking about a guy who has been through similar situations and it makes it easy to relate to each other. what he was saying there is just, is part of it, part of the job. it's what we sign up for. we know what we're getting into. it's the reason the pipeline is so long. it's not something you go in, a couple weeks of training, you
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get dropped into. you know what you're getting yourself into. chris, he was very good at what he did. in the military. and he was also very good at what he did when he got out of the military. and sometimes those two things, they run over, they coexist, if you will, with each other. but at the end of the day, you know, you get up, shake it off. you surround yourself with the people you love like his family, his kids, his parents, brother, and that's the best way to do it. if you dwell on what you did as a job, it just sucks you down. you can't think about it like that. we're there for one reason, one reason only. we do it, get it done, get about our businesses. >> let me ask you a little bit more, so many people trying to understand that soldiers would go to a shooting range. in some sense, i think it's understandable. it's what they were used to, what they were comfortable with, and it could help with the transition. there are reports, of course, as you're probably aware, that the alleged gunman was struggling to adjust. he may have been on suicide
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watch, was suffering from ptsd, and today, former congressman ron paul tweeted about your friend, chris. he said chris kyle's death seems to confirm that he who lives by the sword dies by the sword. treating ptsd at a firing range doesn't make sense. marcus, does it surprise you that chris would have taken a young man like this who was so fragile to a shooting range to treat ptsd, or do you think that would have been normal and understandable? >> is that what he said, huh? >> that's what ron paul said. what do you think about it? >> what i think about it is probably not good for tv. but chris -- he's not a professional doctor. he's not qualified to treat people for ptsd. that wasn't the thing. he was just going there to get this kid to hang out with him, to get his mind off of whatever it was on. and to have a good time, just to get him out of the house.
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i don't think that whatever the reports are saying, you know, kind of being embellished a little bit. i don't think chris was there to treat him for anything. i think he was there to hang out with him as a fellow veteran and to try to be a friend and someone just to hang out with. >> marcus, thank you very much for coming on and talking about your friend. chris kyle appeared on conan o'brien's show to talk about his book and the bounty insurgents put on his head. you can see that interview on cnn.com. it's on our home page. one of the nra's most vocal supporters, ted nugent, gives us an exclusive look at his ranch and the guns he owns. during our visit, he makes a promise to america. >> america, my name is ted nugent and these are all legal guns and i'm going to see that they remain legal because they're all good. yo, give it up, dude!
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up high! ok. don't you have any usefull apps on that thing? who do you think i am, quicken loans? ♪ at quicken loans, our amazingly useful mortgage calculator app allows you to quickly calculate your mortgage payment based on today's incredibly low interest rates... right from your iphone or android smartphone. one more way quicken loans is engineered to amaze. ♪ i had[ designer ]eeling enough of just covering up my moderate to severe plaque psoriasis. i decided enough is enough. ♪ [ spa lady ] i started enbrel. it's clinically proven to provide clearer skin. [ rv guy ] enbrel may not work for everyone -- and may not clear you completely, but for many, it gets skin clearer fast, within 2 months, and keeps it clearer through 6 months. [ male announcer ] enbrel may lower your ability to fight infections. serious, sometimes fatal events, including infections,
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tuberculosis, lymphoma, other cancers, nervous system and blood disorders, and allergic reactions have occurred. before starting enbrel, your doctor should test you for tuberculosis and discuss whether you've been to a region where certain fungal infections are common. you should not start enbrel if you have an infection like the flu. tell your doctor if you're prone to infections, have cuts or sores, have had hepatitis b, have been treated for heart failure, or if you have symptoms such as persistent fever, bruising, bleeding, or paleness. if you've had enough, ask your dermatologist about enbrel. we replaced people with a machine.r, what? customers didn't like it. so why do banks do it? hello? hello?! if your bank doesn't let you talk to a real person 24/7, you need an ally. hello? ally bank. your money needs an ally.
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our fifth story "outfront," shooting guns with ted nugent. our deb feyerick was invited the the rocker's ranch to talk hunting, self-defense, and the second amendment. >> fire in the hole. >> for ted nugent, gun control is putting the second bullet in the same hole as the first.
