Governance and Capacity to Manage Resilience of Health Systems: Towards a New Conceptual Framework.
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ABSTRACT:
SUBMITTER: Blanchet K
PROVIDER: S-EPMC5553211 | biostudies-other | 2017 Apr
REPOSITORIES: biostudies-other
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Project description:BACKGROUND:Health research has scientific, social and political impacts. To achieve such impacts, several institutions need to participate; however, health research funding institutions are seldom nominated in the literature as essential players. The attention they have received has so far focused mainly on their role in knowledge translation, informing policy-making and the need to organise health research systems. In this article, we will focus solely on the governance of national health research funding institutions. Our objectives are to identify the main functions of governance for such institutions and actionable governance functions. This research should be useful in several ways, including in highlighting, tracking and measuring the governance trends in a given funding institution, and to forestall low-level governance. METHODS:First, we reviewed existing frameworks in the grey literature, selecting seven relevant documents. Second, we developed an integrated framework for health research funding institution governance and management. Third, we extracted actionable information for governance by selecting a mix of North American, European and Asian institutions that had documentation available in English (e.g. annual report, legal status, strategy). RESULTS:The framework contains 13 functions - 5 dedicated to governance (intelligence acquisition, resourcing and instrumentation, relationships management, accountability and performance, and strategy formulation), 3 dedicated to management (priority-setting, financing and knowledge transfer), and 5 dedicated to transversal logics that apply to both governance and management (ethics, transparency, capacity reinforcement, monitoring and evaluation, and public engagement). CONCLUSIONS:Herein, we provide a conceptual contribution for scholars in the field of governance and health research as well as a practical contribution, with actionable functions for high-level managers in charge of the governance of health research funding institutions.
| S-EPMC7029568 | biostudies-literature
Project description:BackgroundGrowing interest in public involvement in health research has led to organisational and policy change. Additionally, an emerging body of policy-oriented scholarship has begun to identify the organisational and network arrangements that shape public involvement activity. Such developments suggest the need to clearly conceptualise and characterise public involvement in health research in terms of governance.MethodsWe drew on an established health research system framework to analyse governance functions related to public involvement, adapting scoping review methods to identify evidence from a corpus of journal papers and policy reports. We drew on the logics of aggregation and top down configuration, using a qualitative interpretive approach to combine and link findings from different studies into framework categories.ResultsWe identified a total of 32 scholarly papers and 13 policy reports (n = 45 included papers) with relevance to governance for public involvement. Included papers were broadly consonant in identifying the need for activity to specify and support public involvement across all four governance functions of stewardship, financing, creating and sustaining resources, and research production and use. However, different visions for public involvement, and the activity required to implement it and achieve impact, were particularly evident with respect to the stewardship function, which seeks to set overall directions for research while addressing the potentially competing demands of a system's many constituents.ConclusionsA governance perspective has considerable value for public involvement in health research systems, supporting efforts to coordinate and institutionalise the burgeoning public involvement enterprise. Furthermore, it highlights challenges for what is, ultimately, a highly political intervention, suggesting that diverse publics must be both involved within health research systems and enrolled as governors of them.
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Project description:While the quantity of sustainability governance initiatives and systems has increased dramatically, crises persist over whether specific governance systems can be trusted as legitimate regulators of the sustainability of economic activities. This paper focuses on conceptual tools to improve our understanding of these crises as well as the facilitating factors and barriers for sustainability governance to play a role in transitioning to profoundly more sustainable societies than those that currently exist. Bioenergy is used throughout the paper as an example to aid contextually in understanding the theoretical and abstract arguments. We first define eight premises upon which our argumentation is developed. We then define sustainability, sustainability transition, legitimacy, and trust as a premise for obtaining effectiveness in communication and minimising risks associated with misunderstanding key terms. We proceed to examine the literature on "good governance" in order to reflect upon what defines "good sustainability governance" and what makes governance systems successful in achieving their goals. We propose input, output, and throughput legitimacy as three principles constituting "good" sustainability governance and propose associated open-ended criteria as a basis for developing operational standards for assessing the quality of a sustainability governance system or complex. As sustainability governance systems must develop to remain relevant, we also suggest an adaptive governance model, where continuous re-evaluation of the sustainability governance system design supports the system in remaining "good" in conditions that are complex and dynamic. Finally, we pull from the literature in a broad range of sciences to propose a conceptual "governance research framework" that aims to facilitate an integrated understanding of how the design of sustainability governance systems influences the legitimacy and trust granted to them by relevant actors. The framework is intended to enhance the adaptive features of sustainability governance systems so as to allow the identification of the causes of existing and emerging sustainability governance crises and finding solutions to them. Knowledge generated from its use may form a basis for providing policy recommendations on how to practically solve complex legitimacy and trust crises related to sustainability governance.Supplementary informationThe online version contains supplementary material available at 10.1186/s13705-021-00280-x.
