Strengthening Local Governance in Health Financing in China: A Text-Mining Analysis of Policy Changes between 2009 and 2020

2021 ◽  
Author(s):  
Kai Liu ◽  
Tianyu Wang ◽  
Chen Bai ◽  
Lingrui Liu
Keyword(s):  
Text Mining ◽  
Health Systems ◽  
Cost Containment ◽  
Local Governments ◽  
National Policy ◽  
Health Financing ◽  
Health Governance ◽  
Policy Choices ◽  
Fiscal Resource ◽  
Resource Input

Abstract In the last two decades, developing countries have increasingly engaged in improving the governance of their health systems and promoting policy design to strengthen their health governance capacity. Although many well-designed national policy strategies have been promulgated, obstacles to policy implementation and compliance among localities may undermine these efforts, particularly in decentralized health systems. Studies on health governance have rarely adopted a central-local analysis to investigate in detail local governments’ distinct experiences, orientations, and dynamics in implementing the same national policy initiative. This study examines the policy orientations of prefectural governments in strengthening governance in health financing in China, which has transitioned from emphasizing the approach of fiscal resource input to that of marketization promotion and cost-containment regulation enforcement at the national level since 2009. Employing text-mining methodologies, we analyzed health policy documents issued by multi-level governments after 2009. The analysis revealed three salient findings. First, compared to higher-level authorities, prefectural governments generally opted to use fiscal resource input over marketization promotion and cost-containment regulation enforcement between 2009 and 2020. Second, policy choices of prefectural governments varied considerably in terms of enforcing cost-containment regulations during the same period. Third, the extent of the prefectural government’s orientation toward marketization promotion or cost-containment regulation enforcement was not only determined by the top-down orders of higher-level authorities but was also incentivized by the government’s fiscal dependency and the policy orientations of peer governments. These findings contribute to the health governance literature by providing an overview of local discretion in policy choices, and the political and fiscal dynamics of local policy orientations in promoting health governance in a decentralized health system.

scholarly journals Key factors to facilitate locally driven family planning programming: a qualitative analysis of urban stakeholder perspectives in Africa and Asia

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Lisa Mwaikambo ◽  
Sarah Brittingham ◽  
Saori Ohkubo ◽  
Ruwaida Salem ◽  
Denis Joel Sama ◽  
...  
Keyword(s):  
Family Planning ◽  
Health Systems ◽  
Thematic Analysis ◽  
Urban Areas ◽  
Local Governments ◽  
Scale Up ◽  
Analytical Framework ◽  
Essential Elements ◽  
Evidence Based ◽  
Country Ownership

Abstract Background There has been greater recognition of the importance of country ownership in global health and development. However, operationalising country ownership to ensure the scale up and sustainability of proven interventions remains elusive at best. To address this challenge, we undertook a thematic analysis of interviews collected from representatives of local governments, public health systems, and communities in poor urban areas of East Africa, Francophone West Africa, India, and Nigeria, supported by The Challenge Initiative (TCI), aiming to rapidly and sustainably scale up evidence-based reproductive health and family planning solutions. Methods The main objective of this study was to explore critical elements needed for implementing and scaling evidence-based family planning interventions. The research team conducted thematic analysis of 96 stories collected using the Most Significant Change (MSC) technique between July 2018 and September 2019. After generating 55 unique codes, the codes were grouped into related themes, using TCI’s model as a general analytical framework. Results Five key themes emerged: (1) strengthening local capacity and improving broader health systems, (2) shifting mindsets of government and community toward local ownership, (3) institutionalising the interventions within existing government structures, (4) improving data demand and use for better planning of health services, and (5) enhancing coordination of partners. Conclusion While some themes feature more prominently in a particular region than others, taken together they represent what stakeholders perceive to be essential elements for scaling up locally-driven health programmes in urban areas in Africa and Asia.

scholarly journals Strategies for reducing out of pocket payments in the health system: a scoping review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Faride Sadat Jalali ◽  
Parisa Bikineh ◽  
Sajad Delavari
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Health Financing ◽  
Developed Countries ◽  
Vulnerable Groups ◽  
System A ◽  
Out Of Pocket Payments ◽  
Review Study ◽  
Developing And Developed Countries

Abstract Background Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. Methods Articles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. Results Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. Conclusion The present review identified some strategies that affect the OOP payments According to the health system functions framework. Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures.

