scholarly journals Overcoming institutionalised barriers to digital health systems: An autoethnographic study of the judicialization of a digital health tool.

2021 ◽  
Author(s):  
Dudzai Mureyi
Keyword(s):  
Health Systems ◽  
Digital Health ◽  
Health Sector ◽  
Pharmaceutical Advertising ◽  
Institutional Work ◽  
Digital Tool ◽  
Medicines Information ◽  
Regulatory Bodies

Abstract Background The deployment of digital health systems may be impeded by barriers that or are linked to underlying enduring institutions. Attempting to challenge the barriers without addressing the underpinning institution may be ineffective. This study reflects on ways actors may surmount institutionalised barriers to the uptake of digital tools in health systems. Methods Institutional theory concepts were applied to an autoethnographic case study of efforts to introduce a digital tool to provide citizens with medicines information. Results The tool’s uptake was impeded because of state regulators’ institutionalised interpretation of pharmaceutical advertising laws, which rendered the tool illegal. The regulators’ institutionalised interpretation of pharmaceutical advertising laws was successfully challenged through various actions by the author- a pharmacist, and by allies beyond the health sector. These actions included: framing the tool as legal and constitutional, litigation, and redefining these concepts: ‘advertising’, ‘health institution’, and the role of regulatory bodies vis a vis innovation. Conclusion After identifying a barrier as being institutionalised or linked to an institution, actors might challenge such barriers by engaging in institutional work; i.e. deliberate efforts to challenge the relevant institution (e.g. a law, norm or shared belief). Institutional work may require the actions of multiple actors within and beyond the health sector, including judicial actors. Such cross-sectoral alliances are efficacious because they provide institutional workers with a broader range of strategies, framings, concepts and forums with which to challenge institutionalised barriers. However, actors beyond the health system (e.g. the judiciary) must be inquisitive about the potential implications of the digital health interventions they champion.

scholarly journals The complexity of scaling up an mHealth intervention: the case of SMS for Life in Tanzania from a health systems integration perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carmen Sant Fruchtman ◽  
Selemani Mbuyita ◽  
Mary Mwanyika-Sando ◽  
Marcel Braun ◽  
Don de Savigny ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Large Scale ◽  
Digital Health ◽  
Health Sector ◽  
Building Blocks ◽  
Scaling Up ◽  
Stock Management ◽  
Study Approach

Abstract Background SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. Its goal was to increase visibility to antimalarial stock-outs through the use of SMS technology. The objective of this case study was to show the multiple innovations that SMS for Life brought to the Tanzanian public health sector and to discuss the challenges of scaling up that led to its discontinuation from a health systems perspective. Methods A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Data collection was informed by the health system building blocks. We then carried out a thematic analysis using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework. This served to identify the key reasons for the discontinuation of the programme. Results SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after 4 years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers. Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system. Conclusion This study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.

Institutional work and implementation of a performance measurement and management system in a developing country

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
A.K. Siti-Nabiha ◽  
Teddy Jurnali
Keyword(s):  
Local Government ◽  
Performance Measurement ◽  
Developing Country ◽  
Cultural Work ◽  
Institutional Work ◽  
Content Type ◽  
Public Managers ◽  
Norms And Values

Purpose This paper aims to investigate the actions and activities undertaken by public managers of a local government to institutionalise an externally mandated performance measurement and management (PMM) system in a developing country. Design/methodology/approach A qualitative case study of one of the best-ranked early adopters of PMM in a local government in Indonesia was undertaken, with interviews with public officers at various organisational levels, along with an extensive documentary review. An institutional work perspective was used to explain the types of work undertaken to institutionalise PMM at the organisation. Findings The PMM change was shown to be centralised and directed from the top and facilitated by other public officers. The Mayors’ instrumental and political view of PMM as a tool for efficiency and societal legitimacy enabled the adoption of PMM. The political and cultural work of the Mayor and the key officers involved constructing new rules pertaining to PMM, specifically in dealing with resource allocation and its associated sanctions and rewards, which encouraged more substantive implementation. The substantive implementation of PMM had a significant influence on the norms and values of the local government. Research limitations/implications The case organisation is the local government of a relatively medium-sized city. Therefore, it may be easier to achieve tighter control and coordination as compared to the local government of other larger cities. Originality/value The paper highlights the interrelated nature of institutional work in the creation and disruption of institutions. In addition, the three main types of institutional work, i.e. political, cultural and technical work, are not mutually exclusive. The paper also indicates the processes involved in the implementation of PMM, which unfolds from the establishment of a policy, its impact, and the role of the actors in the process.