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>> two down. >> a lot of people look at the tragedy at sandy hook and they say, something's got to be done. >> agreed, something has to be done. >> they point to weapons that were used as the cause. >> it's not the weapons. the weapons have nothing to do with it. these -- again, these weapons are in every pickup truck in texas. ♪ >> the same platinum selling rocker is passionate about his music, his family, and his firearms. he's fiercely protective of the rights of law abiding gun owners and he's invited us to his 300 acre ranch in weako, texas, to explain why. >> i'll give you some real eye candy in a second. >> we see wild turkey and black buck antelope, all fair game during hunting season. like tens of millions of americans, nugent grew up hunting with his dad and brothers. guns are a family tradition he has avidly passed on to his wife
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and kids. if somebody close to you were killed by a gunman, would your views on guns change? >> absolutely not. no, i would never turn against this wonderful tool that brings me self defense capabilities and brings me great joy in competition and marksmanship training. deb, you climb up this platform. >> i'm trying to understand the nature of the hunt. >> when i get up here, i'm not kidding you, i do 79 concerts, and i get up here, strap myself in,concerts. i get up here, strap myself in, take a deep breath and i sit here for six hours. >> reporter: so it's meditative to you? >> absolute meditation. >> have you ever tried yoga? his belief in the second amendment right to bear arms has transformed nugent into the sometimes fanatical face of the national rifle association. >> boy, you are a city girl. >> reporter: i'm such a city
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girl. >> stand kind of like you're golfing. just squeeze that trigger. >> reporter: geez. as he teaches me gun safety, nugent repeatedly emphasizes that gun violence is caused by criminals, mentally ill and a justice system that paroles fel nochlt s too soon. he believes that limiting guns and ammunition will not stop the massacres like the tragedy at sandy hook elementary. >> reporter: the argument is that he was able to kill as many people as he did because it had multiple bullets. >> the rate of fire in these mass shootings it's not a matter of bullets or fire power. a quail gun in the wrong hands is as deadly as this gun. people have got to come to that reality. >> reporter: the ability to defend his family is something he takes very, very seriously. >> when i'm being assaulted at my home, i and i alone, by any consideration whatsoever, will determine how many bullets i need to protect my family. >> reporter: nugent has been a
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sheriff's deputy for 30 years and carries a concealed glock at all times. i want you and i to solve this problem of gun violence. >> there is no gun violence. there is criminal violence and they use an assortment of tools. >> reporter: let's talk about background checks. >> i like background checks. >> reporter: yes, but not at gun shows or with private sales. a lot of people in law enforcement have to take a psychological exam before they're allowed to carry. why not ordinary citizens? >> i wrote wango tango and i carry a gun. >> reporter: for him, his second amendment is nonnegotiable. >> my name is ted nugent theerks are all legal guns and i'm going to see that they remain legal because they're all good. >> it was just amazing to see. at the end there when you showed the guns, some with the pink camouflage, you said his wife is also into shooting, how many
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guns does he have? >> over 200 guns. he has israeli uzis, guns made in serbia. he wants people to know about these terms. >> ar-15, bushmaster, that was used in newtown. >> he has one of those, too. he has everything. he really has a big stockpile of guns. he collects them the way you and i might collect watches or collect cars, for example. >> wow, okay. president obama has said he doesn't have any intention of confiscating guns, that is not his goal. he's not trying to attack the second amendment. nugent, though, doesn't believe him. >> no. >> why? >> not at all. the majority of guns, 310 million guns are in the hands of law-abiding citizens. the minority are in the hands of criminal criminals. they're the ones committing the crimes. that's why he says, why is the government coming after us saying we're going to ban the
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guns when we're not the ones doing anything? he focuses on criminality, people who have mental illness, making sure people stay in prisons long enough. he says it's not the gun. that's really the point that the nra is trying to convey as part of this debate that's going on in the country right now. >> what were they to do if there were a gun ban, just ignore it? >> in many cases, yes. if you take all the guns away tomorrow, people are out there who will find and get their hands on guns. >> there are hundreds of millions of guns out there. >> absolutely. do you hand in your guns? that's the slippery slope he sees, once you start in that direction you're going to be giving up these things or law enforcement is going to be coming and trying to register them. there's a whole series of reasons why they simply do not trust any sort of gun restriction in that way. >> all right. deb feyerick, thank you very much. still to come, vanilla ice. a camel and i have something in common. i'll tell you what it is, next. [ male announcer ] at his current pace,
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bob will retire when he's 153, which would be fine if bob were a vampire. but he's not. ♪ he's an architect with two kids and a mortgage. luckily, he found someone who gave him a fresh perspective on his portfolio. and with some planning and effort, hopefully bob can retire at a more appropriate age.
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it's not rocket science. it's just common sense. from td ameritrade. britta olsen is my patient. i spend long hours with her checking her heart rate, administering her medication, and just making her comfortable. one night britta told me about a tradition in denmark, "when a person dies," she said, "someone must open the window so the soul can depart." i smiled and squeezed her hand. "not tonight, britta. not tonight." [ female announcer ] to nurses everywhere, thank you, from johnson & johnson. looks like you're in a pickle. yeah. can you get me out of it ? just so happens i know a chap... book any flight and hotel together and get access to our free personal concierge service. any need, any question, we're on call 24/7.
