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Typologies of collaborative governance for scaling nature-based solutions in two strategic South African river systems.

ABSTRACT: Scaled up planning and implementation of nature-based solutions requires better understanding of broad characteristics (typologies) of the current governance and financing landscape, collaborative approaches amidst local complexities, and factors of scalability. An inventory was compiled of water-related ecological infrastructure intervention projects in two river systems in South Africa, incorporating actor, environmental, social, and financial dimensions and benefits. Qualitative participatory analysis revealed eight typologies. Post-hoc classification analysis determined similarities and/or unique characteristics of seven quantitative typologies. Key characterising factors included the complexity/size of financial flows, complexity of partnership/governance arrangements, mandates/goals of actors, type of ecological infrastructure, trade-offs in investment in ecological/built infrastructure, and the model used for social benefits. Identified scalable typologies offer structures suited to increased investment, with other typologies offering specialised local value. A range of ecological infrastructure intervention typologies with differing biophysical and socioeconomic outcomes provide choices for investors with specific goals, and benefits to landscape actors.

SUBMITTER: Midgley SJE

PROVIDER: S-EPMC8249548 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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Typologies of collaborative governance for scaling nature-based solutions in two strategic South African river systems.

Midgley Stephanie J E SJE Esler Karen J KJ Holden Petra B PB Rebelo Alanna J AJ Stuart-Hill Sabine I SI Cullis James D S JDS Methner Nadine N

Ambio 20210601 8

Scaled up planning and implementation of nature-based solutions requires better understanding of broad characteristics (typologies) of the current governance and financing landscape, collaborative approaches amidst local complexities, and factors of scalability. An inventory was compiled of water-related ecological infrastructure intervention projects in two river systems in South Africa, incorporating actor, environmental, social, and financial dimensions and benefits. Qualitative participatory ...[more]

PMID: 34061345

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Project description:BackgroundSignificant knowledge gaps exist in the functioning of institutional designs and organisational practices in purchasing within free healthcare schemes in low resource countries. The study provides evidence of the governance requirements to scale up strategic purchasing in free healthcare policies in Nigeria and other low-resource settings facing similar approaches.MethodsThe study was conducted at the Ministry of Health and in two health districts in Enugu State, Nigeria, using a qualitative case study design. Semi-structured interviews were conducted with 44 key health system actors (16 policymakers, 16 providers and 12 health facility committee leaders) purposively selected from the Ministry of Health and the two health districts. Data collection and analysis were guided by Siddiqi and colleagues' health system governance framework. Data were analysed using a framework approach.ResultsThe key findings show that supportive governance practices in purchasing included systems to verify questionable provider claims, pay providers directly for services, compel providers to procure drugs centrally and track transfer of funds to providers. However, strategic vision was undermined by institutional conflicts, absence of purchaser-provider split and lack of selective contracting of providers. Benefit design was not based on stakeholder involvement. Rule of law was limited by delays in provider payment. Benefits and obligations to users were not transparent. The criteria and procedure for resource allocation were unclear. Some target beneficiaries seemed excluded from the scheme. Effectiveness and efficiency was constrained by poor adherence to purchasing rules. Accountability of purchasers and providers to users was weak. Intelligence and information is constrained by paper-based system. Rationing of free services by providers and users' non-adherence to primary gate-keeping role hindered ethics.ConclusionWeak governance of purchasing function limits potential of FMCHP to contribute towards universal health coverage. Appropriate governance model for strengthening strategic purchasing in the FMCHP and possibly free healthcare interventions in other low-resource countries must pay attention to the creation of an autonomous purchasing agency, clear framework for selective contracting, stakeholder involvement, transparent benefit design, need-based resource allocation, efficient provider payment methods, stronger roles for citizens, enforcement of gatekeeping rules and use of data for decision-making.

Project description:BACKGROUND:Violence victimisation and violence perpetration may co-occur in adolescents. Understanding the sociodemographic correlates of the independent and joint profiles of victimisation and perpetration may inform preventive interventions. This study examined the associations of sociodemographic factors with four violence typologies, namely, 1) non-involvement in both victimisation and perpetration, 2) victims only, 3) perpetrators only, and 4) victim-perpetrators. Trends in the prevalence of the four violence typologies over the three survey years were also examined. METHODS:We used data from the three nationally representative South African Youth Risk Behaviour Surveys conducted in 2002, 2008, and 2011 and included a multi-ethnic sample of adolescents (n?=?30,007; boy: 46.9%, girls: 53.1%; M age?=?16?years, SD?=?.06). RESULTS:The sample consisted of 8030 (30.8%) adolescents who had non-involvement in both victimisation and perpetration, 8217 were victims only (29.8%), 2504 were perpetrators only (9.0%), and 7776 were victim-perpetrators (24.6%). Logistic regression analyses showed that being a girl increased the odds of non-involvement (OR: 1.47, 99% CI: 1.36-1.58) and being victims only (OR: 1.90, 99% CI: 1.76-2.05). Being a boy increased the odds of being perpetrators only (OR: 0.42, 99% CI: 0.37-0.47) and victim-perpetrators (OR: 0.51, 99% CI: 0.47-0.55). Adolescents who did not have an absent mother had higher odds of non-involvement (OR: 0.78, 99% CI: 0.62-0.97). Lower monthly allowance increased the odds of victimisation only (OR: 0.99, 99% CI: 0.97-1.00), whereas higher monthly allowance increased the odds of perpetration only (OR: 1.05, 99% CI: 1.03-1.08). Trend analysis showed that between 2002 to 2011, there was an increase in the prevalence of non-involvement in adolescents (p?<?.001), a decrease in the prevalence of victims only (p?<?.05) and victim-perpetrators (p?<?.001), and no changes in the prevalence of perpetrators only (p?>?.05). CONCLUSIONS:Sociodemographic factors are uniquely associated with different violence typologies suggesting the need for tailored interventions to target adolescents with differed risks to violence victimisation and perpetration. Strengthening family relations, particularly between mother and child, may protect adolescents from the experiences of victimisation and perpetration.

