COVID-19 pandemic in Bangladesh: A scoping review of governance issues affecting response in public sector

Background

On January 30, 2020, WHO declared COVID-19 as a Global Public Health Emergency. The first three COVID-19 cases in Bangladesh were confirmed on March 8, 2020. Thus, Bangladesh got substantial time to prepare the people and the health systems to respond to the outbreak However, neither the health ministry nor the government was found to rise to the occasion and provide the necessary stewardship for a coordinated and comprehensive response.

Objective

The importance of governance to mount an evidence-based pandemic response cannot be overemphasised. This study presents critical reflections on the Bangladesh government's COVID-19 response through a review of selected papers, with expert deliberations on the review findings to consolidate emerging lessons for future pandemic preparedness.

Study design

A scoping review approach was taken for this study.

Methods

Documents focusing on COVID-19 governance were selected from a repository of peer-reviewed articles published by researchers using data from Bangladesh (n = 11).

Results

Findings reveal Bangladesh's COVID-19 response to be delayed, slow, and ambiguous, reflecting poorly on its governance. Lack of governance capability in screening for COVID-19, instituting quarantine and lockdown measures in the early weeks, safety and security of frontline healthcare providers, timely and equitable COVID-19 testing, and logistics and procurement were phenomenal. The pandemic unmasked the weaknesses of the health system in this regard and "created new opportunities for corruption." The failure to harmonise coordination among the government's different agencies for the COVID-19 response, along with poor risk communication, which was not culture-sensitive and context-specific. Over time, the government initiated necessary actions to mitigate the pandemic's impact on the lives and livelihoods of the people. Diagnostic and case management services gained strength after some initial faltering; however, the stewardship functions were not seamless.

Conclusions

Shortage of healthcare workers, incapability of health facilities to cater to COVID-19 suspects and cases, absence of health system resilience, and corruption in procurement and purchases were limited the government's COVID-19 response. These need urgent attention from policymakers to better prepare for the next epidemic/pandemic.

Black box no more: A cross-sectional multi-disciplinary survey for exploring governance and guiding adoption of AI in medical imaging and radiotherapy in the UK

BACKGROUND

Medical Imaging and radiotherapy (MIRT) are at the forefront of artificial intelligence applications. The exponential increase of these applications has made governance frameworks necessary to uphold safe and effective clinical adoption. There is little information about how healthcare practitioners in MIRT in the UK use AI tools, their governance and associated challenges, opportunities and priorities for the future.

METHODS

This cross-sectional survey was open from November to December 2022 to MIRT professionals who had knowledge or made use of AI tools, as an attempt to map out current policy and practice and to identify future needs. The survey was electronically distributed to the participants. Statistical analysis included descriptive statistics and inferential statistics on the SPSS statistical software. Content analysis was employed for the open-ended questions.

RESULTS

Among the 245 responses, the following were emphasised as central to AI adoption: governance frameworks, practitioner training, leadership, and teamwork within the AI ecosystem. Prior training was strongly correlated with increased knowledge about AI tools and frameworks. However, knowledge of related frameworks remained low, with different professionals showing different affinity to certain frameworks related to their respective roles. Common challenges and opportunities of AI adoption were also highlighted, with recommendations for future practice.

Health literacy, governance and systems leadership contribute to the implementation of the One Health approach: a virtuous circle

One Health is an important approach to addressing health threats and promoting health through interdisciplinary health, policy, legislation and leadership research to achieve better human and animal health and better outcomes for the planet. The Covid-19 pandemic has triggered an urgent awareness of the need to develop innovative integrative solutions to address root causes of such threats to health, which requires collaboration across disciplines and amongst different sectors and communities. We explore how achieving the Quadripartite Organizations' One Health Joint Plan of Action can be supported by the concepts of 'One Health literacy' and 'One Health governance' and promote both academic and policy dialogue. We show how One Health literacy and One Health governance influence and reinforce each other, while an interdisciplinary systems leadership approach acts as a catalyst and mechanism for understanding and enacting change. Based on our understanding of how these elements influence the implementation of the One Health approach, we describe a model for considering how external triggering events such as the Covid-19 pandemic may prompt a virtuous circle whereby exposure to and exploration of One Health issues may lead to improved One Health literacy and to better governance. We close with recommendations to international organisations, national governments and to leaders in policy, research and practice to enhance their influence on society, the planetary environment, health and well-being.

Geospatial mapping of carbon estimates for forested areas using the InVEST model and Sentinel-2: A case study in Galicia (NW Spain)

CO2 emissions have increased exponentially in recent years, so measuring and quantifying carbon sequestration is a step towards sustainable forest management and combating climate change. The overall goal of this study is to develop an accurate model for estimating carbon storage and sequestration for forest areas of the Atlantic Biogeographic Region. Specifically, the modelling and field sampling are carried out in the municipality of Baiona (Galicia, NW Spain), which was selected as a representative biome of this region. The methodology consists of carrying out two object-based image analysis (OBIA) classifications in spring and autumn to observe possible stocks of seasonal differences. Two carbon storage and sequestration models are built up (model 1 and model 2): model 1 for forest areas only and model 2 including all other land cover in the study area. Sentinel-2 geospatial data for 2021, Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) tools and geographic information systems (GIS) are used. A Kappa index of 0.92 is obtained for both classifications, thus ruling out any notable seasonal differences in the images used. The results from both models indicate that it is land covers associated with forest uses which store the most carbon in the study area, accounting for >50 % more than the other land covers. It is concluded that the methodology and data used are very useful for quantifying ecosystem services, which will help the governance of the region by implementing measures to mitigate some of the effects of climate change and help to create silvicultural models for the sustainable management of the Atlantic Biogeographic Region.

Understanding Water Governance in the Central Rift Valley of Ethiopia: Governance Framework, Coherence and Practices

Water governance demands multi-sector participation beyond the state; and, appropriate laws, policies, regulations, and institutions need to be developed and put in place for sustainable use of water resources. A good water policy, a critical and integral instrument of water governance, guides water use schemes and ensures equitable water distribution among users. The Ethiopian Central Rift Valley (CRV) is rich in water resources, but these water resources are currently under severe strain owing to an imbalance in human-water interactions. This study examined the state of water resources governance framework, policy coherence, actors' engagement and transparency, accountability, and participation in irrigation water supply in the CRV of Ethiopia. Key informant interviews (KII), focused group discussions, and document reviews were used to gather data for the study. The NVivo 11 program was used to organize, code, and analyze the data. The results revealed that water resources governance practices such as water allocation and apportionment, water resources protection, and conservation activities were inappropriately exercised. Water resources management policy mechanisms were not fully put in place. Lack of coherence in water policy implementation, absence of clear roles and responsibilities of stakeholders, absence of transparency and accountability in irrigation water service delivery, and lack of meaningful participation of key actors in water governance decision-making were observed. As a result, over-abstraction, deterioration of buffer zone areas, and chemical erosion from surrounding farming are attributed to the reduction in water volume and quality in the CRV. These challenges have influenced aquatic ecosystem services and threaten the livelihoods of the surrounding communities. Hence, reforms relating to policy coherence and enforcement, stakeholder engagement, water distribution strategies, and the implementation of water governance principles must be given adequate emphasis.