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super bowl xlvii, last night the baltimore ravens beat the san francisco 49ers, 34-31, a closer game than many expected, making it
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text:
Exhibition: The Other Architect
10th April 2016, The Canadian Centre for Architecture, Montréal, Canada
"The Canadian Centre for Architecture (CCA) presents The Other Architect, an exhibition that emphasizes architecture´s potential to identify the urgent issues of our time. On display are twenty-three case studies dating from the 1960´s to today that illustrate how international and often multidisciplinary groups invented and adopted new methods outside of traditional design practices. The Other Architect is on view in the CCA´s main galleries from 28 October 2015 through 10 April 2016.
The various groups sought to expand the role and responsibility of architects in society by working outside of traditional design practices and pursuing collaborative strategies, new tools and experimental attitudes. Their ingenuity showed the ability of architecture to shape the contemporary cultural agenda, a lesson that remains critically relevant today. [...]"
More details: website

subset: commoncrawl


text:
Butterick 9823; ca. 1960; Misses Eased Sheath Dress: (A) Step-in dress with small shawl collar, set in three-quarter sleeves, eased sheath skirt, self tie belt. (B) notched collar, short sleeves, purchased belt. (C) Contrast trimmed notched collar and sleeves, self belt.
Links to reviews/blog postsEdit
Add a photo to the gallery by clicking the "modify" button below.
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Parents welcome at Advisory Council meeting
Parents are invited to attend the next Parent Advisory Council (PAC) meeting on Monday, September 30 at 7 p.m. at the Discovery Middle School media center in Alexandria.
Parents are encouraged to bring a friend, neighbor or another parent to the meeting.
For more information, call (320) 762-7900.


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Local and state officials joined with Wilbert Plastic Services employees Dec. 14 to celebrate a joint venture with the Ford Motor Company.
Wilbert Plastic Services has received Q1 certification, which means it met the quality standards required to become a parts supplier for Ford. Wilbert is slated to begin manufacturing interior plastic parts for the new Ford Escape, one of which was on display during last week's presentation. The Escape is manufactured in Louisville.
A special-called fiscal court meeting was held Dec. 14 to discuss funding for a new bridge on Tick Creek Road.
The meeting was called just two days after the court decided to move forward with the process and agree to an engineering contract with local engineer Brad Spalding.
"Even though we made the decision on Monday to proceed, everything has been put on hold," said Washington County Judge-Executive John Settles.
FRANKFORT, Ky. (Dec. 12, 2011) – Thousands of people took part in the inauguration events on Dec. 12. Here are a few interesting facts and figures about the day.
1 – Age of youngest participant in Grand March, Lila Beshear, the Governor's youngest grandchild.
2 - Number of hours Inaugural Parade was expected to last.
Lincoln Homestead State Park and a local horse farm will be the backdrop in some scenes of an upcoming Civil War-era film.
Production crews garnered attention at the park last week, as traffic was briefly stopped at times while filming took place.
The movie, a title wasn't disclosed, was also at Stephen Foster in Bardstown and Copper Canyon near Hopkinsville.
Writer, director and producer Fred Ray said the film is "a small drama with some gunfire."
When you don't know where to turn because someone drinks too much, Al-Anon Family Groups can help. Meetings in St. Dominic Church basement on Tuesday at 8 p.m.
Airport board
The Marion Washington County Airport Board will not have a meeting in December. The next regular meeting is scheduled for Jan. 12, 2012.
Wednesday, Dec. 14
Water Commission Meeting
The Better Business Bureau is issuing an urgent scam alert cautioning businesses and consumers about an email that is purporting to be from a bbb.org email address about a recently filed complaint.
The email contains a dangerous attachment regarding a complaint and appears to direct recipients to the BBB website. This is a scam. The BBB does not send complaints as attachments via email.
The email appears to come from a fake BBB employee claiming that the recipient needs to review this matter and advise the BBB of their position.
An accomplishment that Washington County Solid Waste Coordinator George Ann Palmer will proudly point out is that Washington County is the top recycling county in the state.
However, she said there is still room for the county to be a more efficient recycler in the future.
A Springfield family recently received a cold check - from the state government.
Carolyn and Steven Hash raise four grandchildren.
According to Carolyn, the parents pay child support through the child support office.
Every once in a while, Carolyn said they receive a small check for an overage. Recently, they got a check for $7.68 from the state government for a child support overage.
A regular scheduled fiscal court meeting took place Monday morning. The court decided to move forward in the process of constructing a new bridge on Tick Creek Road.
Last month the bridge weight-limit was dropped from nine tons to three tons due to structural problems.
The bridge was closed during heavy rains by the state, but reopened a few days later.
The bridge closure caused headaches for local traffic, sending some motorists 25 minutes out of their way from their normal routes.
Several incidents are currently under investigation by Springfield City Police and the Washington County Sheriff's Office.
A caller reported to Springfield City Police at 4:16 p.m. on Dec. 6 that shots were fired at 128 Domus Court in Springfield. Police reported no evidence to indicate any person or object was struck by the gunfire.
