Multilevel governance framework on grievance redressal for patient rights violations in India

The notion of patient rights encompasses the obligations of the state and healthcare providers to respect the dignity, autonomy and equality of care-seeking individuals in healthcare processes. Functional patient grievance redressal systems are key to ensuring that the rights of individuals seeking healthcare are protected. We critically examined the published literature from high-income and upper-middle-income countries to establish an analytical framework on grievance redressal for patient rights violations in health facilities. We then used lawsuits on patient rights violations from the Supreme Court of India to analyse the relevance of the developed framework to the Indian context. With market perspectives pervading the health sector, there is an increasing trend of adopting a consumerist approach to protecting patient rights. In this line, avenues for grievance redressal for patient rights violations are gaining traction. Some of the methods and instruments for patient rights implementation include charters, ombudsmen, tribunals, health professional councils, separating rules for redressal and professional liability in patient rights violations, blame-free reporting systems, direct community monitoring and the court system. The grievance redressal mechanisms for patient rights violations in health facilities showcase multilevel governance arrangements with overlapping decision-making units at the national and subnational levels. The privileged position of medical professionals in multilevel governance arrangements for grievance redressal puts care-seeking individuals at a disadvantaged position during dispute resolution processes. Inclusion of external structures in health services and the healthcare profession and laypersons in the grievance redressal processes is heavily contested. Normatively speaking, a patient grievance redressal system should be accessible, impartial and independent in its function, possess the required competence, have adequate authority, seek continuous quality improvement, offer feedback to the health system and be comprehensive and integrated within the larger healthcare regulatory architecture.

Forests in common: Learning from diversity of community forest arrangements in Europe

Europe has a wealth of community forest arrangements. This paper aims to transcend the diversity of locally specific terms and forms, to highlight the value of considering them inclusively. Building on methods to make sense of diversity, we use reflexive grounded inquiry in fifteen cases in Italy, Scotland, Slovenia and Sweden. Within four dimensions (forest, community, relationships between them, and relationships with wider society), we identify 43 subdimensions to describe them collectively. Our approach shows how European arrangements contribute to wider discourses of collective natural resource management. Both tradition and innovation in Europe inform options for environmental governance. Arrangements challenge the distinction between 'communities of place' and 'communities of interest', with implications for social and environmental justice. They exemplify multilevel environmental governance through both vertical and horizontal connections. Emerging from long histories of political and environmental pressures, they have a role in enhancing society's connection with nature and adaptive capacity.

The Dynamics of Multiscale Institutional Complexes: the Case of the São Paulo Macrometropolitan Region

The concept of institutional interplay (i.e., the interaction between institutions) is critical if the challenges to multilevel governance are to be better understood and addressed. Drawing on the literature on institutional interplay, this paper develops an analytical approach to examine challenges to multilevel coastal governance. São Paulo Macrometropolitan region (MMP, in Portuguese) is used to ground the empirical analysis. The macrometropolitan is one of the largest urban areas in the Southern Hemisphere; it houses the Metropolitan Region of São Paulo-one of the six most significant in the world. The MMP concentrates critical infrastructure, such as ports, airports, and roads, and considerable knowledge, technology, and innovation hubs. The coastal governance in the MMP area characterizes a highly connected multilevel system formed by 60 organizations (7 international, 29 national, 11 state, and 13 local). These comprised a complex environment featuring a great deal of fragmentation, and, consequently, jurisdictional and functional gaps and overlaps. This case was best described in terms of normative, functional, and political interplay. Interplay management has the potential to improve governance on the cross-level interactions among scale-dependent institutions of the MMP, enhancing synergies, and minimizing tensions among the institutions analyzed. This includes fostering cognitive interaction (i.e., promoting interinstitutional learning and assistance, and enhancing synergy) between institutions with complementary and/or similar objectives. Ultimately, interplay management may reduce fragmentation, improve compliance and monitoring, and increase cost-effectiveness. The findings from this paper may prove useful to other jurisdictions where pressing environmental issues involve multiple governance levels and interacting institutions.

Public health within the EU policy space: a qualitative study of Organized Civil Society (OCS) and the Health in All Policies (HiAP) approach

OBJECTIVES

This article reviews how Organized Civil Society (OCS) groups in the field of public health work across the boundaries between European institutions and policy areas. In particular, it explores 1) how the Health in All Policies (HiAP) approach is conducted by these groups informally within the formal governance structures, and 2) how this advocacy work creates space for public health within the broader political determinants of health.

STUDY DESIGN

A qualitative mixed-methods framework.

METHODS

Political ethnography, including 20 semi-structured interviews conducted with EU health strategy stakeholders and participant observations in public health events (n = 22) in Brussels over a three-year period (2012-2015), as well as four interviews with EU Member State representatives. Three additional semi-structured interviews were conducted with World Health Organization Regional Office for Europe staff members who had been involved in the drafting of the Health 2020 framework and strategy and the accompanying main implementation pillar, European Action Plan for Strengthening Public Health Capacities and Services (EAP-PHS).

RESULTS

The findings provide an insight into OCS work in the field of European public health, offering an account of the experiences of HiAP work conducted by the research participants. The OCS groups perceive themselves as communicators between policy areas within European institutions and between local and supranational levels.

CONCLUSIONS

The structures and political determinants of health that impose limitations on a public institution can at points be transcended by stakeholders, who conduct HiAP work at supranational level, thus negotiating space for public health within the competitive, globalized policy space.