The role of green finance and governance effectiveness in the impact of renewable energy investment on CO2 emissions in BRICS economies

In the context of sustainable development, this study investigates the intricate dynamics among good governance, renewable energy investment, and green finance in BRICS nations. The aim of the study is to assess how green finance and governance effectiveness moderate the impact of renewable energy investment on CO2 emissions. Utilizing the Cross-Sectional Autoregressive Distributed Lag (CS-ARDL) model, a meticulous analysis spanning two decades was conducted to unravel the relationships among key variables and CO2 emissions. The findings underscore a nuanced interplay where renewable energy investments, synergized with robust governance and strategic green finance, significantly mitigate CO2 emissions, contributing to sustainable economic development. However, the study reveals non-linear relationships, highlighting the necessity for optimal allocation and strategic planning to maximize environmental benefits. In the short-run, a government effectiveness policy threshold that should be attained in order for renewable energy investment to reduce CO2 emissions is provided. In the long-run, the negative responsiveness of CO2 emissions to renewable energy investment is further consolidated by green finance. Moreover, enhancing renewable energy investment in the long run is positive for environmental sustainability. It follows that policy makers should tailor policies aimed at enhancing renewable energy investment in the long-run as well as complementing renewable energy investment with green finance in the long-run in order to ensure environmental sustainability by means of reducing CO2 emissions. Policymakers in BRICS nations are urged to strengthen governance structures, promote renewable energy investments, leverage green finance, foster public-private partnerships, adopt a holistic approach, and address non-linear effects to accelerate the transition to a low-carbon economy.

Mismanaged plastic waste and the environmental Kuznets curve: A quantile regression analysis

The relationship between economic growth, governance, and environmental outcomes, particularly mismanaged plastic waste (MPW) leaking out to the ocean, has been a focal point of policy and academic debates. This study aims to understand the dynamics of income and control of corruption across different levels of MPW. Utilizing Quantile Regression models, we explore the generalized and quantile-specific relationships between the variables. The findings confirm the validity of the Environmental Kuznets Curve (EKC), revealing an initial increase in MPW with economic growth, followed by a decline after surpassing a specific economic threshold. However, the EKC is not validated for all quantiles and the shifting point may vary across the distribution. Moreover, control of corruption emerged as a significant factor in determining MPW levels, emphasizing its moderating role at the highest levels of mismanagement. This study underscores the need for synergizing economic strategies with robust environmental policies, guided by strong governance mechanisms.

Identifying leverage points for sustainable nutrient policy integration in Canada

Addressing the 'wicked problem' of nutrient pollution requires coordinated policies spanning across diverse sectors and environmental systems. Using a case study of Canadian legislation, we apply semantic network analysis to identify thematic links across an inventory of 245 nutrient-related policies. Our analysis identifies twelve topics with unique types of connections across multiple facets of Canadian society. 'Hub' policies include broad environmental protection, land use planning, and climate-related legislation with close ties to multiple other topics. 'Bridge' policies create connections among otherwise disconnected topics in the network, representing opportunities to inform new policy proposals. Some legislation, such as food processing regulations, indirectly relates to nutrient use but could inform policy integration towards more coordinated and holistic nutrient management across the food system. A computational text network approach can be useful for addressing challenges in complex policy analysis, including by identifying unique entry points to guide more cross-cutting nutrient policy development.

Global panel data on World governance and state fragility from 2006 to 2022

This global panel dataset contains information collected from two different sources (The Fund for Peace and World Bank), on the governance and stability levels of 178 countries between 2006 and 2022. The dataset includes information on 1) Cohesion (security apparatus (C1), factionalized elites (C2), and group grievance (C3)), 2) Economic (economy (E1), economic inequality (E2), and human flight and brain drain (E3)), 3) Political (state legitimacy (P1), public services (P2), and human rights (P3)) indicators, 4) Social and cross-cutting (demographic pressures (S1), refugees and internally displaced persons (S2), and external intervention (X1)), and 5) Governance (voice and accountability (G1), political stability and absence of violence/terrorism (G2), government effectiveness (G3), regulatory quality (G4), rule of law (G5), and control of corruption (G6)). Data analysis was carried out using SPSS version 29 software to ensure a complete description of the data (labels, type and measure of variables, and uniformity of decimals), as well as the imputation possibility of missing data, which will allow future researchers to study both cross-sectional and longitudinal relationships between the five types of indicators and the eighteen indicators reported.

Why does a public health issue (not) get priority? Agenda-setting for the national burns program in India

There is growing scholarly interest in what leads to global or national prioritisation of specific health issues. By retrospectively analysing agenda-setting for India's national burn program, this study aimed to better understand how the agenda-setting process influenced its design, implementation, and performance. We conducted document review and key informant interview with stakeholders and used a combination of analytical frameworks on policy prioritisation and issue framing for analysis. The READ (Readying material, Extracting data, Analysing data and Distilling findings) approach was used for document reviews, and qualitative thematic analysis was used for coding and analysis of documents and interviews. The findings suggest three critical features of burns care policy prioritisation in India: challenges of issue characteristics, divergent portrayal of ideas and its framing as a social and/or health issue, and over-centralisation of agenda setting. First, lack of credible indicators on the magnitude of the problem and evidence on interventions limited issue framing, advocacy, and agenda-setting. Second, the policy response to burns has two dimensions in India: response to gender-based intentional injuries and the healthcare response. While intentional burns have received policy attention, the healthcare response was limited until the national program was initiated in 2010 and scaled up in 2014. Third, over-centralisation of agenda setting (dominated by a few homogenous actors, located in the national capital, with attention focussed on the national ministry of health) contributed to limitations in program design and implementation. We note following elements to consider when analysing issues of significant burden but limited priority: the need to analyse how actors influence issue framing, the particularities of issues, the inadequacy of any one dominant frame, and the limited intersection of frames. Based on this analysis in India, we recommend a decentralised approach to agenda setting and for the design and implementation of national programs from the outset.

Trauma systems in high socioeconomic index countries in 2050

Considerable political, structural, environmental and epidemiological change will affect high socioeconomic index (SDI) countries over the next 25 years. These changes will impact healthcare provision and consequently trauma systems. This review attempts to anticipate the potential impact on trauma systems and how they could adapt to meet the changing priorities. The first section describes possible epidemiological trajectories. A second section exposes existing governance and funding challenges, how these can be met, and the need to incorporate data and information science into a learning and adaptive trauma system. The last section suggests an international harmonization of trauma education to improve care standards, optimize immediate and long-term patient needs and enhance disaster preparedness and crisis resilience. By demonstrating their capacity for adaptation, trauma systems can play a leading role in the transformation of care systems to tackle future health challenges.

Improving strategic planning for nature: Panacea or pandora's box for the built and natural environment?

This paper assesses how strategic planning for nature can be improved for England's built and natural environment using mainstreaming and landscape-scale concepts. Whilst both concepts feature in academic literature, there has been limited attention on their role as catalytic agents for strategic planning. Addressing this gap, evidence is used from two stakeholder workshops involving 62 senior policy experts managing a range of operational and hypothetical strategic spatial planning challenges. The results reveal a significantly weakened strategic planning arena characterised by policy disintegration, short termism and uncertainty. Key findings highlight the fallacy of pursuing strategic planning for nature in isolation from wider policy integration fusing environmental, economic and social components from the outset. Current barriers to progress include institutional inertia, technocratic vocabularies and neoliberalist priorities exacerbated by a weak underlying theory. Conversely opportunities for mainstreaming processes may help knowledge generation and exchange within transdisciplinary partnerships, whilst landscape scale thinking can improve understanding of issues using natures inherent geometry transforming processes and outcomes. The paper recommends the adoption of strategic planning pathways using mainstreaming and landscape-scale approaches working in tandem. Whilst focused on the English context, our findings are transferable to other planning systems in the Global North, especially those championing neoliberal market led policies.

Remittance inflows and financial development in Sub-Saharan African countries: Does governance matter?

Background

The surge in remittances in most sub-Saharan African countries motivated this study to establish whether remittance inflows enhance financial development and whether governance plays any significant mediating role in the nexus between financial development and remittance inflows.

Purpose

The study examines the impact of remittance inflows on bank-based financial development in 26 sub-Saharan African (SSA) countries using three proxies of bank-based financial development. The study also examines whether government regulatory quality and effectiveness modulate the impact of remittance on bank-based financial development.

Method

The generalised method of moments (GMM) estimation technique is used to examine this linkage.