Anyone with information regarding the shooting is encouraged to contact Springfield City Police at (859) 336-5450. Callers can remain anonymous.
Copyright © 2017
The Springfield Sun is your source for local news, sports, events and information in Springfield, KY, and the surrounding area.


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Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia
In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs) constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up.
Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation.
Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme.
Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other interventions to ensure the supply of sufficient quality maternity services and to address other non-financial barriers to demand. If these conditions are met, voucher and HEF schemes can be further scaled up under close monitoring and evaluation.
The Millennium Development Goal 5 (MDG5) aims to reduce the maternal mortality ratio by three quarters between 1990 and 2015
Effective strategies to reduce maternal mortality are well known nowadays. Ensuring access to skilled birth attendants and emergency obstetric care are two priority interventions fundamental to the prevention of avoidable maternal deaths
The Cambodian maternal mortality ratio is among the highest in South and South-East Asia, at 472 maternal deaths per 100,000 live births
To tackle financial barriers to access, developing countries are implementing various demand-side approaches to financing health care that subsidize the consumers directly. Among these, vouchers are considered a potentially effective means of targeting health services to specific population groups
The aim of this paper is to assess to what extent voucher and HEF schemes have improved access to skilled birth attendants for poor women. This study was conducted in three rural health districts in Cambodia, as part of an international research project, "Poverty and Illness"
Study setting and interventions
Kampong Cham is the biggest province in Cambodia with a total population of 1,680,000. The public health system in this province consists of ten operational health districts (ODs), each with a referral hospital and several health centres. The provincial hospital is the referral hospital of Kampong Cham OD, located in the provincial town. All the public health facilities receive free drugs and medical supplies, staff salaries, and a budget for running costs (which make up about 60-70% of the total recurrent costs) from the government. In addition, they charge fees from patients. Along with the public health system, there are numerous and often unregulated private practices. According to the Cambodia Demographic and Health Survey 2005, 12.3% of births in Kampong Cham province took place in a health facility and only 8.2% occurred in public facilities. About 53% of women delivered at home with traditional birth attendants
The study was conducted in three of the ten ODs in Kampong Cham province, namely Cheung Prey, Chamkar Leu and Prey Chhor. There are three referral hospitals (without operation theatres for surgical interventions) and 42 health centres, serving a total population of approximately 538,000. Surgical cases, including caesarean sections, are referred to the provincial hospital. Since 2005, the Ministry of Health and the Belgian Technical Cooperation have implemented several health financing schemes, including Health Equity Fund (HEF), vouchers, and performance-based contracting (PBC) to improve access to basic health services for the population, especially the poor, in the three ODs. At the end of 2007, the government introduced a delivery incentive scheme nation-wide to boost deliveries in public health facilities. Through this scheme, midwives and other health personnel receive a government incentive of USD12.5 for each live birth attended in a referral hospital and USD15 in a health centre on top of the fees they charge from patients.
The HEF scheme (See Additional file
Additional file 1
Health Equity Fund: definition, questionnaire and eligibility criteria. The file includes definition of a Health Equity Fund scheme, questionnaire and eligibility criteria used for interviews of potentially poor patients at hospitals to determine their eligibility for Health Equity Fund assistance.
Click here for file
The voucher scheme was launched in Cheung Prey, Prey Chhor and Chamkar Leu operational health districts (ODs) in February, June and July 2007, respectively. The objective was to improve access to safe delivery for poor women, thereby contributing to the reduction of maternal and newborn mortality and morbidity. The management of the voucher scheme was sub-contracted to the NGOs operating HEF in the area, as voucher management agencies (VMA). The voucher recipients are poor pregnant women in the catchment area. Public health centres are selected to provide health services to the voucher recipients. To ensure sufficient quality for safe delivery, only 30 of the 42 health centres in the three ODs were selected on the basis of three criteria: they (1) can provide the minimum package of services (as recommended by the Ministry of Health for a health centre), (2) have at least one skilled midwife available in time of need, and (3) have a record of relatively high utilisation for antenatal care and delivery. Only these health centres were thus contracted to provide maternal services to voucher recipients in a timely and professional way.
Poor pregnant women are identified by local health volunteers and VMA staff at home, using the same pre-defined questionnaire and eligibility criteria as for HEF. Each eligible poor woman receives a voucher with five detachable coupons, which entitle her to free services at the health centre (for three antenatal care visits, delivery and one postnatal care visit) and transportation costs for five round trips between her home and the health centre, and for referrals from the health centre to the referral hospital in case of complications. User fees and other related costs at referral hospitals are paid for by the HEF. Voucher recipients are encouraged to use all five coupons for their pregnancy, but they are free to use only one or a few of them. The vouchers are only valid for the current pregnancy. At the end of each month, the VMA pay the contracted health centres on the basis of the number of coupons and the price of user fees (about USD7.5 for a normal delivery and USD0.25 for each antenatal and postnatal care visit). The VMA provide cash advances to the contracted health centres to pay for the transportation cost of voucher recipients using a pre-defined price-list. The list estimates the transportation cost for each village in the catchment area to the health centre, taking USD0.1 per kilometre, the estimated rate for moto-taxis, as the unit-based fare. For monitoring purposes, the VMA collected routine data on the number of poor pregnant women identified, the number of vouchers distributed, the utilisation of vouchers for ANC, delivery, postnatal care and referral services, the costs of services provided through the voucher schemes and the number of deliveries supported by HEF at hospitals.