Health Care Cost Containment in Large American Cities

1989 ◽  
Vol 18 (1) ◽  
pp. 87-100 ◽  
Author(s):  
Perry Moore
Keyword(s):  
Health Care ◽  
Cost Containment ◽  
Local Governments ◽  
Health Care Cost ◽  
The United States ◽  
Public Agencies ◽  
The Public ◽  
Survey Results ◽  
The Cost ◽  
American Cities

This research provides information about the health care cost containment efforts of local governments and agencies across the United States, particularly in large American cities. Survey results indicate that while the public sector lags behind the private sector, public agencies are beginning to match the cost containment efforts of private employers. While initiation of these efforts represents considerable recent progress, their tangible benefits are not yet apparent.

scholarly journals COVID-19 opens a window of reflection for comparative health systems and global health research

2020 ◽  
Vol 63 ◽  
pp. 190-208
Author(s):  
Tuba İ. Ağartan
Keyword(s):  
Global Health ◽  
Health Systems ◽  
National Policy ◽  
Global Health Research ◽  
Policy Actors ◽  
Opportunities For Learning ◽  
National Information ◽  
The Voice ◽  
North And South ◽  
Health Field

AbstractThe Covid-19 crisis that led to the loss of thousands of lives and initiated one of the most complex social and economic upheavals has also a created a window of reflection for health systems researchers to revisit our major concepts, frameworks, and underlying assumptions. This commentary reviews two literatures that remain rather separate: comparative health policy and global health. First, I examine whether convergence in circumstances brought about by the spread of Covid-19 creates opportunities for learning “about” as well as unpacking the motivations of policy actors and how they use the cross-national information. However, given the emphasis on national policy actors and processes, this literature may overlook the importance of global actors, institutions and ideas. Second, global health differentiates itself with an emphasis on multilateralism as a political positioning and its multidisciplinary and multi-sectoral approach. However, the global health field is also challenged to consider its mission, political standing on multilateralism, changing relationships between North and South and its commitment to multidisciplinary approach. I argue that health systems scholars should use the window of opportunity created by Covid-19 pandemic to reexamine their methodologies and rearticulate their positioning by acknowledging the voice and agency of the Global South.

scholarly journals Issues of Local Significance on Preventive Work with People Exposed to the Ideology of Terrorism in Ethnic Communities in the Flows of Labor Migrants

2020 ◽  
pp. 44-48
Author(s):  
Aleksei Ivanovich Levin ◽  
Lyudmila Viktorovna Levina ◽  
Natalya Vladimirovna Grevtseva
Keyword(s):  
Migrant Workers ◽  
Local Governments ◽  
Local Community ◽  
National Policy ◽  
Social Effects ◽  
Ethnic Communities ◽  
Labor Migrants ◽  
Preventive Work ◽  
General Complex ◽  
Illegal Activities

The present study considers the issues of organiza-tion of activities aimed at prevention of manifesta-tions of extremism and terrorism among migrant workers by local governments. The tasks assigned to local authorities are determined by national policy priorities and the local operational situation. There are specified a number of social effects that arise as a result of the influx of migrants, especially in the labor sphere. It is also noted that labor migrants may, under certain circumstances, become dissemi-nators of extremism and terrorism ideology. Special attention is paid to the processes of involvement of migrants from Central Asia in illegal activities. In connection with the above stated circumstances, there are determined complex tasks concerning pre-vention of extremism manifestations in places of compact settlement of migrants, as well as the tasks of interdepartmental interaction, general, complex and additional preventive activities, targeted work with certain individuals. In conclusion it is empha-sized that competent preventive work with labor migrants and the local community will allow to maintain peaceful interaction between different con-fessions and nationalities within a municipality.

scholarly journals Disaster management strategies and relation of good governance for the coastal Bangladesh

2021 ◽  
Vol 3 (2) ◽  
pp. 269-279
Author(s):  
Prabal Barua ◽  
◽  
Abhijit Mitra ◽  
Saeid Eslamian ◽  
◽  
...  
Keyword(s):  
Disaster Management ◽  
Local Governments ◽  
Local Community ◽  
Good Governance ◽  
Local Level ◽  
Management Strategies ◽  
National Policy ◽  
Successful Implementation ◽  
Community Members ◽  
Management Policies

