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Schulmann K, Bruen C, Parker S, Siersbaek R, Conghail LM, Burke S. The role of governance in shaping health system reform: a case study of the design and implementation of new health regions in Ireland, 2018-2023. BMC Health Serv Res 2024; 24:578. [PMID: 38702678 PMCID: PMC11069256 DOI: 10.1186/s12913-024-11048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Effective governance arrangements are central to the successful functioning of health systems. While the significance of governance as a concept is acknowledged within health systems research, its interplay with health system reform initiatives remains underexplored in the literature. This study focuses on the development of new regional health structures in Ireland in the period 2018-2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation. METHODS This qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis. RESULTS The analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors. The findings highlight how these challenges can be addressed through strengthening governance arrangements and processes. Importantly, the research reveals the interwoven nature of the five TAPIC dimensions of governance and the need to engage with the complexity and relationality of health system reform processes. CONCLUSIONS Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed.
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Affiliation(s)
- Katharine Schulmann
- Centre for Health Policy & Management, Trinity College Dublin, Dublin, D02 YT92, Ireland.
| | - Carlos Bruen
- Centre for Health Policy & Management, Trinity College Dublin, Dublin, D02 YT92, Ireland
| | - Sarah Parker
- Centre for Health Policy & Management, Trinity College Dublin, Dublin, D02 YT92, Ireland
| | - Rikke Siersbaek
- Discipline of Clinical Medicine, Trinity College Dublin, Dublin, D08 W9RT, Ireland
| | - Luisne Mac Conghail
- Centre for Health Policy & Management, Trinity College Dublin, Dublin, D02 YT92, Ireland
| | - Sara Burke
- Centre for Health Policy & Management, Trinity College Dublin, Dublin, D02 YT92, Ireland
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Abdelmagid N, Southgate RJ, Alhaffar M, Ahmed M, Bani H, Mounier-Jack S, Dahab M, Checchi F, Sabahelzain MM, Nor B, Rao B, Singh NS. The Governance of Childhood Vaccination Services in Crisis Settings: A Scoping Review. Vaccines (Basel) 2023; 11:1853. [PMID: 38140257 PMCID: PMC10747651 DOI: 10.3390/vaccines11121853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
The persistence of inadequate vaccination in crisis-affected settings raises concerns about decision making regarding vaccine selection, timing, location, and recipients. This review aims to describe the key features of childhood vaccination intervention design and planning in crisis-affected settings and investigate how the governance of childhood vaccination is defined, understood, and practised. We performed a scoping review of 193 peer-reviewed articles and grey literature on vaccination governance and service design and planning. We focused on 41 crises between 2010 and 2021. Following screening and data extraction, our analysis involved descriptive statistics and applying the governance analysis framework to code text excerpts, employing deductive and inductive approaches. Most documents related to active outbreaks in conflict-affected settings and to the mass delivery of polio, cholera, and measles vaccines. Information on vaccination modalities, target populations, vaccine sources, and funding was limited. We found various interpretations of governance, often implying hierarchical authority and regulation. Analysis of governance arrangements suggests a multi-actor yet fragmented governance structure, with inequitable actor participation, ineffective actor collaboration, and a lack of a shared strategic vision due to competing priorities and accountabilities. Better documentation of vaccination efforts during emergencies, including vaccination decision making, governance, and planning, is needed. We recommend empirical research within decision-making spaces.