The Role of Companies-in-Movements in Regional Sustainability Transitions. A Case Study on the Economy for the Common Good in South Tyrol

2019 ◽  
Vol 20 (3) ◽  
pp. 376-405
Author(s):  
Niklas S. Mischkowski ◽  
Philipp Späth
Keyword(s):  
Structural Change ◽  
Social Movement ◽  
Common Good ◽  
Sustainability Transitions ◽  
Institutional Work ◽  
South Tyrol ◽  
The Common Good ◽  
The Common

This study explores the movement for an ›Economy for the Common Good‹ from a sustainability transitions perspective. Special interest lies in the integration of companies in a social movement. The underlying study was carried out in the region of South Tyrol, Italy. It reveals what institutional work was involved, explores impacts and reflects on the role that companies, especially small and medium-sized ones, can play in structural change.

scholarly journals EXPLORING THE ABSENCE OF WATCHDOG JOURNALISM IN NIGERIA BROADCAST MEDIA

2020 ◽  
Vol 8 (1) ◽  
pp. 480-490
Author(s):  
Maryam Abdu Gainaka ◽  
Syed Agil Alsagoff ◽  
Akmar Hayati Ahmad Ghazali
Keyword(s):  
Freedom Of Information ◽  
Investigative Journalism ◽  
Broadcast Media ◽  
Face To Face ◽  
Study Approach ◽  
Regulatory Bodies ◽  
Capital Intensive ◽  
Insight Into

Purpose of the study: The research became necessary to explore the watchdog role of broadcast media in Nigeria. The study was conducted for the purpose of understanding how broadcast media interpret the watchdog function and the reason for its rarity in Nigeria broadcast media. Methodology: The study used the qualitative case study approach. Two broadcast media were purposively selected for the study-FRCN and AIT. Semi-structured face to face interview was used to collect data from ten informants comprising of senior editors and field reporters who were purposively selected for the study. Researchers used thematic analysis for data analysis to interpret and discuss findings. Main findings: The broadcast media perform the watchdog role through reporting of investigations not initiated by them and also through their programs. The absence of watchdog in their media is influenced by the interference of broadcast media owners, enormous economic and commercial pressures on them being a more capital intensive media as well as the failure of broadcast media practitioners to explore the freedom of information Act like their print counterparts do. Application/Implication: The findings offer a reference point for media regulatory bodies to discover broadcast media issues that are useful for making regulations to improve media practice. It contributes to the call for media social responsibility by providing insight into the impediments of fulfilling the media’s social obligation as a watchdog. Novelty/originality: Research in the area of media watchdog role and functions have often focused on audience perceptions and evaluations of print media. This study explored broadcast media and added to the conceptualization of the concept of media as watchdog beyond investigative journalism only.

Public-private partnerships and collaboration in digital health: a scoping review and case study analysis of applications during the COVID-19 pandemic (Preprint)

2021 ◽  
Author(s):  
Nishali Kirit Patel ◽  
Elinor Wahal ◽  
Adriana Mancilla Galindo ◽  
Alejandra Rodarte ◽  
Tim Jesudason ◽  
...  
Keyword(s):  
Public Health ◽  
Case Studies ◽  
Literature Search ◽  
Digital Health ◽  
Grey Literature ◽  
Public Private Partnerships ◽  
Search Results ◽  
Stage Process