The performance-based contracting (PBC) scheme started in late 2005 and was gradually expanded to all government health facilities and management bodies in the three ODs as a strategy to address the vicious cycle of underpaid health staff, and poorly performing and thus under-utilised health services. This strategy was inspired by the 'Cambodian New Deal' experiment in Sotnikum, which is described in detail elsewhere
In two other ODs in Kampong Cham province, Memot and Ponheakrek, the Ministry of Health and its development partners implemented a special "contracting" scheme initially in Memot in 1999 as a first phase, and then in Ponheakrek in 2004 as a second phase. Several studies have described the first phase of this contracting model and demonstrated its effectiveness
Conceptual framework
Poor people may encounter numerous barriers to accessing health care
Figure 1
Strategy used to improve access to skilled birth attendants
Strategy used to improve access to skilled birth attendants.
The hospital-based HEF that identifies poor patients and pays user fees and other access-related costs on their behalf improves financial access for the poor to hospital care, including delivery
The PBC and the delivery incentive scheme address the issue of low staff income through performance and output-based cash incentives. The PBC helps improve the general performance of providers whereas the delivery incentive scheme focuses on the midwife and delivery. More generally, these interventions can also improve quality of care and partly address financial barriers by preventing informal payments
Data collection
In this case study, we used a combination of methods to collect quantitative and qualitative data. We collected data on the number of vouchers distributed and the number of voucher and HEF beneficiaries between 2006 and 2008 from the database and reports of the VMA and HEF agents.
Data on deliveries in public health facilities (facility deliveries) in the three study ODs were extracted from the routine health information system. For comparison, similar data were also gathered for other ODs in Kampong Cham province. In the routine health information system, data on deliveries in the facilities are collected every month by the health facilities in consultation with community representatives who gather information on deliveries during the previous month in all villages in the catchment area of the health centre.
To calculate denominators for the assessed indicator, facility deliveries as percentage of the expected number of births, we used the population figure estimated by the recent census and the crude birth rate of 25.9‰ for rural areas as estimated by the Cambodia Demographic and Health Survey 2005
Qualitative data were collected through focus group discussions and key informant interviews. We conducted nine focus group discussions in late 2007 with a total of 87 voucher recipients. Five groups included 51 voucher recipients who did not use their vouchers for delivery (non-user group) whereas the four other groups included 36 voucher recipients who used their vouchers (user group). Participants were randomly selected from the list of voucher recipients and beneficiaries at health centres, the non-user group from health centres with low utilisation rates of vouchers for delivery and the user group from health centres with high utilisation rates of vouchers. The aim of the focus group discussions was to understand reasons for use and non-use of vouchers. For similar purposes, the first author conducted in-depth interviews with 20 voucher recipients, both voucher users and non-users, in early 2009. He also interviewed 18 key informants, including village health volunteers, traditional birth attendants, health centre midwives, health centre chiefs, district and provincial chiefs of maternal and child health programmes, managers of the two VMA and HEF implementing NGOs and key staff of the Belgian Technical Cooperation to gain insight in the implementation process and the effectiveness of voucher and HEF schemes.
Data analysis
WHO defines a skilled attendant as "an accredited health professional - such as a midwife, doctor or nurse - who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns"
In order to assess the effectiveness of vouchers and HEFs in improving access to skilled birth attendants, an indicator on deliveries in public health facilities as percentage of the expected number of births was computed in MS excel. This indicator was calculated for the nine rural ODs in Kampong Cham province operating under the management umbrella of the Provincial Health Department. We first assessed the trend of this indicator between 2006 and 2008 in the three study ODs and then compared it to the situation in two other groups of ODs without voucher and HEF schemes: respectively, a group of two ODs with special contracting and the delivery incentive scheme, and a group of four ODs with only the delivery incentive scheme. To avoid bias, we excluded Kampong Cham OD from the comparison, as this OD covers the provincial town and the urban area, and the provincial hospital providing referral services for the whole province is also based there.
The operational analysis of the voucher scheme focused on three main stages: health centre selection, voucher distribution and voucher utilisation. The last-named was analysed among voucher recipients in 2007, as some of the voucher recipients in 2008 had not yet delivered at the time of the study.