Results

The results show that when financial development is proxied by liquid liabilities and bank deposits, remittance inflow is found to have an unconditional positive impact on bank-based financial development, while governance is found to reinforce the positive relationship between remittance and financial development. However, when financial development is proxied by deposit money bank assets, remittance is found to have no profound effect on bank-based financial development, but it was found to interact with government effectiveness to yield a positive influence on financial development.

Conclusion

Overall, remittance inflows were found to have an overwhelming positive impact on the banking sector development. It was also found that good governance generally tends to reinforce the positive impact of remittances on banking sector development.

Novelty

This study adds value to the extant literature by providing answers to the role that governance plays in enhancing the impact of remittances on financial development in sub-Saharan African countries.

Development of an evidence-informed governance and stewardship framework for elderly healthcare in Iran: A qualitative study

Background

The ageing population poses significant challenges to healthcare systems, necessitating the establishment of high-functioning, integrated frameworks for elderly healthcare. This study aimed to explore the key challenges associated with the stewardship of elderly care in Iran and to develop a holistic stewardship framework.

Methods

For this qualitative study, thirty semi-structured interviews were conducted with key Iranian healthcare stakeholders, utilizing purposive and snowball sampling during 2021-2022. Inductive open coding was utilized to generate new concepts related to key stewardship challenges. The World Health Organization's conceptual framework, outlining the three stewardship tasks, served as the basis for crafting a tailored framework for elderly healthcare stewardship in Iran.

Results

Fourteen main challenges and 38 sub-challenges were identified for elderly healthcare stewardship in Iran, categorized according to the WHO framework's three stewardship tasks. Challenges related to WHO stewardship task 1, involving health policy formulation and vision definition, included challenges in vision definition, planning, policymaking, and intergovernmental institutional superiority. Challenges related to WHO stewardship task 2, delineating governance and stewardship through control and regulation, encompassed issues such as support for the elderly, system responsiveness, behavior of healthcare providers, organizational structure, and cross-sectoral leadership challenges. Challenges associated with WHO stewardship task 3, about the use of collective intelligence, explored stakeholder collaboration, information for decision-making, and challenges within the elderly information system, covering data documentation, reporting, analysis, accessibility, distribution, and circulation. Subsequently, a framework was developed, covering areas like defining the vision and direction of health policy, managing information systems, evidence-informed policymaking, and delivering elderly health services with a holistic approach.

Conclusion

The present framework shows how a management information system, guided by evidenced-informed policymaking and the formulation of customized health policies, can facilitate the provision of elderly health services based on identified needs. It presents a governance and stewardship pathway that can be adopted by Iranian health policymakers and similar middle-income countries facing analogous challenges in ageing and aged care system stewardship, serving as a model for developing their own frameworks.

Exploring cross-boundary collaboration for youth mental health in Sweden - a qualitative study using the integrative framework for collaborative governance

BACKGROUND

Youth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system.

METHODS

We conducted 42 interviews (November 2020 to March 2022) with health and social care professionals and managers in the youth mental health system in Sweden. Interviews explored participants' experience and understanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergent study design using reflexive thematic analysis.

RESULTS

The analysis produced three themes. The first shows that collaboration is considered as essential and important, and that it serves diverse purposes and holds multiple meanings in relation to professionals' roles and responsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, and target levels, and the third captures the challenges and criticisms in collaborating across the youth mental health landscape, but also in growing possibilities for future development.

CONCLUSION

We conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system.

The use of private regulatory measures to create healthy food retail environments: a scoping review

OBJECTIVE

Different forms of public and private regulation have been used to improve the healthiness of food retail environments. The aim of this scoping review was to systematically examine the types of private regulatory measures used to create healthy food retail environments, the reporting of the processes of implementation, monitoring, review and enforcement and the barriers to and enablers of these.

DESIGN

Scoping review using the Johanna Briggs Institute guidelines. Ovid MEDLINE, PsycINFO, Embase, CINAHL Plus, Business Source Complete and Scopus databases were searched in October 2020 and again in September 2023 using terms for 'food retail', 'regulation' and 'nutrition'. Regulatory measure type was described by domain and mechanism. Deductive thematic analysis was used to identify reported barriers and enablers to effective regulatory governance processes using a public health law framework.

SETTING

Food retail.

PARTICIPANTS

Food retail settings using private regulatory measures to create healthier food retail environments.

RESULTS

In total, 17 694 articles were screened and thirty-five included for review from six countries, with all articles published since 2011. Articles reporting on twenty-six unique private regulatory measures cited a mix of voluntary (n 16), mandatory (n 6) measures, both (n 2) or did not disclose (n 2). Articles frequently reported on implementation (34/35), with less reporting on the other regulatory governance processes of monitoring (15/35), review (6/35) and enforcement (2/35).

CONCLUSIONS

We recommend more attention be paid to reporting on the monitoring, review and enforcement processes used in private regulation to promote further progress in improving the healthiness of food retail environments.

Governance models for historical hospitals: evidence from Italy

Many hospitals and health care organizations over the centuries have inherited handcrafts of artistic value, objects of worships, donations from pilgrims, votive offerings, legates as a result of their centuries-old activity in the social and health care of their community. The value of these artistic assets and the role in the territory of these hospitals have transformed them into cultural heritage over time, introducing the issue of the coexistence of cultural and care management. Therefore, the aim of this paper is to identify governance models of what we will call historical hospitals, that is, hospitals that because of their history, their assets, and their artistic heritage, far from being places only dedicated to provision of health care services represent cultural heritage. To pursue this research objective, five Italian historical hospitals were selected and identified as significant case studies for their historic and artistic relevance. Through the analysis of these case studies the paper identifies models of governance of historical hospitals and the reasons of their adoption.

Balancing growth targets and environmental regulations: An empirical analysis of dual policy impact on corporate environmental responsibility-insights from China

Balancing economic growth with environmental conservation poses a universal challenge for governments worldwide. This study investigates the intricate interplay between governments' economic-environmental trade-offs and their implementation of policies aimed at promoting Corporate Environmental Responsibility (CER). Given the discretion of Chinese local governments in economic and environmental policy, we take China as a case study. To conduct this research, we first merge critical data on China's economic growth targets and environmental regulations with information on listed enterprises. Then, we employ a "U-shaped" relationship model to examine the impact of these trade-offs on CER implementation. The results reveal that: (1)The effective fulfillment of CER by enterprises is primarily driven by stricter environmental regulations. (2) Economic growth targets can, to some extent, diminish the policy effect of environmental regulations on CER fulfillment. (3)The crowding-out effect of economic growth targets is particularly pronounced within specific subsets of enterprises, including state-owned enterprises, heavily polluting firms, and those facing high profit pressure. These findings imply that when local governments implement contradictory policies, they must consider not only enterprises' political connections and economic contributions but also pay close attention to the survival dilemma of enterprises. This balancing act aims to harmonize conflicting policy objectives. This research deepens the understanding of how institutional and policy frameworks impact enterprise engagement in CER, especially within the context of governments' economic-environmental trade-offs. It sheds light on the strategies employed by China and other emerging economies to effectively leverage contradictory policies to foster sustainable green growth.

AI implementation in the UK landscape: Knowledge of AI governance, perceived challenges and opportunities, and ways forward for radiographers

INTRODUCTION

Despite the rapid increase of AI-enabled applications deployed in clinical practice, many challenges exist around AI implementation, including the clarity of governance frameworks, usability of validation of AI models, and customisation of training for radiographers. This study aimed to explore the perceptions of diagnostic and therapeutic radiographers, with existing theoretical and/or practical knowledge of AI, on issues of relevance to the field, such as AI implementation, including knowledge of AI governance and procurement, perceptions about enablers and challenges and future priorities for AI adoption.

