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Does Federalism Prevent Democratic Accountability? Assigning Responsibility for Rates of COVID-19 Testing

ABSTRACT: Does federalism prevent citizens from holding governments accountable for their actions? The pandemic represents the ideal scenario for testing the effects of federalism on democratic accountability because citizens are highly motivated to hold governments accountable for preventing or failing to prevent the rapid transmission of the virus. Previous research suggests that a number of institutional and political factors complicate the accountability function in federal systems. We add to this literature by assessing the effect of one political factor, exclusivity (measured in terms of policy variation at one level), on accountability. The coronavirus pandemic provides a unique opportunity to assess this factor given the high levels of issue saliency, media attention, and low levels of intergovernmental and interparty conflict it has generated. Drawing on original data from the May 2020 Democratic Checkup Survey and public data from the Canadian National Microbiology Laboratory, our preliminary findings suggest that interprovincial policy variation with respect to coronavirus testing is not correlated with public assessments of the adequacy of provincial testing, and so it seems that Canadians are not able to assign responsibility to the correct level of government despite ideal conditions for doing so.

SUBMITTER: Kennedy J

PROVIDER: S-EPMC8805446 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThis paper aims to provide insights into the role of traditional authorities in two maternal health programmes in Northern Malawi. Among strategies to improve maternal health, these authorities issue by-laws: local rules to increase the uptake of antenatal and delivery care. The study uses a framework of gendered institutions to critically assess the by-law content, process and effects and to understand how responsibilities and accountabilities are constructed, negotiated and reversed.MethodsFindings are based on a qualitative study in five health centre catchment areas in Northern Malawi. Data were collected using meeting observations and document search, 36 semi-structured individual interviews and 19 focus group discussions with female maternal health service users, male community members, health workers, traditional leaders, local officials and health committee members. A gender and power sensitive thematic analysis was performed focusing on the formulation, interpretation and implementation process of the by-laws as well as its effects on women and men.ResultsIn the study district, traditional leaders introduced three by-laws that oblige pregnant women to attend antenatal care; bring their husbands along and; and to give birth in a health centre. If women fail to comply with these rules, they risk being fined or denied access to maternal health services. The findings show that responsibilities and accountabilities are negotiated and that by-laws are not uniformly applied. Whereas local officials support the by-laws, lower level health cadres' and some community members contest them, in particular, the principles of individual responsibility and universality.ConclusionsThe study adds new evidence on the understudied phenomenon of by-laws. From a gender perspective, the by-laws are problematic as they individualise the responsibility for maternal health care and discriminate against women in the definition and application of sanctions. Through the by-laws, supported by national policies and international institutions, women bear the full responsibility for failures in maternal health care, suggesting a form of 'reversed accountability' of women towards global maternal health goals. This can negatively impact on women's reproductive health rights and obstruct ambitions to achieve gender inequality and health equity. Contextualised gender and power analysis in health policymaking and programming as well as in accountability reforms could help to identify these challenges and potential unintended effects.

Project description:BackgroundAfrican countries leveraged testing capacities to enhance public health action in response to the COVID-19 pandemic. This paper describes experiences and lessons learned during the improvement of testing capacity throughout the COVID-19 response in Senegal, Uganda, Nigeria, and the Democratic Republic of the Congo (DRC).MethodsThe four countries' testing strategies were studied using a mixed-methods approach. Desk research on COVID-19 testing strategies was conducted and complemented by interviewing key informants. The findings were synthesized to demonstrate learning outcomes across the four countries.ResultsThe four countries demonstrated severely limited testing capacities at the onset of the pandemic. These countries decentralized COVID-19 testing services by leveraging preexisting laboratory systems such as PCR and GeneXpert used for the diagnosis of tuberculosis (TB) to address this gap and the related inequities, engaging the private sector, establishing new laboratories, and using rapid diagnostic tests (RDTs) to expand testing capacity and reduce the turnaround time (TAT). The use of digital platforms improved the TAT. Testing supplies were sourced through partners, although access to global markets was challenging. Case detection remains suboptimal due to high costs, restrictive testing strategies, testing access challenges, and misinformation, which hinder the demand for testing. The TAT for PCR remained a challenge, while RDT use was underreported, although Senegal manufactured RDTs locally. Key findings indicate that regionally coordinated procurement and manufacturing mechanisms are required, that testing modalities must be simplified for improved access, and that the risk-based testing strategy limits comprehensive understanding of the disease burden.ConclusionAlthough testing capacities improved significantly during the pandemic, case detection and access to testing remained suboptimal. The four countries could benefit from further simplification of testing modalities and cost reduction. Local manufacturing and pooled procurement mechanisms for diagnostics are needed for optimal pandemic preparedness and response.

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Does Federalism Prevent Democratic Accountability? Assigning Responsibility for Rates of COVID-19 Testing

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