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Project description:BACKGROUND:With the 40th anniversary of the Declaration of Alma-Ata, a global effort is underway to re-focus on strengthening primary health care systems, with emphasis on leveraging community health workers (CHWs) towards the goal of achieving universal health coverage for all. Institutionalizing effective, sustainable community health systems is currently limited by a lack of standard metrics for measuring CHW performance and the systems they work within. Developed through iterative consultations, supported by the Bill & Melinda Gates Foundation and in partnership with USAID and UNICEF, this paper details a framework, list of indicators, and measurement considerations for monitoring CHW performance in low- and middle-income countries. METHODS:A review of peer-reviewed articles, reports, and global data collection tools was conducted to identify key measurement domains in monitoring CHW performance. Three consultations were successively convened with global stakeholders, community health implementers, advocates, measurement experts, and Ministry of Health representatives using a modified Delphi approach to build consensus on priority indicators. During this process, a structured, web-based survey was administered to identify the importance and value of specific measurement domains, sub-domains, and indicators determined through the literature reviews and initial stakeholder consultations. Indicators with more than 75% support from participants were further refined with expert qualitative input. RESULTS:Twenty-one sub-domains for measurement were identified including measurement of incentives for CHWs, supervision and performance appraisal, data use, data reporting, service delivery, quality of services, CHW absenteeism and attrition, community use of services, experience of services, referral/counter-referral, credibility/trust, and programmatic costs. Forty-six indicators were agreed upon to measure the sub-domains. In the absence of complete population enumeration and digitized health information systems, the quality of metrics to monitor CHW programs is limited. CONCLUSIONS:Better data collection approaches at the community level are needed to strengthen management of CHW programs and community health systems. The proposed list of metrics balances exhaustive and pragmatic measurement of CHW performance within primary healthcare systems. Adoption of the proposed framework and associated indicators by CHW program implementors may improve programmatic effectiveness, strengthen their accountability to national community health systems, drive programmatic quality improvement, and plausibly improve the impact of these programs.
| S-EPMC6868857 | biostudies-literature
Project description:This article proposes a conceptual and methodological framework for analyzing agroecosystem resilience, in which aspects such as agrarian structure and peasant community agency are included as determining factors. The methodology is applied to a comparison of two peasant communities in Latin America (Brazil and Colombia), emphasizing the capacity to transform unsustainable power structures in place of adapting to them. We find that when agrarian structure is more equitable and peasant agency is strongly developed through political formation, organization and women's participation, then there is a greater construction of resilience that improves peasant livelihoods and dignity. This application demonstrates that when agency is strongly developed, as in the case of Brazil, it is possible to transform structural conditions that restrict resilience. The inclusion and consideration of biophysical variables, management practices, agrarian structure and agency, through a participatory approach, allows for the identification of factors that inhibit or potentiate the resilience of agroecosystems.
| S-EPMC7176124 | biostudies-literature
Project description:BackgroundResearch ethics is intertwined with and depends on building robust and responsive research governance systems alongside researchers. Globally there has been substantial investment in agriculture, nutrition, and health (ANH) research motivated by the need to improve health outcomes, such as micronutrient deficiencies in Sub-Saharan Africa. Although there has been a notable focus on ethical issues inherent in ANH studies, there has been scanty research examining researchers' attitudes related to ANH research. This study was conducted to explore the perspectives of researchers who conducted an agronomic biofortification study in Malawi.MethodologyIn-depth interviews were conducted with a purposive sample of ten ANH researchers. Interviews were conducted online via Zoom, audio-recorded, transcribed verbatim, and thematically analysed using the Leadership, Ethics, Governance and Systems Framework.ResultsFour core aspects emerged: Leadership: The relevance of building ethics leadership and ethical competence among researchers.EthicsThere is a need to develop a framework that operationalises core ethical values that can guide the implementation of ANH research. Governance: Research guidelines were perceived to be too generic to guide ANH research. Systems: Researchers' recommended the establishment of a specialised ANH research ethics committee.ConclusionsThe findings highlight the significance of building ethics leadership and supporting ethical competency amongst researchers. Researchers recommended the development of tailored approaches rather than utilising generic governance systems and frameworks that are drawn from medical research and thus not fit for purpose in this field. In Malawi, specialised ethics review committees are needed to guide ANH research.
