Research on International Cooperative Governance of the COVID-19

Governance in mental healthcare policies during the COVID-19 pandemic in Mexico

The COVID-19 pandemic has become the greatest burden of disease worldwide and in Mexico, affecting more vulnerable groups in society, such as people with mental disorders (MD). This research aims to analyze the governance processes in the formulation of healthcare policies for people with MD in the face of the COVID-19 pandemic. An analytical qualitative study, based on semi-structured interviews with key informants in the healthcare system was conducted in 2020. The study followed the theoretical-methodological principles of the Governance Analytical Framework (GAF). The software ATLAS.ti-V.9 was used for inductive thematic analysis, classifying themes and their categories. To ensure the proper interpretation of the data, a process of triangulation among the researchers was carried out. The findings revealed that in Mexico, the federal Secretary of Health issued guidelines for mental healthcare, but there is no defined national policy. Decision-making involved multiple actors, with different strategies and scopes, depending on the type of key-actor and their level of influence. Majority of informants described a problem of implementation in which infection control policies in the psychiatric population were the same as in the general populations which decreased the percentage of access to healthcare during the pandemic, without specific measures to address this vulnerable population. The results suggest that there is a lack of specific policies and measures to address the needs of people with mental disorders during the COVID-19 pandemic in Mexico. It also highlights the importance of considering the role of different actors and their level of influence in the decision-making process.

Viewing the global health system as a complex adaptive system - implications for research and practice

The global health system (GHS) is ill-equipped to deal with the increasing number of transnational challenges. The GHS needs reform to enhance global resilience to future risks to health. In this article we argue that the starting point for any reform must be conceptualizing and studying the GHS as a complex adaptive system (CAS) with a large and escalating number of interconnected global health actors that learn and adapt their behaviours in response to each other and changes in their environment. The GHS can be viewed as a multi-scalar, nested health system comprising all national health systems together with the global health architecture, in which behaviours are influenced by cross-scale interactions. However, current methods cannot adequately capture the dynamism or complexity of the GHS or quantify the effects of challenges or potential reform options. We provide an overview of a selection of systems thinking and complexity science methods available to researchers and highlight the numerous policy insights their application could yield.   We also discuss the challenges for researchers of applying these methods and for policy makers of digesting and acting upon them. We encourage application of a CAS approach to GHS research and policy making to help bolster resilience to future risks that transcend national boundaries and system scales.

Attributes of national governance for an effective response to public health emergencies: Lessons from the response to the COVID-19 pandemic

Background

The Coronavirus Disease 2019 (COVID-19) pandemic takes variable shapes and forms in different regions and countries. This variability is explained by several factors, including the governance of the epidemic. We aimed to identify the key attributes of governance in response to the COVID-19 pandemic and gain lessons for an effective response to public health emergencies.

Methods

We employed a mixed-methods design. We mapped the attributes of governance from well-established governance frameworks. A negative binomial regression was conducted to identify the effect of the established governance measures on the epidemiology of the COVID-19 pandemic. We used publicly available data on COVID-19 cases and deaths in countries around the world. Document review was conducted to identify the key approaches and attributes of governance during the pre-vaccine era of the response to the COVID-19 pandemic. We conducted a thematic analysis to identify key attributes for effective governance.

Results

The established governance measures, including generation of intelligence, strategic direction, regulation, partnership, accountability, transparency, rule of law, control of corruption, responsiveness, effectiveness, efficiency, equity, ethics, and inclusiveness, are necessary but not sufficient to effectively respond to and contain the COVID-19 pandemic. Additional attributes of national governance were identified: 1) agile, adaptive, and transformative governance; 2) collective (collaborative, inclusive, cooperative, accountable, and transparent) governance; 3) multi-level governance; 4) smart and ethical governance: sensible, pragmatic, evidence-based, political, learner, and ethical.

Conclusions

The current governance frameworks and their attributes are not adequate to contain the COVID-19 pandemic. We argue that countries need agile, adaptable, and transformational, collaborative, multi-level, smart and ethical governance to effectively respond to emerging and re-emerging public health threats. In addition, an effective response to public health emergencies depends not only on national governance but also on global governance. Hence, global health governance should be urgently renewed through a paradigm shift towards universal health coverage and health security to all populations and in all countries. This requires enhanced and consistent global health diplomacy based on knowledge, solidarity, and negotiation.

Supervision for the Public Health Services for Older Adults Under the Background of Government Purchasing: An Evolutionary Game Analysis Framework

As an important measure to involve services for older adults, the government procurement practices have become a key link for public health services. However, the information asymmetry between public health service purchasers and public health service undertakers triggers a supervision dilemma. Based on this background, this study uses the evolutionary game theory to analyze the symbiotic evolution between local governments and public health service institutions under different reward and punishment mechanisms, explore game evolution, strategy adjustment, and influencing factors of different game subjects, and analyze the necessity and appropriate intensity of dynamic rewards and punishment mechanisms. The results show that: under the static condition, the penalty can change the strategies of local governments to a certain extent, but it is still difficult to achieve complete self-discipline management of public health service institutions. If local governments implement a dynamic reward or penalty mechanism in the supervision process of public health services for older adults, the equilibrium between them tends to be evolutionary stable. For three dynamic mechanisms, a dynamic reward mechanism is more conducive to adopting a self-discipline behavior of public health service institutions, which is helpful to realize the supervision of public health services for older adults. Also, there is a positive correlation between the proportion of public health service institutions who adopt a "self-discipline behavior" strategy and the maximum punishment intensity, and a negative correlation with the reward intensity. This study provides theoretical and decision-making references for governments to explore the promotion and implementation of public health services in older adults.

An Evolutionary Game Model of the Supply Decisions between GNPOs and Hospitals during a Public Health Emergency

The distribution of medical supplies tied to the government-owned nonprofit organizations (GNPOs) is crucial to the sustainable and high-quality development of emergency response to public health emergencies. This paper constructs a two-sided GNPO–hospital game model in a Chinese context, and explores the strategies and influencing factors of medical supply distribution in public health emergencies based on evolutionary game theory. The results show that: (1) GNPOs, as the distributor of medical supplies, should choose strategies that balance efficiency and equity as much as possible. (2) Hospitals, as the recipient of medical supplies, should actively choose strategies that maximize the total benefit to society and strengthen trust in GNPOs. Meanwhile, hospital managers need to pay attention to reducing the impact of communication and coordination costs and strive for the reduction of conflicts between different values. (3) The government should strengthen supervision to avoid conflicts between medical distributors and receivers during a public health emergency and ensure the rescue efficiency. This study provides some reference for the sustainable development of emergency relief in public health emergencies.