METHODS

An online survey was designed and distributed to UK-based qualified radiographers who work in medical imaging and/or radiotherapy and have some previous theoretical and/or practical knowledge of working with AI. Participants were recruited through the researchers' professional networks on social media with support from the AI advisory group of the Society and College of Radiographers. Survey questions related to AI training/education, knowledge of AI governance frameworks, data privacy procedures, AI implementation considerations, and priorities for AI adoption. Descriptive statistics were employed to analyse the data, and chi-square tests were used to explore significant relationships between variables.

RESULTS

In total, 88 valid responses were received. Most radiographers (56.6 %) had not received any AI-related training. Also, although approximately 63 % of them used an evaluation framework to assess AI models' performance before implementation, many (36.9 %) were still unsure about suitable evaluation methods. Radiographers requested clearer guidance on AI governance, ample time to implement AI in their practice safely, adequate funding, effective leadership, and targeted support from AI champions. AI training, robust governance frameworks, and patient and public involvement were seen as priorities for the successful implementation of AI by radiographers.

CONCLUSION

AI implementation is progressing within radiography, but without customised training, clearer governance, key stakeholder engagement and suitable new roles created, it will be hard to harness its benefits and minimise related risks.

IMPLICATIONS FOR PRACTICE

The results of this study highlight some of the priorities and challenges for radiographers in relation to AI adoption, namely the need for developing robust AI governance frameworks and providing optimal AI training.

Governance, institutional and economic frameworks for Urban Forests as a Nature-Based Solution in Europe

Urban forests as nature-based solutions (UF-NbS) play a crucial role for promoting the health and well-being of urban populations. Despite increasing recognition of their importance, knowledge gaps remain regarding UF-NbS implementation, particularly with respect to their performance, their perception, and on decision-making and governance practices for their implementation and management. Grounded in a project-as-practice approach and based on sixteen UF-NbS case histories, this paper seeks to gain insights into UF-NbS project actualities by an identification of characteristic trends as a function of a projects' scope and purpose, or challenge-orientation, respectively. A particular emphasis is on project structure and coordination, on the scope and depth of participation and stakeholder involvement, and on funding mechanisms. Identified trends reveal centrally coordinated, single-responsible public authorities as the most common project structure, but with certain feature contents, i.e., regeneration and reclamation, as being associated with more decentralised forms of governance. It is concluded that irrespective of challenge-orientation, comparatively broad participation appears to be realised within the UF-NbS framework, however, the depth of participation differs considerably. With respect to funding, a strong reliance on public capital is asserted for the UF-NbS context, however, various forms of private contributions appear reasonably common across the assessed case histories. Recommendations for policy-making and avenues of future research are identified, including the validation of identified trends, the fostering of collaboration, the dispersal of decision-making authority, the encouragement for implementing non-tokenistic modes of participation in UF-NbS governance, and the promotion of potentially under-utilised funds.

Public-Private Partnerships in Mexico: Implications of Engaging With the Food and Beverage Industry for Public Health Nutrition

BACKGROUND

In the last few years, Mexico adopted public health policies to tackle non-communicable diseases (NCDs), such as front of package nutrition labelling, food marketing restrictions to children, and a soda tax. In parallel, transnational food and beverage industries (F&BIs), their allies, and the government have agreed on public-private partnerships (PPPs) to implement policies or deliver programs. However, research has questioned the benefits of PPPs and exposed its limitations as a suitable mechanism to improve public health. This study analyses how four PPPs between the Mexican government, the F&BI, and allies are working to achieve their goals. We critically assessed the objectives, scope, reported impacts, governance principles and perceived risks and benefits for the public health agenda of these PPPs.

METHODS

This qualitative study is based on 26 interviews with key actors, and 170 publicly available documents, including 22 obtained through freedom of information (FOI) requests related to four purposively selected PPPs aiming to improve health.

RESULTS

We found that the four PPPs studied had minimal public information available on their implementation and impact. The private partners tend to dictate the design, information management, and implementation of the programs, while promoting their brands. Few independent evaluations of the PPPs exist, and none reported on their effectiveness or public health benefits. Good governance principles, such as accountability, transparency, fairness, participation, integrity, and credibility, were barely followed in each of the cases studied. Public officials did not automatically question the conflict of interest (CoI) of such arrangements. When there were COI, the potential risks these posed did not always outweigh the financial benefits of working with the F&BI and its allies.

CONCLUSION

The four PPPs studied produced minimal gains for public health while boosting credibility for the participating transnational F&BIs. It shows the lack of awareness of how these PPPs might be hindering public health gains.

Responding to 'wicked problems': policy and governance on drug-related deaths in English and Welsh prisons, 2015-2021

BACKGROUND

Prison settings have been neglected in the growing literature on drug-related deaths. This paper explores policy and practice issues regarding the governance of drug-related deaths in prisons in England and Wales from 2015-2021.

METHODS

Thematic documentary analysis was conducted on national level policy documents published between 2015-2021 (e.g. drug strategies, prison policy documents, Her Majesty's Inspectorate of Prisons and Prison and Probation Ombudsman (PPO) annual reports and guidance for staff). At the local (prison) level, all of the PPO fatal investigation reports and their associated action plans relating to 171 drug-related deaths from 2015-2021 were analysed thematically. Various modes of governance were identified using Head's 'wicked problems' conceptual framework including avoidance and denial, coercive controls, compartmentalised micro-management, incremental and pragmatic adjustment and technocratic problem-solving.

RESULTS

There was strong evidence of the dominance of denial of the problem of drug-related deaths, coercive controls, micro-management and reliance on technological solutions in the early years (2015-2018). In some prisons, there developed a move towards the adoption of more pragmatic and incremental policies and push towards comprehensive policies over time. In others, remnants of denial and coercion remained. In our analysis, the focus on new psychoactive substances came to dominate attention, to the relative neglect of other substances and of the contribution of mental and physical illness to these deaths. Staff are not equipped, supported or resourced adequately to deal with the two 'wicked problems' of increasing rates of drug use and mental illness which collide in the prison setting.

CONCLUSION

The PPO investigations repeatedly recommend reducing supply and improving monitoring and surveillance and the emergency response. There is less focus on prevention and reducing demand or improving the wider environmental context and culture in which the deaths occur. Policy needs to pay more attention to the fundamental issues driving the current deterioration in conditions in prisons.

Public participation in human genome editing research governance: what do scientists think?

Within the numerous policy and governance recommendations for human genome editing research, anticipatory public engagement seems universally agreed upon as a vital endeavor. Yet it is unclear whether and how scientists whose research involves genome editing see value in engaging the public in discussions of genome editing research governance. To address this question, we interviewed 81 international scientists who use genome editing in their research. The views of our scientist interviewees about public engagement occupied a broad spectrum from enthusiastic support to strong skepticism. But most scientists' views landed somewhere in the middle, seeing public engagement as merely informing the public about the science of genome editing. We argue that such a stance reflects the traditional "knowledge-deficit model." Beyond addressing the operational difficulties of public engagement, many scientists' adherence to the deficit model is a deeper barrier that needs to be addressed if public engagement is to occur and be successful.

Consensus-based indicators for evaluating and improving the quality of regional collaborative networks of intensive care units: Results of a nationwide Delphi study

PURPOSE

To select a consensus-based set of relevant and feasible indicators for monitoring and improving the quality of regional ICU network collaboratives.

METHODS

A three-round Delphi study was conducted in the Netherlands between April and July 2022. A multidisciplinary expert panel prioritized potentially relevant and feasible indicators in two questionnaire rounds with two consensus meetings between both rounds. The RAND/UCLA appropriateness method was used to categorize indicators and synthesize results. A core set of highest ranked indicators with consensus-based levels of relevance and feasibility were finally tested in two ICU networks to assess their measurability.

RESULTS

Twenty-four indicators were deemed as relevant and feasible. Seven indicators were selected for the core set measuring the standardized mortality rate in the region (n = 1) and evaluating the presence, content and/or follow-up of a formal plan describing network structures and policy agreements (n = 3), a long-term network vision statement (n = 1), and network meetings to reflect on and learn from outcome data (n = 2). The practice tests led to minor reformulations.