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Project description:BackgroundPublic health programs can only deliver benefits if they are able to sustain activities over time. There is a broad literature on program sustainability in public health, but it is fragmented and there is a lack of consensus on core constructs. The purpose of this paper is to present a new conceptual framework for program sustainability in public health.MethodsThis developmental study uses a comprehensive literature review, input from an expert panel, and the results of concept-mapping to identify the core domains of a conceptual framework for public health program capacity for sustainability. The concept-mapping process included three types of participants (scientists, funders, and practitioners) from several public health areas (e.g., tobacco control, heart disease and stroke, physical activity and nutrition, and injury prevention).ResultsThe literature review identified 85 relevant studies focusing on program sustainability in public health. Most of the papers described empirical studies of prevention-oriented programs aimed at the community level. The concept-mapping process identified nine core domains that affect a program's capacity for sustainability: Political Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Public Health Impacts, and Strategic Planning. Concept-mapping participants further identified 93 items across these domains that have strong face validity-89% of the individual items composing the framework had specific support in the sustainability literature.ConclusionsThe sustainability framework presented here suggests that a number of selected factors may be related to a program's ability to sustain its activities and benefits over time. These factors have been discussed in the literature, but this framework synthesizes and combines the factors and suggests how they may be interrelated with one another. The framework presents domains for public health decision makers to consider when developing and implementing prevention and intervention programs. The sustainability framework will be useful for public health decision makers, program managers, program evaluators, and dissemination and implementation researchers.
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Project description:Purpose:Population ageing has been steadily rising in Iran and in the over 60-year-old population, the ratio increased from 5.4% in 1986 to 8.6% in 2016 which represents an increase of 4.3 million over the past three decades. The inevitable impacts of a growing elderly population on the demand-side of the health care provision (HCP) equilibrium call for an urgent revision of the current arrangements of the Iran's National health care system (INHS). The main aim of this study was to scrutinize the best available scientific evidence on the international integrated elderly health care governance (HCG) models to revamp health care practice and policy-making processes in Iran. Materials and Methods:This multiphasic study consists of a scoping review of existent HCP modalities for the elderly population worldwide, and the disposition of an optimal HCP scheme for the elderly population and its application for the detection of the gaps in Iran. The final stage includes a Delphi-based consultation and consensus process which was reciprocated in three rounds and the key subjects were requested to give their judgment on the eventuated HCP layout designed to serve the ageing Iranian population. Results:The yielded model (IEHCG-IR) included four dimensions consistent with the four levels of prevention along with social support services. The structure and feasibility of the preliminary framework were approved by 83.6% of the study participants. Conclusion:The study findings could have important implications for future policy making in the INHS and the suggested healthcare framework for the elderly Iranian population could be a preliminary model for health system re-engineering.
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Project description:Over the past century, the environment of the Gulf of Mexico has been significantly altered and impaired by extensive human activities. A national commitment to restore the Gulf was finally initiated in response to the unprecedented Deepwater Horizon oil spill in 2010. Consequently, there is a critical need for an assessment framework and associated set of indicators that can characterize the health and sustainability of an ecosystem having the scale and complexity of the Gulf. The assessment framework presented here was developed as an integration of previous ecological risk- and environmental management-based frameworks for assessing ecosystem health. It was designed to identify the natural and anthropogenic drivers, pressures, and stressors impinging on ecosystems and ecosystem services, and the ecological conditions that result, manifested as effects on valued ecosystem components. Four types of societal and ecological responses are identified: reduction of pressures and stressors, remediation of existing stressors, active ecosystem restoration, and natural ecological recovery. From this conceptual framework are derived the specific indicators to characterize ecological condition and progress toward achieving defined ecological health and sustainability goals. Additionally, the framework incorporates a hierarchical structure to communicate results to a diversity of audiences, from research scientists to environmental managers and decision makers, with the level of detail or aggregation appropriate for each targeted audience. Two proof-of-concept studies were conducted to test this integrated assessment and decision framework, a prototype Texas Coastal Ecosystems Report Card, and a pilot study on enhancing rookery islands in the Mission-Aransas Reserve, Texas, USA. This Drivers-Pressures-Stressors-Condition-Responses (DPSCR4 ) conceptual framework is a comprehensive conceptual model of the coupled human-ecological system. Much like its predecessor, the ecological risk assessment framework, the DPSCR4 conceptual framework can be tailored to different scales of complexity, different ecosystem types with different stress regimes, and different environmental settings. Integr Environ Assess Manag 2019;15:544-564. © 2019 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).
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Project description:Studies of small-scale, self-organized social-ecological systems have contributed to our understanding of successful governance of shared resources. However, the lack of formal analytically tractable models of such coupled infrastructure systems makes it difficult to connect this understanding to such concepts as stability, robustness, and resilience, which are increasingly important in considering such systems. In this paper, we mathematically operationalize a widely used conceptual framework via a stylized dynamical model. The model yields a wide range of system outcomes: sustainability or collapse, infrastructure at full or partial capacity, and social agents seeking outside opportunities or exclusively engaging in the system. The low dimensionality of the model enables us to derive these conditions in clear relationships of biophysical and social factors describing the coupled system. Analysis of the model further reveals regime shifts, trade-offs, and potential pitfalls that one may face in governing these self-organized systems. The intuition and insights derived from the model lay ground for more rigorous treatment of robustness and resilience of self-organized coupled infrastructure systems, which can lead to more effective governance.
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