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Affiliation(s)
- Nada Abdelmagid
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Health in Humanitarian Crises Centre, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Mervat Alhaffar
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Syria Research Group (SYRG), Co-Hosted by the London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Matab Ahmed
- School of Health Sciences, Ahfad University for Women (AUW), Omdurman P.O. Box 167, Sudan
| | - Hind Bani
- School of Health Sciences, Ahfad University for Women (AUW), Omdurman P.O. Box 167, Sudan
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, The London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Maysoon Dahab
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Health in Humanitarian Crises Centre, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Health in Humanitarian Crises Centre, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Majdi M. Sabahelzain
- School of Health Sciences, Ahfad University for Women (AUW), Omdurman P.O. Box 167, Sudan
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Barni Nor
- Department of Women’s and Children’s Health, Uppsala University, 751 23 Uppsala, Sweden
| | - Bhargavi Rao
- Department of Global Health and Development, Faculty of Public Health and Policy, The London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Neha S. Singh
- Health in Humanitarian Crises Centre, The London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, The London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
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Liwanag HJ, James O, Frahsa A. A review and analysis of accountability in global health funding, research collaborations and training: towards conceptual clarity and better practice. BMJ Glob Health 2023; 8:e012906. [PMID: 38084477 PMCID: PMC10711908 DOI: 10.1136/bmjgh-2023-012906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/21/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Accountability is a complex idea to unpack and involves different processes in global health practice. Calls for accountability in global health would be better translated to action through a better understanding of the concept and practice of accountability in global health. We sought to analyse accountability processes in practice in global health funding, research collaborations and training. METHODS This study is a literature review that systematically searched PubMed and Scopus for articles on formal accountability processes in global health. We charted information on processes based on accountability lines ('who is accountable to whom') and the outcomes the processes were intended for ('accountability for what'). We visualised the representation of accountability in the articles by mapping the processes according to their intended outcomes and the levels where processes were implemented. RESULTS We included 53 articles representing a wide range of contexts and identified 19 specific accountability processes for various outcomes in global health funding, research collaborations and training. Target setting and monitoring were the most common accountability processes. Other processes included interinstitutional networks for peer checking, litigation strategies to enforce health-related rights, special bodies that bring actors to account for commitments, self-accountability through internal organisational processes and multipolar accountability involving different types of institutional actors. Our mapping identified gaps at the institutional, interinstitutional and broader system levels where accountability processes could be enhanced. CONCLUSION To rebalance power in global health, our review has shown that analysing information on existing accountability processes regarding 'who is accountable to whom' and 'accountability for what' would be useful to characterise existing lines of accountability and create lines where there are gaps. However, we also suggest that institutional and systems processes for accountability must be accompanied by political engagement to mobilise collective action and create conditions where a culture of accountability thrives in global health.
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Affiliation(s)
- Harvy Joy Liwanag
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Oria James
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Annika Frahsa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Brown GW, Rhodes N, Tacheva B, Loewenson R, Shahid M, Poitier F. Challenges in international health financing and implications for the new pandemic fund. Global Health 2023; 19:97. [PMID: 38053177 DOI: 10.1186/s12992-023-00999-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The failures of the international COVID-19 response highlighted key gaps in pandemic preparedness and response (PPR). The G20 and WHO have called for additional funding of $10.5 billion per year to adequately strengthen the global PPR architecture. In response to these calls, in 2022 the World Bank announced the launch of a new Financial Intermediary Fund (The Pandemic Fund) to catalyse this additional funding. However, there is considerable unclarity regarding the governance makeup and financial modalities of the Pandemic Fund, and divergence of opinion about whether the Fund has been successfully designed to respond to key challenges in global health financing. METHODS/RESULTS The article outlines eight challenges associated with global health financing instruments and development aid for health within the global health literature. These include misaligned aid allocation; accountability; multistakeholder representation and participation; country ownership; donor coherency and fragmentation; transparency; power dynamics, and; anti-corruption. Using available information about the Pandemic Fund, the article positions the Pandemic Fund against these challenges to determine in what ways the financing instrument recognizes, addresses, partially addresses, or ignores them. The assessment argues that although the Pandemic Fund has adopted a few measures to recognise and address some of the challenges, overall, the Pandemic Fund has unclear policies in response to most of the challenges while leaving many unaddressed. CONCLUSION It remains unclear how the Pandemic Fund is explicitly addressing challenges widely recognized in the global health financing literature. Moreover, there is evidence that the Pandemic Fund might be exacerbating these global financing challenges, thus raising questions about its potential efficacy, suitability, and chances of success. In response, this article offers four sets of policy recommendations for how the Pandemic Fund and the PPR financing architecture might respond more effectively to the identified challenges.
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Affiliation(s)
- Garrett Wallace Brown
- School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT, UK.
| | - Natalie Rhodes
- School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT, UK
| | - Blagovesta Tacheva
- School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT, UK
| | | | - Minahil Shahid
- Centre for Policy and Impact in Global Health, Duke University, Durham, USA
- Global Health Institute, Duke University, Durham, USA
| | - Francis Poitier
- Nuffield Centre for International Development and Health, University of Leeds, Leeds, UK
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McCoy D, Khosla R. Public health leaders must confront the power imbalances that harm global health. Nat Med 2023; 29:2158-2159. [PMID: 37420099 DOI: 10.1038/s41591-023-02446-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Affiliation(s)
- David McCoy
- United Nations University - International Institute for Global Health (UNU-IIGH), Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia.