CONCLUSIONS

This study generated relevant and feasible indicators for monitoring and improving the quality of ICU network collaboratives based on the collective opinion of various experts. The indicators may help to effectively govern such networks.

Non-steroidal anti-inflammatory drugs in football - a "Keeping SCORE" approach to judicious use

Non-steroidal anti-inflammatory drug (NSAID) use in elite sport is high, with football being no exception. Increased awareness of significant adverse drug reactions from published research and retired players commentary in the media have made the topic mainstream. Despite this increased awareness, usage rates show no sign of significantly reducing. Footballers, like all elite athletes are focused on maximising their performance and potential - even at the expense of their long-term health. An educational intervention prior to the 2010 FIFA Men's World Cup aimed at reducing rates was ineffective, suggesting that education alone is not the answer. Our author group propose a 'safer use' rather than 'no use' of NSAIDs in football. A 'Keeping SCORE' approach is suggested, designed as a prescribing aid. The approach guides medical staff towards focusing on Safety checks, Clinical indication/judgement, Open dialogue, Recording, and Evaluation.

Firm-level carbon risk perception and ESG performance

In a sustainable economy, each firm perceives different levels of carbon risk, but there are few studies on the relationship between a firm's carbon risk perception and Environmental, Social, and Governance (ESG) performance. This paper examines the impact of firm-level carbon risk perception on ESG performance using Chinese A-share listed firms during 2011-2020. We find a positive relationship between firm-level perception of carbon risk and firm ESG performance. Further analysis shows that analyst coverage and media attention exert a substantial moderating effect on the link between carbon risk perception and ESG performance. We identify three channels through which carbon risk perception affects ESG performance. First, rising carbon risk perception enables firms to take measures to reduce pollutants and greenhouse gas emissions and increases environmental (E) scores. Second, this perception encourages firms to take responsibility for social employment and increases social (S) scores. Finally, it improves firm sustainable governance and further increases governance (G) scores. Our research has an important guiding role in promoting firm ESG practice.

Recovery of suspended reimbursements of high-cost drugs subjected to monitoring registries and negotiated agreements (MEAs): a tool for governance and clinical appropriateness in the Italian reality

The Monitoring Registries and negotiated agreements (MEAs) established by the Italian Medicines Agency (AIFA) exemplify a pinnacle of excellence in Italian healthcare governance, playing a pivotal role in achieving economic sustainability and ensuring judicious allocation of financial resources. Within a local territorial health company catering to a populace of around 1 million individuals in Italy, an assessment of the meticulous implementation of all negotiation procedures was carried out by scrutinizing the monitoring records. This examination served to pinpoint and address potential issues in the platform management executed by healthcare professionals, including physicians and pharmacists. Such issues had the potential to result in economic setbacks owing to the non-reimbursement from pharmaceutical companies. Through diligent verification undertaken by the pharmacists, a financial recovery amounting to approximately €579,443.4 for the fiscal year 2022 was achieved. The essence of this analysis is to underscore how collaborative, multidisciplinary efforts between physicians and pharmacists yield tangible economic advantages. This collaborative approach ensures a streamlined healthcare system characterized by efficiency, devoid of unnecessary expenditures, and marked by the highest standards of care appropriateness, ultimately serving the best interests of the citizens.

Moderating effect of governance on healthcare and environmental emissions

Governance has become indispensable within the healthcare sector, but previous studies have not explored the potential environmental benefits linked to healthcare governance. Thus, this study focuses on the role of governance in moderating healthcare and environmental emissions in 159 low, lower-middle, upper-middle and high-income countries. To do so, cross-sectional autoregressive distributed lag (CS-ARDL) techniques were applied using panel data from 1999 to 2021, followed by the computation of threshold and marginal effect of governance on healthcare and environmental emissions nexus. Findings revealed that, with the exception of high-income countries in the short run, governance has an insignificant impact on healthcare and emissions nexus in low-, lower-middle and upper-middle-income countries. Surprisingly, the findings imply that, in the long run, countries with greater levels of governance are likely to have lesser environmental impacts related to healthcare. There was also evidence indicating that low, lower-middle, upper-middle and high-income countries must reach a certain level of governance before realising the benefits of healthcare. Therefore, to achieve lower environmental impacts from healthcare, countries must promote effective governance policies that can incentivise and enforce sustainable practices and technologies in the healthcare sector.

Unlocking the importance of perceived governance: The impact on COVID-19 in NUTS-2 European regions

In the immediate aftermath of the pandemic, governments implemented non-pharmaceutical interventions (NPIs). Previous literature suggests that NPI effectiveness is influenced by governance quality. The acceptance and perceived necessity of these measures by the public are crucial to their success, as NPIs cannot be easily enforced without public support. Does regional governance also play a role? This study examines the correlation between the quality of governance in European NUTS-2 regions and the spread of COVID-19. The findings indicate that overall perceived governance, and its perceived quality and corruption pillars, significantly impact the effectiveness of these interventions. This effect was pronounced during the first wave and then diminished in importance, disappearing before vaccines were available, suggesting that regional governance matters especially in the immediate aftermath of an exogenous shock.

Patterns of infringement, risk, and impact driven by coal mining permits in Indonesia

Coal mining is known for its contributions to climate change, but its impacts on the environment and human lives near mine sites are less widely recognised. This study integrates remote sensing, GIS, stakeholder interviews and extensive review of provincial data and documents to identify patterns of infringement, risk and impact driven by coal mining expansion across East Kalimantan, Indonesia. Specifically, we map and analyse patterns of mining concessions, land clearing, water cover, human settlement, and safety risks, and link them with mining governance and regulatory infractions related to coal mining permits. We show that excessive, improper permit granting and insufficient monitoring and oversight have led to deforestation, widespread overlaps of concessions with settlements, extensive boundary and regulatory violations, lacking reclamation, and numerous deaths. As the world's largest thermal coal exporter, Indonesia's elevated coal infringements, risks, and impacts translate to supply chain, sustainability, and human rights concerns for global coal markets.

Administrative law as a determinant of public health

Administrative law comprises the rules, values, and processes by which government and regulatory decision-making is subject to administrative monitoring, review, and accountability. It impacts public health in two ways: through the design, powers, and processes of institutions that enforce administrative law; and through the substantive rules of administrative law. Yet despite its fundamental regulation of the way in which public health decisions are made, insufficient research has been conducted on administrative law as a determinant of public health. Administrative law and public health operate as siloed academic disciplines with very little cross-disciplinary collaboration, engagement, or understanding. This results in major, untapped research opportunities exploring how administrative law could contribute to an optimized model of planetary health in both higher income and lower-middle income countries. Put simply, a holistic, global view of the determinants of public health must take due account of the accountability rules and controls that regulate how public health, and other, decisions are made. This commentary is a call to action to better understand how administrative law mechanisms, such as judicial review, administrative tribunals, ombudsmen, information commissioners, public auditors, and human rights monitors, can be designed or redesigned to better promote sustainable public health outcomes.

"Hospitals respond to demand. Public health needs to respond to risk": health system lessons from a case study of northern Queensland's COVID-19 surveillance and response

BACKGROUND

The vast region of northern Queensland (NQ) in Australia experiences poorer health outcomes and a disproportionate burden of communicable diseases compared with urban populations in Australia. This study examined the governance of COVID-19 surveillance and response in NQ to identify strengths and opportunities for improvement.

METHODS

The manuscript presents an analysis of one case-unit within a broader case study project examining systems for surveillance and response for COVID-19 in NQ. Data were collected between October 2020-December 2021 comprising 47 interviews with clinical and public health staff, document review, and observation in organisational settings. Thematic analysis produced five key themes.