BACKGROUND The emergence of digital technologies over the past decade has presented a novel opportunity to address healthcare challenges associated with COVID-19 and accelerate progress towards achieving the health-related goals under the 2030 Sustainable Development Agenda. Public-private partnerships (PPPs) have played a vital role in scaling up digital health solutions and disseminating curated scientific information in the face of the infodemic. However, several challenges remain around the effectiveness of PPP-related digital solutions and antagonistic viewpoints of engaging the private sector. We sought to evaluate the role of public-private partnerships in the digital public health space during COVID-19 and identify key lessons learned and challenges in the uptake of digital health solutions globally. OBJECTIVE Electronic and grey literature search results from PubMed, Google, and Google Scholar were screened by one reviewer through a two-stage process. We included all relevant systematic reviews, interventional, observational, and descriptive studies published in English published from January 2020 to June 2021. Two case study analyses on digital health chatbots, informed by expert opinion, were also performed to assess for the role of public-private partnerships in advancing digital public health solutions. METHODS Electronic and grey literature search results from PubMed, Google, and Google Scholar were screened by one reviewer through a two-stage process. We included all relevant systematic reviews, interventional, observational, and descriptive studies published in English published from January 2020 to June 2021. Two case study analyses on digital health chatbots, informed by expert opinion, were also performed to assess for the role of public-private partnerships in advancing digital public health solutions. RESULTS Forty-five articles met the inclusion criteria for qualitative analysis, the majority of which were secondary research. Results of the publications can be broadly categorized into three groups: (1) models and definitions of public-private partnerships used in the healthcare space; (2) purposes of and motivations of public-private partnerships in global public health; and (3) and facilitators, barriers, and challenges to date. CONCLUSIONS The literature review as well as the case studies analysis reveal that PPPs can represent a valid option for tackling global healthcare issues with a digital health approach. Further research is needed to complement the initial findings of the present paper, as well as to assess a wider pool of case studies and the different features that they might present.

scholarly journals Understanding the Role of Values in Health Policy Decision-Making From the Perspective of Policy-Makers and Stakeholders: A Multiple-Case Embedded Study in Chile and Colombia

2019 ◽  
Author(s):  
Marcela Vélez ◽  
Michael G. Wilson ◽  
Julia Abelson ◽  
John N. Lavis ◽  
Guillermo Paraje
Keyword(s):  
Decision Making ◽  
Health Systems ◽  
Latin American ◽  
Human Dignity ◽  
Comparative Approach ◽  
Policy Makers ◽  
Key Informants ◽  
Multiple Case

Background: Chile and Colombia are examples of Latin American countries with health systems shaped by similar values. Recently, both countries have crafted policies to regulate the participation of private for-profit insurance companies in their health systems, but through very different mechanisms. This study asks: what values are important in the decision-making processes that crafted these policies? And how and why are they used? Methods: An embedded multiple-case study design was carried out for 2 specific decisions in each country: (1) in Chile, the development of the Universal Plan of Explicit Entitlements -AUGE/GES - and mandating universal coverage of treatments for high-cost diseases; and (2) in Colombia, the declaration of health as a fundamental right and a mechanism to explicitly exclude technologies that cannot be publicly funded. We interviewed key informants involved in one or more of the decisions and/or in the policy analysis and development process that contributed to the eventual decision. The data analysis involved a constant comparative approach and thematic analysis for each case study. Results: From the 40 individuals who were invited, 28 key informants participated. A tension between 2 important values was identified for each decision (eg, solidarity vs. individualism for the AUGE/GES plan in Chile; human dignity vs. sustainability for the declaration of the right to health in Colombia). Policy-makers used values in the decisionmaking process to frame problems in meaningful ways, to guide policy development, as a pragmatic instrument to make decisions, and as a way to legitimize decisions. In Chile, values such as individualism and free choice were incorporated in decision-making because attaining private health insurance was seen as an indicator of improved personal economic status. In Colombia, human dignity was incorporated as the core value because the Constitutional Court asserted its importance in its use of judicial activism as a check on the power of the executive and legislative branches. Conclusion: There is an opportunity to open further exploration of the role of values in different health decisions, political sectors besides health, and even other jurisdictions.

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