| | - Rajat Khosla
- United Nations University - International Institute for Global Health (UNU-IIGH), Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
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Larson CP, Plamondon KM, Dubent L, Bicaba F, Bicaba A, Minh TH, Nguyen A, Girard JE, Ramdé J, Gyorkos TW. The Equity Tool for Valuing Global Health Partnerships. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00316. [PMID: 35487557 PMCID: PMC9053142 DOI: 10.9745/ghsp-d-21-00316] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/15/2022] [Indexed: 11/15/2022]
Abstract
There is a need to more comprehensively identify and respond to equity in global health partnerships. The Equity Tool can support dialogue at any stage of a partnership, by individuals at any level. This assists partnerships to embrace ways of recognizing, understanding, and advancing equity in all their processes. Global health partnerships (GHPs) involve complex relationships between individuals and organizations, often joining partners from high-income and low- or middle-income countries around work that is carried out in the latter. Therefore, GHPs are situated in the context of global inequities and their underlying sociopolitical and historical causes, such as colonization. Equity is a core principle that should guide GHPs from start to end. How equity is embedded and nurtured throughout a partnership has remained a constant challenge. We have developed a user-friendly tool for valuing a GHP throughout its lifespan using an equity lens. The development of the EQT was informed by 5 distinct elements: a scoping review of scientific published peer-reviewed literature; an online survey and follow-up telephone interviews; workshops in Canada, Burkina Faso, and Vietnam; a critical interpretive synthesis; and a content validation exercise. Findings suggest GHPs generate experiences of equity or inequity yet provide little guidance on how to identify and respond to these experiences. The EQT can guide people involved in partnering to consider the equity implications of all their actions, from inception, through implementation and completion of a partnership. When used to guide reflective dialogue with a clear intention to advance equity in and through partnering, this tool offers a new approach to valuing global health partnerships. Global health practitioners, among others, can apply the EQT in their partnerships to learning together about how to cultivate equity in their unique contexts within what is becoming an increasingly diverse, vibrant, and responsive global health community.
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Affiliation(s)
- Charles P Larson
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Katrina M Plamondon
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Okanagan, Canada
| | - Leslie Dubent
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
| | - Frank Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - Tran Hung Minh
- Center for Creative Initiatives in Health and Population, Hanoi, Vietnam
| | - An Nguyen
- HealthBridge Vietnam, Hanoi, Vietnam
| | - Jacques E Girard
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- Direction en Santé Mondiale, Faculté de Médecine, Université Laval, Québec, Canada
| | - Jean Ramdé
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- HealthBridge Vietnam, Hanoi, Vietnam
| | - Theresa W Gyorkos
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
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Ibragimova I. Governance for global health: the role of Nordic countries. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2022. [DOI: 10.1108/ijhg-12-2021-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeGlobal health challenges and threats could be confronted by collaborative efforts of international community. Governance for global health is a set of formal and informal processes, operating beyond state boundaries, and refers to institutions and mechanisms established at the national, regional and international levels. Nordic countries demonstrated a long-standing commitment to development assistance for health (DAH), and more recently to governance for global health. Governance for global health tools could be used effectively to achieve collective solutions for the maintenance and promotion of health as a common good, could ensure accountability and transparency, and reconcile the interests of different actors on the international and national levels. The aim of this paper is to provide an overview of tools and approaches in support of eight sub-functions of governance for global health applied by the Nordic countries. This will help international audience to compare those mechanisms with similar mechanisms that are available or planned in their countries and regions, and may benefit policy scholars and practitioners.Design/methodology/approachThis study uses qualitative review of research literature, policy documents and information available from institutional websites related to the governance of global health in four Nordic countries. In total, 50 selected publications were analyzed using framework synthesis, mapping all findings to 8 dimensions (sub-functions) of governance for global health and related tools.FindingsReview reveals which tools are available, how they have been applied by the Nordic countries and influenced all domains (sub-functions) of governance for global health at different levels: national governments, agencies and networks; bilateral and multilateral partnerships; inter-governmental institutions and international health-related organizations. Common trends and approaches in governance for global health have been formulated.Originality/valueThis study is unique in relation to the prior literature as it looks at the role of Nordic countries in the governance for global health system through the lens of tools applied in support to its sub-functions.