RESULTS

Study findings highlight key strengths of the COVID-19 response, including rapid implementation of response measures, and the relative autonomy of NQ's Public Health Units to lead logistical decision-making. However, findings also highlight limitations and fragility of the public health system more generally, including unclear accountabilities, constraints on local community engagement, and workforce and other resourcing shortfalls. These were framed by state-wide regulatory and organisational incentives that prioritise clinical health care rather than disease prevention, health protection, and health promotion. Although NQ mobilised an effective COVID-19 response, findings suggest that NQ public health systems are marked by fragility, calling into question the region's preparedness for future pandemic events and other public health crises.

CONCLUSIONS

Study findings highlight an urgent need to improve governance, resourcing, and political priority of public health in NQ to address unmet needs and ongoing threats.

Trend analysis of proton pump inhibitor consumption and expenditure: The real-world evidence

INTRODUCTION

Proton pump inhibitors (PPIs) constitute a widely utilized pharmaceutical class, frequently associated with notable instances of therapeutic inappropriateness. Such patterns of misuse not only contribute to elevated healthcare expenditure, but may also exacerbate clinical conditions in certain patients.

METHODS

A comprehensive analysis was conducted between 2019 and 2023 to assess all prescriptions dispensed using the Anatomical, Therapeutic and Chemical (ATC) classification system, which allowed trends among primary PPIs to be visualized. This was achieved by calculating the defined daily dose (DDD) and then defining the total expenditure incurred on these drugs.

RESULTS

With regard to the prescription of PPIs, an upward trend in consumption was observed with a decreasing expenditure, due to the phenomena of drug generics and increased competition between pharmaceutical companies, ranging from €9,512,481.22 in the first six months of 2019 to €8,509,820.80 in the first six months of 2023. From 2019 to 2023, consumption increased by approximately 3 million DDDs for a total ranging from 18,483,167.59 DDDs to 21,480,871.00 DDDs. Pantoprazole and esomeprazole, the most expensive drugs compared to omeprazole, rabeprazole and lansoprazole, accounted for 61.4% of therapies in the first six months of 2023, up from 2019, where these two drugs were prescribed 54.9%.

CONCLUSION

Within this analysis, we provide an illustrative representation of the prescribing trends for PPIs within a European context. Omeprazole, rabeprazole and lansoprazole appear to be the cheapest drugs compared to pantoprazole and esomeprazole. However, the results show that the most widely used PPIs, despite their therapeutic equivalence, are precisely the high-cost ones, thus generating higher expenditure for central governments.

Evaluating the NMC proficiencies framework: perspectives of students and educators 5 years on

It is now half a decade since the Nursing and Midwifery Council (NMC) launched Future Nurse: Standards of Proficiency for Registered Nurses. Applicable nationally, this proficiencies framework dictates specific elements of nursing praxis that all pre-registrants must achieve in order to qualify as registered nurses, before going on to gain employment in either the NHS or adjacent healthcare providers. The NMC proficiencies framework is subdivided into seven proficiencies and two annexes, each of which contains multiple specific criteria detailing the skillset pre-registrants must demonstrate, in order to be signed off by a qualified educator. Subsequently, in the last 5 years the standards have brought about significant alterations to the delivery of nursing programmes at UK higher education institutions. This article reports the results of a pair of service evaluations, which gathered feedback from both pre-registrant students and educators in relation to their direct experiences of the NMC's proficiencies framework. The authors compare the contemporary perspectives collated here against earlier academic appraisals of the guidance framework, in order to outline its past and present reception at the level of delivery.

Hospital governance accountability structure: a scoping review

INTRODUCTION

Hospitals, as complex organizations with clinical, financial, and social functions, face different barriers to providing high-quality and safe services at reasonable costs. Various initiatives have been carried out in hospital governance to improve quality, safety, and accountability. This research aims to identify the structures and dimensions that make hospital governance accountable.

METHODS

The research used Arksey and O'Malley's scoping review framework to examine the research literature on hospital governance structure and accountability. The literature review included PubMed, Web of Science, Embase, Scopus ProQuest, Google search engine, and Google Scholar databases from 2010 to 2023. Data were analyzed using the content analysis method.

RESULTS

Excluding unrelated and duplicate sources, 40 articles and reports were included in the study. The studies were reviewed and analyzed based on organizational type, type of source, year of publication, objectives, and key findings. Accountable governance features were extracted from the selected articles and reports. The four main themes include inclusive governance, commitment to accountability, planning for accountability, and autonomous governance. Thirteen subthemes were extracted from the study literature.

CONCLUSION

Various initiatives have been implemented regarding the reform of the governance structure of public hospitals in different countries. Many of these reforms aim to improve financial and clinical accountability. The study results could be used to identify the structures and dimensions that make hospital governance accountable.

An urgent call to action: The absolute necessity to ban asbestos production and sales

The issue with asbestos highlights the shortcomings in the global management of health policies for dangerous substances. The perils of asbestos dust were identified about a century ago. A significant number of individuals succumb to asbestos-related diseases worldwide annually. A considerable portion of occupational cancer fatalities are believed to be due to asbestos. A large population across the globe is exposed to asbestos in their workplaces. To address issues like asbestos, it is crucial for policymakers to prioritize public interest, and third parties should actively participate in scrutinizing the actions of these policymakers.

The 2022 community-based integrated care reform in Italy: From desiderata to implementation

The Italian National Recovery and Resilience Plan allocated € 7 Bn for community care. In May 2022, the Italian government issued a Decree to define the strategy for the development of community-based integrated care. The reform aims to create uniformly a network of services close to where patients live, thus overcoming geographical disparities between regions. The strategy is based on a strong role of the central government in community care, but still leaves autonomy to regions. Levelling availability of services across territories, setting uniform targets with a short period horizon and disregarding starting points may create important implementation problems. Financial constraints will also hamper the implementation of the reform. Ultimately the development of Italian community care will depend on the institutional and managerial capabilities of regions and local health authorities. Firstly, they should shape the actual implementation of community care services by defining organizational arrangements, priority targets and models of care delivery. Secondly, they should develop strategies to face the lack of financial resources and the shortage of healthcare workforce. This contribution informs international readers about a major policy in a European country and its implementation challenges. It offers insights into inter-government relations in NHS-type healthcare systems (Nordic countries and Spain), showcasing the complexity of policymaking involving multiple political actors and resulting indeterminacy of policies and their implementation.

Organisational barriers and facilitators to the implementation of best practices within paediatric forensic radiographic practice - A scoping review

INTRODUCTION

Implementation and application of evidence-based practice through legislation, international and national guidelines and local protocols is integral to the successful undertaking of forensic radiographic practice, because of its medico-legal role. This research aims to evaluate those organisational barriers and facilitators to its effective implementation.

METHODS

This scoping review was undertaken according to the JBI updated guidelines using the PCC mnemonic. A systematic search of 10 databases was undertaken to identify literature addressing the research question relating to this aspect of forensic radiography practice. Handsearching and snowballing were also included to enhance this search strategy. The search focussed on forensic imaging of paediatrics, the living and deceased.

RESULTS

Of the 301 papers initially selected, 9 articles were identified as eligible for inclusion, encompassing an international perspective. Through Inductive Content Analysis, 5 conceptual categories were developed: ineffective organisational governance, education translation, system brakes, default practice, and value-based judgement.

CONCLUSION

The results indicate that there are many complex and multifactorial organisational issues impacting upon effective implementation of best practices within paediatric forensic imaging. There is a need to address these issues, before attempting strategies for future implementation. It is essential to recognise that there can be no one-size-fits approach, but rather tailored strategies are required recognising individual needs within the multi-disciplinary scope of forensic radiographic practice.

IMPLICATIONS FOR PRACTICE

Failure to recognise and address the identified issues impacting upon effective implementation, may have significant implications on the processes and individuals involved in the forensic imaging acquisition pathway. Successful addressing of these issues may enable the professionals involved in organisational governance to create a more conducive and receptive environment for best-practice implementation.