Although Bangladesh’s immense steps in preparing the disaster management policies following the values of good governance issue, the quantity to which these policies have productively been executing at the local level remnants mostly unknown. The objectives of this investigation were dual: firstly, to inspect the roles and efficiency of the local-level governance and disaster management organization, and lastly, to recognize the obstacles to the execution of national the policies and Disaster-Risk-Reduction guidelines at the local community level. The authors applied qualitative research and case Study approach, using techniques from the Participatory Rural Appraisal toolbox to collect data from local community members as well as government and NGO officials. From the finding of the study, it was revealed that interactive disaster governance, decentralization of disaster management, and compliance by local-level institutions with good governance principles and national policy guidelines can be extremely effective in reducing disaster-loss and damages. According to coastal community members, the local governments have generally failed to uphold good governance principles, and triangulated data confirm that the region at large suffers from rampant corruption, political favoritism, lack of transparency and accountability and minimal inclusion of local inhabitants in decision-making – all of which have severely impeded the successful implementation of national disaster-management policies. This study contributes to these research gaps, with identification of further research agenda in these areas. The paper deals with International Sendai Framework that called for enhancement of local level community resilience to disasters. Thus, it contributes to numerous policy and practice areas relating to good disaster governance. The study identified the specific manifestations of these failures in coastal communities in Bangladesh. These results underscore the vital need to address the wide gap between national DRR goals and the on-the-ground realities of policy implementation to successfully enhance the country’s resilience to climate change-induced disasters.

scholarly journals Post-Soviet Transformations of Health Systems in the South Caucasus

2014 ◽  
Vol 1 (1) ◽  
pp. 48-70 ◽  
Author(s):  
Sophie Hohmann ◽  
Cécile Lefèvre
Keyword(s):  
Health Care ◽  
Health Systems ◽  
International Aid ◽  
The South ◽  
South Caucasus ◽  
Global Crisis ◽  
Oil Boom ◽  
Policy Choices ◽  
The Impact ◽  
Country Specific

This article analyzes post-Soviet changes to the health systems in the three South Caucasus countries of Armenia, Azerbaijan, and Georgia. After a severe economic and social crisis and deindustrialization in the 1990s, divergent trends emerged in the 2000s. Azerbaijan saw a spectacular recovery in growth, fuelled by an oil boom, while the impact of the 2009 global crisis restrained Georgia and Armenia’s capacity to allocate budgets to health care. Many similarities can be identified between the three countries, particularly in the 1990s, attributed to a common Soviet past and to the same trends in international aid. Differences and country-specific features increasingly manifested themselves in the 2000s, and resulting from diverging policy choices.

scholarly journals Politics and Finite Flexibilities: The UN Drug Control Conventions and their Future Development

AJIL Unbound ◽  
2020 ◽  
Vol 114 ◽  
pp. 285-290
Author(s):  
David Bewley-Taylor
Keyword(s):  
Future Development ◽  
National Policy ◽  
Domestic Policy ◽  
Drug Control ◽  
Policy Choices ◽  
Systemic Pressure ◽  
Drug Prohibition

Domestic policy choices concerning the non-medical use of cannabis are generating increased interest in what has been usefully called the global drug prohibition regime. Commentators are questioning whether the UN-based treaty system can accommodate national policy approaches that deviate from the regime's prohibitive ethos. As tension around cannabis “legalization” builds it becomes ever more urgent to relieve systemic pressure, a process to which inter se treaty modification may be key.

Intergovernmental Relations and Energy Policy: What We Know and What We Still Need to Learn

2018 ◽  
Vol 50 (3) ◽  
pp. 203-212
Author(s):  
Luke Fowler
Keyword(s):  
Energy Policy ◽  
Local Governments ◽  
Intergovernmental Relations ◽  
National Policy ◽  
Energy Policies ◽  
Local Authorities ◽  
Political Issue ◽  
National State ◽  
State And Local

Although energy has become a key political issue in recent decades, a comprehensive national policy is lacking, and state and local governments are playing increasingly important and diverse roles. This essay reviews what we know about intergovernmental relations in energy policy, including overlaps between national, state, and local authorities; the character of intergovernmental interactions; and interstate variations. In sum, this essay illustrates why intergovernmental issues in energy policies are an interesting and important area of inquiry, reviews current scholarship in key areas, and suggests possible future avenues for research on this topic.

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