The qualitative data from the focus group discussions and in-depth interviews were manually coded, grouped and analysed.
Ethical consideration
This study is part of the EC-funded Poverty and Illness research project, which received ethical approval from the Cambodian National Ethics Committee for Health Research on 10 August 2007 with reference number 063 NECHR. Verbal consent was obtained from each participant and respondent prior to the focus group discussion and interview.
Utilization of vouchers and HEF
A total of 2,725 vouchers were distributed in the three health districts within less than two years of operation. During this period, 2,062 vouchers were used by poor pregnant women for ANC1, 1,498 for ANC2, 1,140 for ANC3, 1,280 for delivery and 684 for postnatal care. Of the 1,280 voucher users for delivery, 215 delivered in referral hospitals; 63 of them were referred by health centres whereas 152 others went straight to the hospitals possibly after advice given by the health centres during ANC visits.
Figure 2
Vouchers distributed and used in 2007 and 2008
Vouchers distributed and used in 2007 and 2008.
In 2006, HEF supported 132 poor pregnant women who delivered at the three district hospitals. The respective figures for 2007 and 2008 were 346 and 549; these included the voucher holders.
Facility deliveries in the three study ODs
Among the total of 5,611 facility deliveries in the three study ODs in 2008, 4,391 (78.3%) happened in health centres and 1,220 (21.7%) in referral hospitals. Vouchers supported 876 (19.9%) of the total health centre deliveries while HEF supported 549 (45%) of the total hospital deliveries. In total, 1,425 poor pregnant women benefited from the voucher and HEF schemes, which accounts for 25.4% of the total number of facility deliveries. Vouchers and HEFs financed 11.4% of the expected number of births in the three study ODs (estimated at 12,485) and 40.6% of the expected number of births among poor women (3,509) in 2008.
Figure 3
Facility deliveries by type of beneficiary in the three ODs between 2006 and 2008
Facility deliveries by type of beneficiary in the three ODs between 2006 and 2008.
Comparison of facility delivery trends in the three study ODs and two other groups of ODs
Figure 4
Comparison of facility deliveries in three groups of ODs in Kampong Cham between 2006 and 2008
Comparison of facility deliveries in three groups of ODs in Kampong Cham between 2006 and 2008.
Operational analysis of the voucher scheme
The operational process of the voucher scheme can be divided into three stages: (1) health centre selection, (2) voucher distribution and (3) voucher utilisation.
(1) Health centre selection. By 2008, only 30 (71.4%) of the 42 health centres in the three ODs had been selected and included in the voucher scheme. Twelve health centres and their catchment villages were not covered because they did not meet the selection criteria (six health centres lacked proper infrastructures). Pregnant women living in the catchment areas of these twelve health centres were thus automatically excluded from the voucher scheme.
(2) Voucher distribution. Voucher distribution started with the pre-selection of potentially poor pregnant women in the target villages by village health volunteers. These women were later interviewed by VMA staff. On the basis of the schedule set for 2007, the VMA staff was supposed to make a total of 894 visits to the 329 villages in the catchment areas of the 30 contracted health centres. In reality, only 545 (60.9%) of the scheduled visits took place.
(3) Voucher utilisation. Analysis of the 1,093 poor pregnant women who received vouchers in 2007 shows that 855 (78.2%) of them had used their vouchers for ANC1, 665 (60.8%) for ANC2, 501 (45.8%) for ANC3 and 487 (44.6%) for delivery. Therefore, more than half of the voucher recipients did not make use of their voucher for delivery.
Results from focus group discussions
None of the 87 women participating in the focus group discussions had delivered in the health centre prior to the introduction of the voucher scheme, although about half of them had previously sought ANC at the health centre. Almost all the women had used vouchers to seek ANC at the contracted health centres at least once, even those who had not used their voucher for delivery (the non-user group).
All the women participating in the user group were in general satisfied with the services provided at the health centres. They reported three main reasons for using their vouchers for delivery at health centres. First, with a voucher they could get free care and some money to pay for transportation costs. Second, they felt safer when delivering at the health centre (compared to home deliveries with traditional birth attendants). Third, they could immediately get their child vaccinated after the delivery at the health centre.
Women participating in the non-user group reported several reasons for the non-use of their vouchers for delivery at health centres. Transportation and intra-household constraints were mentioned as the two main reasons. First, some women lived in remote areas far away from the health centres. Although they knew that transportation costs would be paid for by the voucher scheme, they could seldom find appropriate means of transport when the deliveries happened in the middle of the night. If they did manage to find transport, they anticipated that the price would be much higher than the day time price approved by the voucher scheme. They therefore feared that such higher costs would not be fully covered by the voucher scheme. Second, several intra-household constraints made it difficult for some poor pregnant women to leave their home. Many women claimed that if they came to deliver at health centres, nobody would look after their house and take care of their children or that nobody could accompany them to health centres. In addition, many of them expressed dissatisfaction with health centre services and staff. Some women reported poor staff attitudes and extra payments hinted by midwives. Some doubted the midwife's availability at night for delivery.