Renewable energy and natural resource protection: Unveiling the nexus in developing economies

Natural Resource Protection (NRP) has been on the agenda of the Sustainable Development Goals (SDGs) and is considered a pathway to sustainable development. The analysis of the determinants of NRP has received the attention of policymakers in framing evidence-based policies and strategies. Renewable energy (RE) is a major contributor to natural resource protection. However, existing studies have provided inconclusive evidence on the role of renewable energy in the NRP. This study primarily focuses on the assessment of how RE influences NRP in 22 developing economies. This study considers the nonlinear association between RE and NRP. Moreover, the role of governance effectiveness, financial technology, urbanization, and FDI in the NRP were also assessed. Furthermore, the analyses also explore the NRP-Kuznets curve by examining the role of economic growth in the NRP. The study, which detected cross-sectional dependence (CSD), heterogeneity, autocorrelation, and heteroskedasticity in the data, uses pooled regression with Driscoll-Kraay Standard Errors (DKSEs) and GLS for the econometric analysis. The results revealed a U-shaped relationship between renewable energy and NRP. Moreover, governance effectiveness, FINTECH, and FDI contribute to NRP, but urbanization has a negative impact on NRP. The analysis concludes an inverted U-shaped association between GDP per capita and NRP. A Bayesian regression analysis was also performed to validate the robustness of the results. Based on these findings, this study makes policy recommendations for improving NRP. Policymakers should prioritize renewable energy and sustainable resource exploitation through incentives and investments. Improving governance, adopting environmental rules, and involving stakeholders are critical. Financial technology can facilitate long-term investment in sustainability. Sustainable urban design should reduce the adverse effects of urbanization. FDI should be aligned with long-term development goals and appropriate resource management. Balancing economic growth with environmental protection requires multifaceted measures that promote green development and resource efficiency. Policy coherence and stakeholder participation are also critical.

Governing health service purchasing agencies: Comparative study of national purchasing agencies in 10 countries in eastern Europe and central Asia

This study discusses findings from comparative case studies of the governance of health services purchasing agencies in 10 eastern European and central Asian countries established over the past 30 years, and the relationship between governance attributes, institutional development, and the progress made in strategic purchasing. The feasibility and effectiveness of implementing international recommendations from the health sector and wider public sector governance literature and practice are also discussed. The study finds that only those countries that have transitioned from middle to high-income status during the study period have been successful in comprehensively and consistently implementing internationally recommended practices. Moreover, these countries have made varying progress in developing capable purchasers with technical and operational independence, as well as advancing strategic purchasing. However, the current middle-income countries (MICs) in the study have implemented only certain elements of recommended governance practices, often superficially. Notably, the study reveals that some international recommendations, particularly those related to higher degrees of purchaser autonomy and the associated governance structures observed in western European social health insurance funds, have proven challenging to implement effectively or sustain in the MICs. None of the MICs succeeded in strategic purchasing beyond a limited agenda or scale, and even then, only implementing and sustaining them during favorable conditions. Difficulties in maintaining these achievements can be attributed, in part, to governance deficiencies. However, setbacks are commonly linked to periods of political and economic instability, which in turn lead to fluctuations in policy priorities, institutional instability, and inadequacies in health budgets. The study findings point to some actions related to civil society and stakeholder engagement, accountability frameworks, and digitalization in MICs that can facilitate continuity in health reforms and the functioning of purchasing institutions despite these challenges. The findings of the study provide important lessons for countries designing or newly implementing health purchasing agencies and for countries reviewing the performance and governance of their health purchasing agencies with a view to developing or strengthening strategic purchasing.

GLD-SAIPAR Covid-19 survey in Zambia dataset

In March 2020, Zambia reported their first cases of Covid-19, with the government restricting non-essential travel, banning large public gatherings, and establishing emergency committees to spearhead efforts to contain the pandemic at a national level. The Governance and Local Development Institute (GLD) in collaboration with South African Institute for Policy and Research (SAIPAR) implemented a survey in 2020 to generate a dataset to provide better understanding of citizens' responses to such measures, and the impact of the pandemic on their individual lives and communities. To generate as complete a picture as possible of the local situations over time, we conducted two survey rounds. These rounds resulted in a total of 3925 completed surveys (1022 respondents took both rounds), gathering information on issues including knowledge of Covid-19; attitudes and fears surrounding health and economic impacts; social, economic, and health vulnerabilities; social distancing practices and other preventative measures. Particular attention was paid to the local variation in concerns over the social stigma, levels of enforcement, and engagement of different authorities.

The diabetic patient between sustainability and effectiveness of new treatments

Objectives

The increased issuance and distribution of new agents for type 2 diabetes mellitus, due to relaxed prescribing rules, has resulted not only in a greater proximity of treatments to the patient, as envisioned by post-Covidio 19 European policies, but also in an unexpected increase in healthcare spending.

Methods

An analysis of a database called "Health Card" was performed in order to evaluate all prescriptions for the new classes of medications used for type 2 diabetes.

Results

New legislation called "note 100" was introduced in early 2022, outlining the eligibility of certain categories of drugs used for the treatment of type 2 diabetes mellitus for direct prescription by primary care physicians in Italy. This investigation therefore delves into an examination of the prescribing patterns related to these drugs, contrasting the year 2021, prior to the implementation of Note 100, with the year 2022, following the incorporation of the new legislation. The result resulted in an exponential increase in prescriptions and consumption (+ 38%) and increased healthcare spending of more than three million euros for these drug categories.

Conclusion

This analysis highlights how regulation on the one hand leads to facilitating prescribing to meet a population need that is not fully satisfied, but on the other hand leads to increased prescribing and increased health care expenditures that may likely mask phenomena of prescribing inappropriateness.

From industrialization to dehumanization: understanding the deriving forces of environment and implications for sustainable development

Environment has detrimental effects on economic activity and human survival. Climate change is increasingly conducive to natural disasters, epidemics, social conflicts, food security, financial shocks, economic hardships, and life subsistence. In pursuit of this issue, this study empirically investigates the effects in outcome variable CO2 provoked by independent variables governance, technological innovation, renewable energy, economic growth, and economic policy uncertainty in APEC economies. The APEC region accounts for 60% of global emissions, 62% of world GDP, 48% of global trade and contribute 8.7% renewable energy annually. A dynamic panel PMG-ARDL model is applied under the assumption of maximum likelihood estimation with DH causality and CS-ARDL for the period of 1996-2020. Our empirical results confirm that governance, technology innovation, and transitional energy have significant and positive effect to mitigate CO2 emissions. The region needs to design policy mechanisms supportive to promote institutional quality, enhances transparency, ensure political stability and rule of law. It develops the infrastructure that ensures the adaptation of technology innovations, promotes green growth, improves energy efficiency, and implements carbon pricing mechanism. Economic policy uncertainty has insignificant and positive effects on environmental degradation. The findings show that governance, technological development, and transitional energy have an essential role to mitigate CO2 emissions and achieve sustainable development. Moreover, this study will be helpful in understanding the implications of SDGs and achieving specific targets such as (SDG-7: Clean energy sources) and (SDG-8: Sustainable development goal) based on the largest set of emitters APEC.

Battling for net zero carbon: the position of governance and financial indicators

Africa, over the past years, has put various measures in place in the fight against carbon emissions. Achieving net zero carbon has caused the continent researchers to investigate various conditions required for a successful transition. Therefore, the political system cannot be left out since it plays a major role in decision-making. This study contributes to previous literature analyzing the empirical effect of financial development and governance quality on carbon emissions. The study is focused on 52 African countries with data from 1996 to 2021. Panel quantile and generalized method of moments are used for the analysis. The result indicates that financial development contributes to environmental degradation, government effectiveness, rule of law, and political stability which promote environmental pollution; however, control of corruption, renewable energy, and economic growth promote ecological sustainability. According to the aforementioned, it is crucial for governments to include financial development plans in national environmental strategies, particularly for those in African nations. Furthermore, governments should put restrictions on trade to control the trade of high-carbon technologies.