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Plamondon KM, Brisbois B, Dubent L, Larson CP. Assessing how global health partnerships function: an equity-informed critical interpretive synthesis. Global Health 2021; 17:73. [PMID: 34215301 PMCID: PMC8254362 DOI: 10.1186/s12992-021-00726-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Global health partnerships (GHPs) are situated in complex political and economic relationships and involve partners with different needs and interests (e.g., government agencies, non-governmental organizations, corporations, universities, professional associations, philanthropic organizations and communities). As part of a mixed methods study designed to develop an equity-sensitive tool to support more equity-centred North-South GHPs, this critical interpretive synthesis examined reported assessments of GHPs. Results We examined 30 peer-reviewed articles for power dynamics, equity and inequities, and contradictions or challenges encountered in North-South partnerships. Among articles reviewed, authors most often situated GHPs around a topical focus on research, capacity-building, clinical, or health services issues, with the ‘work’ of the partnership aiming to foster skills or respond to community needs. The specific features of GHPs that were assessed varied widely, with consistently-reported elements including the early phases of partnering; governance issues; the day-to-day work of partnerships; the performance, impacts and benefits of GHPs; and issues of inclusion. Articles shared a general interest in partnering processes and often touched briefly on issues of equity; but they rarely accounted for the complexity of sociopolitical and historical contexts shaping issues of equity in GHPs. Further, assessments of GHPs were often reported without inclusion of voices from all partners or named beneficiaries. GHPs were frequently portrayed as inherently beneficial for Southern partners, without attention to power dynamics and inequities (North-South, South-South). Though historical and political dynamics of the Global North and South were inconsistently examined as influential forces in GHPs, such dynamics were frequently portrayed as complex and characterized by asymmetries in power and resources. Generally, assessments of GHPs paid little attention to the macroeconomic forces in the power and resource dynamics of GHPs highlights the importance of considering the broader political. Our findings suggest that GHPs can serve to entrench both inequitable relationships and unfair distributions of power, resources, and wealth within and between countries (and partners) if inequitable power relationships are left unmitigated. Conclusions We argue that specific practices could enhance GHPs’ contributions to equity, both in their processes and outcomes. Enhancing partnering practices to focus on inclusion, responsiveness to North-South and South-South inequities, and recognition of GHPs as situated in a broader (and inequitable) political economy. A relational and equity-centred approach to assessing GHPs would place social justice, humility and mutual benefits as central practices—that is, regular, routine things that partners involved in partnering do intentionally to make GHPs function well. Practicing equity in GHPs requires continuous efforts to explicitly acknowledge and examine the equity implications of all aspects of partnering. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00726-z.
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Affiliation(s)
- Katrina M Plamondon
- Michael Smith Foundation for Health Research Scholar, School of Nursing, Faculty of Health & Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Ben Brisbois
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Leslie Dubent
- Canadian Coalition for Global Health Research, 46 Cremona Crescent, Nepean, ON, K2G 1A1, Canada
| | - Charles P Larson
- Faculty of Medicine and Health Sciences, School of Population and Global Health, McGill University, 772 Sherbrooke Street West, Montreal, QC, H3A 1G1, Canada
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Naher N, Balabanova D, Hutchinson E, Marten R, Hoque R, Tune SNBK, Islam BZ, Ahmed SM. Do social accountability approaches work? A review of the literature from selected low- and middle-income countries in the WHO South-East Asia region. Health Policy Plan 2020; 35:i76-i96. [PMID: 33165587 PMCID: PMC7649670 DOI: 10.1093/heapol/czaa107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 11/12/2022] Open
Abstract
Governance failures undermine efforts to achieve universal health coverage and improve health in low- and middle-income countries by decreasing efficiency and equity. Punitive measures to improve governance are largely ineffective. Social accountability strategies are perceived to enhance transparency and accountability through bottom-up approaches, but their effectiveness has not been explored comprehensively in the health systems of low- and middle-income countries in south and Southeast Asia where these strategies have been promoted. We conducted a narrative literature review to explore innovative social accountability approaches in Bangladesh, Bhutan, India, Indonesia, the Maldives, Myanmar and Nepal spanning the period 2007-August 2017, searching PubMed, Scopus and Google Scholar. To augment this, we also performed additional PubMed and Google Scholar searches (September 2017-December 2019) to identify recent papers, resulting in 38 documents (24 peer-reviewed articles and 14 grey sources), which we reviewed. Findings were analysed using framework analysis and categorized into three major themes: transparency/governance (eight), accountability (11) and community participation (five) papers. The majority of the reviewed approaches were implemented in Bangladesh, India and Nepal. The interventions differed on context (geographical to social), range (boarder reform to specific approaches), actors (public to private) and levels (community-specific to system level). The initiatives were associated with a variety of positive outcomes (e.g. improved monitoring, resource mobilization, service provision plus as a bridge between the engaged community and the health system), yet the evidence is inconclusive as to the extent that these influence health outcomes and access to health care. The review shows that there is no common blueprint which makes accountability mechanisms viable and effective; the effectiveness of these initiatives depended largely on context, capacity, information, spectrum of actor involvement, independence from power agendas and leadership. Major challenges that undermined effective implementation include lack of capacity, poor commitment and design and insufficient community participation.