Results from key informant interviews
All the key informants observed a significant improvement in facility deliveries in the study area. Many of the village health volunteers and traditional birth attendants interviewed claimed that there were almost no home deliveries any more in their villages. The traditional birth attendants referred all pregnant women to health centres for delivery. Other key informants also confirmed this. They reported several reasons for this improvement. First, poor pregnant women who received a voucher could now go to the health centre without having to overcome financial barriers. Second, thanks to the cash incentives from the PBC and delivery incentive scheme, midwives and health centre personnel had become more committed to ensuring 24-hour services at health centres and to providing more health education to promote facility deliveries during outreach activities. Third, village health volunteers and traditional birth attendants also received cash incentives from the health centre for referrals of pregnant women for delivery at the health centre. Fourth, the district and provincial health management teams applied stronger monitoring and stricter rules for 24-hour services. Informal payments were no longer allowed.
The results show that the number of facility deliveries increased sharply after the introduction of the voucher and HEF schemes. This increase was much greater in the three study ODs than in other ODs without voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. Furthermore, many of the voucher and HEF beneficiaries delivered in public health facilities for the first time, as indicated by the focus group discussions. Poor pregnant women who made use of vouchers to deliver at health centres and hospitals had previously delivered at home with traditional birth attendants. This suggests that in the three study ODs in Kampong Cham, voucher and HEF schemes indeed improved access to facility deliveries for poor women.
However, we should be cautious when interpreting these data, especially about the impact of the voucher and HEF schemes on improved access to skilled birth attendants for poor women. First, the increase in facility deliveries could represent just a shift from deliveries attended at home by trained health professionals. Second, several health financing schemes under implementation in the study area and other socio-economic factors might have contributed to the increase in facility deliveries. Third, it is rather early to perceive the full effect of the voucher scheme since it has only been fully implemented for less than two years.
An increase in facility deliveries could represent just a shift from deliveries attended at home by trained health professionals (skilled attendants) to facility deliveries. Hence, analysis of the trend in the percentage of deliveries at home attended by trained health professionals is necessary. Unfortunately, we do not have reliable data for that analysis. According to the Cambodia Demographic and Health Survey 2005
In the study area, besides vouchers and HEFs, several other factors could have contributed to the increase in facility deliveries. The overall increase, especially the increase in self-paid facility deliveries, can be explained by the overall improvement in provider performance. Thanks to the PBC and the delivery incentive scheme, midwives were more regularly present at the health facility and changed their behaviour for the better. One could claim that the sharp increase in facility deliveries (which included voucher and HEF beneficiaries) in the three study ODs in 2008 was due to the introduction of the delivery incentive scheme; the incentive of USD12.5-USD15 per attended delivery provided through this scheme is about twice the price of the fee for delivery paid for by voucher, HEF and patients. However, comparison among the three groups of ODs shows that the delivery incentive scheme does not suffice if implemented alone. The comparison also shows that the combination of special contracting and the delivery incentive scheme can achieve relatively good results. However, results attained with the voucher and HEF schemes tend to be better. Furthermore, the PBC and the delivery incentive scheme do not address financial barriers of access for pregnant women, especially poor pregnant women. Even if the health centre and hospital offer good quality delivery services, poor pregnant women who cannot afford to pay the cost of transport and user fees will not go there. In a Cambodian survey, other factors such as improved road access and increasing awareness among women of how to deliver safely were also found to be important determinants of increased facility delivery
Two years of implementation is rather short to reveal the full effect of the voucher scheme. This innovative scheme usually needs time to refine its operation and overcome its shortcomings as highlighted by the operational analysis. The exclusion of twelve health centres that did not meet the selection criteria from the intervention automatically ruled out about 29% of poor pregnant women from the scheme. The failure of VMA staff to visit all villages as scheduled (to identify poor pregnant women and distribute vouchers) also deprived many poor pregnant women of the chance to receive vouchers. Moreover, many poor pregnant women who received vouchers did not use them for recommended maternal services at contracted facilities.