Dataset of exceptional women directors and carbon information disclosures of global energy companies

Dataset in this article contains solid information on the novel dataset of exceptional women directors (EWDs) and carbon information disclosures (CID) of global energy leading companies. The data presented is related to the research article entitled "The Effect of Women's Leadership on Carbon Disclosure by the Top 100 Global Energy Leaders" [1]. In exploring the degree of EWDs' and the level of CID, the content analysis technique based on the enhanced scoring indicators were deployed to obtain the data of the 97 companies based on accessible materials from companies' websites or any associated reports such as sustainability, environmental, annual, or integrated reports within three-year periods (2018 - 2020) for the global energy leading companies which listed in Thomson Reuters Database 2017. Data on EWDs' engagement and CID are extracted from the available information, reports, and materials. The data are collected based on the enhanced version of the EWD's indicators adapted from Ramon Llorens, García-Meca and Pucheta-Martínez [2], Hillman, Cannella and Paetzold [3], and Jaaffar and Amran [4]. Meanwhile, data collected for CID by using Carbon Disclosures Index (CDI) comprising 90 scores within nine aspects; Strategy and Policy; Climate Change Risks and Opportunities; Corporate GHG Emissions Targets; Company Wide Carbon Footprint; GHG Emissions Change Over Time; Energy-Related Reporting; Emission Reduction Initiatives Implementation; Carbon Emission Accountability; and Quality of Disclosure as suggested by the prior scholars [5], [6], [7]. This dataset shed light as an indicator to measure exceptional women director in the energy companies in promoting transparent carbon disclosure performance as well as boosting women leadership involvement and participation in the most polluting sector which aligned with the United Nations Sustainable Development Goals; SDG 5 gender equality, SDG 10 reduced inequality, and SDG 13 climate action.

The Italian experience with the use of monitoring registers attached to negotiated agreements (MEAs) of the Italian Medicines Agency is a tool for governance and clinical appropriateness

The use of monitoring registers with annexed negotiation agreements (MEAs) of the Italian Medicines Agency (AIFA) are the pillar of Italian healthcare governance to guarantee the correct allocation of economic healthcare resources. In Italy, an analysis was conducted in the context of a local health authority where all negotiation activities were implemented to verify the amount of reimbursements that can be recovered through the use of all available procedures on the monitoring registers. The purpose of this analysis was to highlight any criticalities which, if not properly addressed by doctors and pharmacists, can lead to considerable financial loss. Correct verification by the hospital pharmacy resulted in an economic recovery of approximately EUR 579,443.40 for the year 2022 and EUR 682,225.30 in the first 9 months of 2023. This analysis is intended to highlight how effective collaboration between doctors and pharmacists can lead to clear economic advantages with an efficient health system to the total benefit of citizens.

Revisiting the nexus between economic growth and environment health: an empirical study on 180 nations

Sustainability is considered to be one of the biggest issues in the current time. This study aims to understand the role of sustainability further by revisiting the much-debated and intricate relationship between economic growth and environmental performance and to provide guidance to policymakers. Using a large sample of data from 180 countries over the period from 2002 to 2017 a measure that captures the various aspects of environmental performance, the study performs a test of the Environmental Kuznets Curve (EKC) hypothesis, which defines the relationship between economic growth and environmental deterioration. Controlling for several associated macroeconomic and governance variables, the results suggest that for certain regions, viz. Asia, Eastern Europe, and North America, higher economic growth, as proxied by per capita GDP, has a negative association with environmental performance (measured by Environmental Performance Indices, EPI), indicating that the former may prove detrimental to the later. The results suggest a unidirectional relationship between the two variables and are also robust to endogeneity concerns that are often emphasized in the EKC literature. The study documents similar results for lower-income and lower-middle-income countries. Interestingly, the authors also find that small-sized governments in developing nations have a positive association with environmental performance.

Losing the Public, for Better or for Worse: A Lesson from John Everett Gordon (1890-1983) and John Rodman Paul (1893-1971)

The Covid-19 pandemic has laid bare a tension around scientific expertise that has major implications for the effectiveness of health systems. Critical engagement with this tension, however, is largely missing from the lessons and programs consolidating in the wake of the emergency. Lacking good frameworks for discussing the tension, the vague term "public trust" has proliferated into a buzzword that stands in for more articulate discussion. The tension between experts and the public is not new, however. It is useful to look back to the 1930s, when health experts identifying as "new epidemiologists" imagined a new modern science of epidemiology that, some believed, would resolve evident failures in public cooperation. Historical analysis of different approaches to the production and use of epidemiological knowledge in these years reveals a debate about power at the heart of epidemiology, and a critical framework for discussing the tension around epidemiological expertise in public health.

Organising for One Health in a developing country

Globally, zoonotic diseases pose an enormous and growing public health challenge, and developing countries like India are at the epicentre of it. Although there is general recognition of this reality, governments around the world have struggled to organise appropriately to respond to it. The widely held view is that organising for One Health requires effective cross-sectoral collaboration, but the prerequisites to enable such collaboration appear almost unattainable. Perhaps an entirely different approach is needed, which is over and above effective collaborations between competing government ministries. The approach would have to recognise that while any organisational response will need to be able to address identified zoonotic diseases and respond effectively to them in times of crises, it would also be required to have the ability to shape the response to megatrends such as climate change, deforestation, and the underlying development models of the country. The paper analyses the success and failures associated with the way in which India, Bangladesh, Kenya, and Rwanda have organised for One Health. It also studies the underlying pathways through which zoonotic spillovers take place, and epidemics gather momentum. Based on these critical analyses, the paper concludes that attempts to build single overarching units to address these challenges have only been partially effective. Given the scale and complexity of the challenge, it recommends that, even at the risk of duplication and the very real possibility that unaddressed gaps will remain, an approach, which builds multiple sharply focused units, would have a greater chance of success.

Having a real say: findings from first nations community panels on pandemic influenza vaccine distribution

BACKGROUND

Recent deliberations by Australian public health researchers and practitioners produced an ethical framework of how decisions should be made to distribute pandemic influenza vaccine. The outcome of the deliberations was that the population should be considered in two categories, Level 1 and Level 2, with Level 1 groups being offered access to the pandemic influenza vaccine before other groups. However, the public health researchers and practitioners recognised the importance of making space for public opinion and sought to understand citizens values and preferences, especially First Nations peoples.

METHODS

We conducted First Nations Community Panels in two Australian locations in 2019 to assess First Nations people's informed views through a deliberative process on pandemic influenza vaccination distribution strategies. Panels were asked to make decisions on priority levels, coverage and vaccine doses.

RESULTS

Two panels were conducted with eighteen First Nations participants from a range of ages who were purposively recruited through local community networks. Panels heard presentations from public health experts, cross-examined expert presenters and deliberated on the issues. Both panels agreed that First Nations peoples be assigned Level 1 priority, be offered pandemic influenza vaccination before other groups, and be offered two doses of vaccine. Reasons for this decision included First Nations people's lives, culture and families are important; are at-risk of severe health outcomes; and experience barriers and challenges to accessing safe, quality and culturally appropriate healthcare. We found that communication strategies, utilising and upskilling the First Nations health workforce, and targeted vaccination strategies are important elements in pandemic preparedness and response with First Nations peoples.

CONCLUSIONS

First Nations Community Panels supported prioritising First Nations peoples for pandemic influenza vaccination distribution and offering greater protection by using a two-dose full course to fewer people if there are initial supply limitations, instead of one dose to more people, during the initial phase of the vaccine roll out. The methodology and findings can help inform efforts in planning for future pandemic vaccination strategies for First Nations peoples in Australia.