Project description:BackgroundFew estimates exist of the life expectancy of HIV-positive adults receiving antiretroviral treatment (ART) in low- and middle-income countries. We aimed to estimate the life expectancy of patients starting ART in South Africa and compare it with that of HIV-negative adults.Methods and findingsData were collected from six South African ART cohorts. Analysis was restricted to 37,740 HIV-positive adults starting ART for the first time. Estimates of mortality were obtained by linking patient records to the national population register. Relative survival models were used to estimate the excess mortality attributable to HIV by age, for different baseline CD4 categories and different durations. Non-HIV mortality was estimated using a South African demographic model. The average life expectancy of men starting ART varied between 27.6 y (95% CI: 25.2-30.2) at age 20 y and 10.1 y (95% CI: 9.3-10.8) at age 60 y, while estimates for women at the same ages were substantially higher, at 36.8 y (95% CI: 34.0-39.7) and 14.4 y (95% CI: 13.3-15.3), respectively. The life expectancy of a 20-y-old woman was 43.1 y (95% CI: 40.1-46.0) if her baseline CD4 count was ? 200 cells/µl, compared to 29.5 y (95% CI: 26.2-33.0) if her baseline CD4 count was <50 cells/µl. Life expectancies of patients with baseline CD4 counts ? 200 cells/µl were between 70% and 86% of those in HIV-negative adults of the same age and sex, and life expectancies were increased by 15%-20% in patients who had survived 2 y after starting ART. However, the analysis was limited by a lack of mortality data at longer durations.ConclusionsSouth African HIV-positive adults can have a near-normal life expectancy, provided that they start ART before their CD4 count drops below 200 cells/µl. These findings demonstrate that the near-normal life expectancies of HIV-positive individuals receiving ART in high-income countries can apply to low- and middle-income countries as well. Please see later in the article for the Editors' Summary.

Project description:In many countries, healthcare systems suffer from fragmentation between hospitals and primary care. In response, many governments institutionalized healthcare networks (HN) to facilitate integration and efficient healthcare delivery. Despite potential benefits, the implementation of HN is often challenged by inefficient collaborative dynamics that result in delayed decision-making, lack of strategic alignment and lack of reciprocal trust between network members. Yet, limited attention has been paid to the collective dynamics, challenges and enablers for effective inter-organizational collaborations. To consider these issues, we carried out a scoping review to identify the underlying processes for effective inter-organizational collaboration and the contextual conditions within which these processes are triggered. Following appropriate methodological guidance for scoping reviews, we searched four databases [PubMed (n = 114), Web of Science (n = 171), Google Scholar (n = 153) and Scopus (n = 52)] and used snowballing (n = 22). A total of 37 papers addressing HN including hospitals were included. We used a framework synthesis informed by the collaborative governance framework to guide data extraction and analysis, while being sensitive to emergent themes. Our review showed the prominence of balancing between top-down and bottom-up decision-making (e.g. strategic vs steering committees), formal procedural arrangements and strategic governing bodies in stimulating participative decision-making, collaboration and sense of ownership. In a highly institutionalized context, the inter-organizational partnership is facilitated by pre-existing legal frameworks. HN are suitable for tackling wicked healthcare issues by mutualizing resources, staff pooling and improved coordination. Overall performance depends on the capacity of partners for joint action, principled engagement and a closeness culture, trust relationships, shared commitment, distributed leadership, power sharing and interoperability of information systems To promote the effectiveness of HN, more bottom-up participative decision-making, formalization of governance arrangement and building trust relationships are needed. Yet, there is still inconsistent evidence on the effectiveness of HN in improving health outcomes and quality of care.

Dataset Information

Typologies of collaborative governance for scaling nature-based solutions in two strategic South African river systems.

Publications

Typologies of collaborative governance for scaling nature-based solutions in two strategic South African river systems.

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