To improve the voucher scheme further, more efforts are needed to address the above-mentioned shortcomings. Instead of limiting vouchers to public health centres, the implementers could consider contracting qualified private providers for service delivery, at least in the catchment areas of the twelve excluded health centres. This would allow the voucher recipients to select a provider convenient to them, which might in turn increase their satisfaction and would also create competition among participating providers to improve the quality of their services
Despite some weaknesses in the methods, this study provides useful lessons for further improvement and scaling-up of vouchers and HEFs in Cambodia. The available evidence suggests that the combination of vouchers and HEFs, if carefully designed and implemented, has a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. Nevertheless, these demand-side financing schemes have their own limitations. In the Cambodian context, vouchers and HEFs require other interventions, such as PBC and delivery incentive scheme, to improve provider performance to a level necessary for ensuring the supply of reasonable quality maternity services for potential users. Moreover, vouchers and HEFs cannot overcome many other non-financial barriers, such as distance, intra-household constraints and socio-cultural practices. To achieve the full potential of vouchers and HEFs, more efforts are needed to address their limitations, including the operational shortcomings of the voucher scheme in terms of distribution and utilisation. Voucher and HEF schemes can be scaled up to areas with reasonably good public health services, but close monitoring and evaluation are needed to ensure further improvement.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
PI processed and analysed the data and wrote the draft and final version of the manuscript. DH and NS collected data and contributed to the revised version of the manuscript. WVD provided content expertise throughout the design and implementation of the study and contributed to the final version of the manuscript. All authors read and approved the final manuscript.
We thank the field staff of the Ministry of Health and the Belgian Technical Cooperation and local health volunteers in Kampong Cham for their hard work during the project implementation and data collection. We are very grateful to Kristof Decoster and Bruno Meessen for their comments on previous drafts of this paper. We also thank the reviewers and editors.
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Pre-publication history
The pre-publication history for this paper can be accessed here:


text:
Fuligo Septica
Also known as dog vomit, slime mold, and Scrambled egg slime.
It is known to also grow on wood substances in the months of May through October.
Typically found in decaying, moist, and shady places. For example: forest floors. They also produce an abundance of any slime mold.
They spread in a fan-shaped pattern, which is also what they are shaped like. They form structures called " Plasmodia", these usually do the moving and consuming food for them.
They contribute by decomposing dead vegetation , and by eating bacteria, yeasts, and also fungi.
Five types of Myxogastria are Echinostelida, Liceida, Physarida, Stemonitida, and Trichiida.
They all live in very moist colonies.
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Fuligo Septica
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Voyeur : April 2009
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Abu Dhabi: Ambitious goals for public transport
The public transport network in Abu Dhabi conducted 64 million passenger journeys last year and plans to raise that figure to 76 million this year
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By 2016, five percent of all people who commute to work in Abu Dhabi will ride the bus, cutting hundreds of thousands of car trips per day. This will rid the air of hundreds of metric tons of carbon dioxide every year, a senior official said yesterday.
"By 2030, the emirate's mass transport system will be more than sufficient to serve all commuters, leaving wider spaces for those who would prefer to walk or ride their bicycles to work," Saeed Mohammad Al Hameli, general manager of the Abu Dhabi Department of Transport, said.
Al Hameli was speaking after briefing the media on the third Mena Congress of the International Union of Public Transport, to be held in Abu Dhabi from March 26-28. "Our strategies are aimed at achieving zero emission levels in terms of traffic pollutants, encouraging reliance on public transportation and discouraging the so-called car culture which dominates the UAE, while acting in a proactive and responsible manner to ensure environment and transportation sustainability in Abu Dhabi," Al Hameli said.
The public transport network in Abu Dhabi conducted 64 million passenger journeys last year and plans to raise that figure to 76 million this year. The public bus network in the capital is in for an ambitious expansion that will see the current 79 routes increased to 120, and bus stops every 300 metres this year.
To meet its target of 76 million bus journeys, the Department of Transport will add 150 buses to its fleet, which will be better equipped for people with special needs. As many as 380 air-conditioned bus shelters will also be added to the existing 81 and almost 50 kilometres of bus lanes will be integrated into the main roads. The capital has released plans for a low-carbon public transport network under its Abu Dhabi Plan 2030, which includes a Metro system, regional rail, a comprehensive tram network and a ferry link to Dubai.
The Abu Dhabi Metro, which will run approximately 131 kilometres and be supported by tram and bus feeder services, is set to be operational by 2016-17. Besides serving the projected increase in the population, the Metro will connect the proposed Central Business District with Sowwah Island, Reem Island, Saadiyat Island, Yas Island, Abu Dhabi International Airport and Masdar, the Capital City District, Emerald Gateway, Zayed Sports City and Adnec.
Hosted by the Department of Transport (DoT) in Abu Dhabi, the International Union of Public Transport (UITP) will holds its third Middle East and North Africa (Mena) Congress from March 26 to 28 at the Jumeirah at Etihad Towers Hotel in Abu Dhabi.
For the first time in its 125-year history, the UITP will also simultaneously hold its First International Taxi Conference, aiming to develop the offering of taxis in the region, integrate it with other modes of public transport, create a competitive operational environment for taxis and to raise the standard of this mode of public transport, Abdullah Saleh Nasser, head of the UITP Mena Office, said.
The Congress is held under the 8G' concept, which is modelled on eight generations' strategies which form the building blocks to deliver world-class public transport systems that meet the transportation needs of future generations in the Mena region.
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