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Affiliation(s)
- Nahitun Naher
- Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS&UHC), BRAC James P. Grant School of Public Health, BRAC University, 5th Floor (Level-6), ICDDR,B Building, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Eleanor Hutchinson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Robert Marten
- Alliance for Health Policy and Systems Research, Science Division, World Health Organization, avenue Appia 20, 1211, Geneva 27, Switzerland
| | - Roksana Hoque
- Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS&UHC), BRAC James P. Grant School of Public Health, BRAC University, 5th Floor (Level-6), ICDDR,B Building, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Samiun Nazrin Bente Kamal Tune
- Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS&UHC), BRAC James P. Grant School of Public Health, BRAC University, 5th Floor (Level-6), ICDDR,B Building, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Bushra Zarin Islam
- Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS&UHC), BRAC James P. Grant School of Public Health, BRAC University, 5th Floor (Level-6), ICDDR,B Building, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Syed Masud Ahmed
- Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS&UHC), BRAC James P. Grant School of Public Health, BRAC University, 5th Floor (Level-6), ICDDR,B Building, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
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Danhoundo G, Nasiri K, Wiktorowicz ME. Improving social accountability processes in the health sector in sub-Saharan Africa: a systematic review. BMC Public Health 2018; 18:497. [PMID: 29653531 PMCID: PMC5899409 DOI: 10.1186/s12889-018-5407-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social accountability is a participatory process in which citizens are engaged to hold politicians, policy makers and public officials accountable for the services that they provide. In the Fifteenth Ordinary Session of the Assembly of the African Union, African leaders recognized the need for strong, decentralized health programs with linkages to civil society and private sector entities, full community participation in program design and implementation, and adaptive approaches to local political, socio-cultural and administrative environments. Despite the increasing use of social accountability, there is limited evidence on how it has been used in the health sector. The objective of this systematic review was to identify the conditions that facilitate effective social accountability in sub-Saharan Africa. METHODS Electronic databases (MEDLINE, PsycINFO, Sociological Abstracts, Social Sciences Abstracts) were searched for relevant articles published between 2000 and August 2017. Studies were eligible for inclusion if they were peer-reviewed English language publications describing a social accountability intervention in sub-Saharan Africa. Qualitative and quantitative study designs were eligible. RESULTS Fourteen relevant studies were included in the review. The findings indicate that effective social accountability interventions involve leveraging partnerships and building coalitions; being context-appropriate; integrating data and information collection and analysis; clearly defined roles, standards, and responsibilities of leaders; and meaningful citizen engagement. Health system barriers, corruption, fear of reprisal, and limited funding appear to be major challenges to effective social accountability interventions. CONCLUSION Although global accountability standards play an important guiding role, the successful implementation of global health initiatives depend on national contexts.
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Affiliation(s)
- Georges Danhoundo
- Faculty of Health (York University), 435 Health, Nursing & Environmental Studies Bldg, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
| | - Khalidha Nasiri
- Faculty of Health (York University), 435 Health, Nursing & Environmental Studies Bldg, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
| | - Mary E Wiktorowicz
- Dahdaleh Institute for Global Health Research, Community and Global Health, Health Policy and Management, Faculty of Health, York University, Toronto, Canada
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Danhoundo G, Wiktorowicz ME, Premji SS, Nasiri K. Determinants of bed net policy implementation: A case study of Southern Benin. Int J Health Plann Manage 2017; 33:e279-e292. [DOI: 10.1002/hpm.2465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Mary E. Wiktorowicz
- Dahdaleh Institute for Global Health Research, Community and Global, Health Policy and Management, Faculty of Nursing; York University; Canada
| | - Shahirose Sadrudin Premji
- UofC, Cumming School of Medicine, Department of Community Health Sciences, Faculty of Nursing; University of Calgary (UofC); Calgary Canada
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Jones CM, Clavier C, Potvin L. Are national policies on global health in fact national policies on global health governance? A comparison of policy designs from Norway and Switzerland. BMJ Glob Health 2017; 2:e000120. [PMID: 28589007 PMCID: PMC5435252 DOI: 10.1136/bmjgh-2016-000120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 12/03/2022] Open
Abstract
Background Since the signing of the Oslo Ministerial Declaration in 2007, the idea that foreign policy formulation should include health considerations has gained traction on the United Nations agenda as evidenced by annual General Assembly resolutions on global health and foreign policy. The adoption of national policies on global health (NPGH) is one way that some member states integrate health and foreign policymaking. This paper explores what these policies intend to do and how countries plan to do it. Methods Using a most similar systems design, we carried out a comparative study of two policy documents formally adopted in 2012. We conducted a directed qualitative content analysis of the Norwegian White Paper on Global health in foreign and development policy and the Swiss Health Foreign Policy using Schneider and Ingram's policy design framework. After replicating analysis methods for each document, we analysed them side by side to explore the commonalities and differences across elements of NPGH design. Results Analyses indicate that NPGH expect to influence change outside their borders. Targeting the international level, they aim to affect policy venues, multilateral partnerships and international institutions. Instruments for supporting desired changes are primarily those of health diplomacy, proposed as a tool for negotiating interests and objectives for global health between multiple sectors, used internally in Switzerland and externally in Norway. Conclusion Findings suggest that NPGH designs contribute to constructing the global health governance system by identifying it as a policy target, and policy instruments may elude the health sector actors unless implementation rules explicitly include them. Research should explore how future NPGH designs may construct different kinds of targets as politicised groups of actors on which national governments seek to exercise influence for global health decision-making.
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Affiliation(s)
- Catherine M Jones
- Chaire Approches communautaires et inégalités de santé, Montréal, Québec, Canada
- Institut de recherche en santé publique de l'Université de Montréal, Montréal, Québec, Canada
- Département de Médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada
- Regroupement stratégique Politiques publiques et santé des populations, Réseau de recherche en santé des populations du Québec, Montréal, Québec, Canada
| | - Carole Clavier
- Regroupement stratégique Politiques publiques et santé des populations, Réseau de recherche en santé des populations du Québec, Montréal, Québec, Canada
- Département de Science Politique, de l'Université du Québec à Montréal, Montréal, Québec, Canada
| | - Louise Potvin
- Chaire Approches communautaires et inégalités de santé, Montréal, Québec, Canada
- Institut de recherche en santé publique de l'Université de Montréal, Montréal, Québec, Canada
- Département de Médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada
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Martin G, MacLachlan M, Labonté R, Larkan F, Vallières F, Bergin N. Globalization and Health: developing the journal to advance the field. Global Health 2016; 12:6. [PMID: 26961760 PMCID: PMC4785659 DOI: 10.1186/s12992-016-0143-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/10/2022] Open
Abstract
Founded in 2005, Globalization and Health was the first open access global health journal. The journal has since expanded the field, and its influence, with the number of downloaded papers rising 17-fold, to over 4 million. Its ground-breaking papers, leading authors -including a Nobel Prize winner- and an impact factor of 2.25 place it among the top global health journals in the world. To mark the ten years since the journal's founding, we, members of the current editorial board, undertook a review of the journal's progress over the last decade. Through the application of an inductive thematic analysis, we systematically identified themes of research published in the journal from 2005 to 2014. We identify key areas the journal has promoted and consider these in the context of an existing framework, identify current gaps in global health research and highlight areas we, as a journal, would like to see strengthened.
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Affiliation(s)
- Greg Martin
- Centre for Global Health, Trinity College, University of Dublin, Dublin, Ireland.
| | - Malcolm MacLachlan
- Centre for Global Health, Trinity College, University of Dublin, Dublin, Ireland. .,School of Psychology, Trinity College, University of Dublin, Dublin, Ireland. .,Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa. .,Palacky University, Olomouc, Czech Republic.
| | - Ronald Labonté
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Fiona Larkan
- Centre for Global Health, Trinity College, University of Dublin, Dublin, Ireland.,School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | - Frédérique Vallières
- Centre for Global Health, Trinity College, University of Dublin, Dublin, Ireland.,School of Psychology, Trinity College, University of Dublin, Dublin, Ireland
| | - Niamh Bergin
- Masters in Global Mental Health Programme, University of Glasgow, Glasgow, Scotland
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