Bridging the policy-implementation gap in federal health systems: lessons from the Nigerian experience

The Partnership for Reviving Routine Immunization in Northern Nigeria - Maternal, Newborn and Child Health initiative supports efforts by the government of Nigeria to bridge primary health care (PHC) policies and services at three levels of government: federal, state and local. The paper suggests that understandings informed by complexity theory and complex adaptive systems have been helpful in shaping policy and programme design across these levels. To illustrate this, three initiatives are explored: <em>Bringing PHC under one roof</em>, enhancing access to funding provided by the Global Alliance for Vaccines and Immunization, and strengthening the midwives service scheme. These initiatives have demonstrated how concepts and experience developed at subnational level can influence national policy and practice, and how work at subnational levels can add value to nationally conceived and nationally driven plans for PHC.

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A Transdisciplinary Complex Adaptive Systems (T-CAS) Approach to Developing a National School-Based Culture of Prevention for Health Improvement: the School Health Research Network (SHRN) in Wales

Prevention Science ◽

10.1007/s11121-018-0969-3 ◽

2018 ◽

Vol 22 (1) ◽

pp. 50-61 ◽

Cited By ~ 10

Author(s):

Simon Murphy ◽

Hannah Littlecott ◽

Gillian Hewitt ◽

Sarah MacDonald ◽

Joan Roberts ◽

...

Keyword(s):

Complex Adaptive Systems ◽

Health Research ◽

Adaptive Systems ◽

School Health ◽

Systems Approach ◽

Research Network ◽

Health Improvement ◽

Policy And Practice ◽

Complex Adaptive ◽

Culture Of Prevention

AbstractThe paper reflects on a transdisciplinary complex adaptive systems (T-CAS) approach to the development of a school health research network (SHRN) in Wales for a national culture of prevention for health improvement in schools. A T-CAS approach focuses on key stages and activities within a continuous network cycle to facilitate systems level change. The theory highlights the importance of establishing transdisciplinary strategic partnerships to identify and develop opportunities for system reorientation. Investment in and the linking of resources develops the capacity for key social agents to take advantage of disruption points in the re-orientated system, and engagement activities develop the network to facilitate new social interactions and opportunities for transdisciplinary activities. A focus on transdisciplinary action research to co-produce interventions, generate research evidence and inform policy and practice is shown to play an important part in developing new normative processes that act to self-regulate the emerging system. Finally, the provision of reciprocal network benefits provides critical feedback loops that stabilise the emerging adaptive system and promote the network cycle. SHRN is shown to have embedded itself in the system by securing sustainability funding from health and education, a key role in national and regional planning and recruiting every eligible school to the network. It has begun to reorient the system to one of evidence generation (56 research studies co-produced) and opportunities for data-led practice at multiple levels. Further capacity development will be required to capitalise on these. The advantages of a complex systems approach to address barriers to change and the transferability of a T-CAS network approach across settings and cultures are highlighted.

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Implementation of shared decision-making in healthcare policy and practice: a complex adaptive systems perspective

Evidence & Policy A Journal of Research Debate and Practice ◽

10.1332/174426419x15468571657773 ◽

2020 ◽

Vol 16 (3) ◽

pp. 393-411 ◽

Cited By ~ 1

Author(s):

Sarah Munro ◽

Jude Kornelsen ◽

Elizabeth Wilcox ◽

Sarah Kaufman ◽

Nick Bansback ◽

...

Keyword(s):

Decision Making ◽

Patient Safety ◽

Complex Adaptive Systems ◽

Adaptive Systems ◽

Decision Makers ◽

Shared Decision ◽

Policy And Practice ◽

Risks And Benefits ◽

Social Risks ◽

Complex Adaptive

Background:Despite the suggested benefits of shared decision-making (SDM), its implementation in policy and practice has been slow and inconsistent. Use of complex adaptive systems (CAS) theory may provide understanding of how healthcare system factors influence implementation of SDM. Methods:Using the example of choice of mode of birth after a previous caesarean section, in-depth, semi-structured interviews were conducted with patients, providers, and decision makers in British Columbia, Canada, to explore the system characteristics and processes that influence implementation of SDM. Implementation and knowledge translation principles guided study design, and constructionist grounded theory informed iterative data collection and analysis. Findings:Analysis of interviews (n=58) revealed that patients formed early preferences for mode of delivery (after the primary caesarean) through careful deliberation of social risks and benefits. Physicians acted as information providers of clinical risks and benefits, while decision makers revealed concerns related to liability and patient safety. These concerns stemmed from perceptions of limited access to surgical resources, which had resulted from budget constraints. Discussion and conclusions:To facilitate the effective implementation of SDM in policy and practice it may be critical to initiate SDM once patients become aware of their healthcare options, assist patients to address the social risks that influence their preferences, manage perceptions of risk related to patient safety and litigation among physicians, and enhance access to healthcare resources.

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Emerging Issues in Decentralized Resource Governance: Environmental Federalism, Spillovers, and Linked Socio-Ecological Systems

Annual Review of Resource Economics ◽

10.1146/annurev-resource-110319-114535 ◽

2020 ◽

Vol 12 (1) ◽

pp. 259-279 ◽

Cited By ~ 1

Author(s):

William Shobe

Keyword(s):

Complex Adaptive Systems ◽

Adaptive Systems ◽

Environmental Governance ◽

National Policy ◽

Ecological Systems ◽

Local Policy ◽

Environmental Federalism ◽

Resource Governance ◽

Complex Adaptive ◽

Emerging Issues

Spillovers among jurisdictions are ubiquitous and likely to increase with increasing population and consumption, so the centralization or decentralization of environmental governance is of pressing concern in a world of tightly linked socio-ecological systems. Spillovers play a key role in federalism analysis because they tend to reduce benefits from decentralization. Laboratory federalism, a common rationale for decentralization, has not proven successful as a model of local policy innovation. Given a national policy toward a public good, differences in preferences across jurisdictions may push national policy toward a quantity instrument rather than a tax instrument. Finally, the lack of interaction between environmental federalism analysis and studies of adaptive governance and linked complex adaptive systems leaves both literatures incomplete. The increasing urgency of global sustainability issues argues for linking insights from environmental federalism with the literature on linked socio-ecological complex adaptive systems.

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Killing the goose? The value chain for sorghum beer in Kenya

Journal of Agribusiness in Developing and Emerging Economies ◽

10.1108/jadee-03-2017-0028 ◽

2018 ◽

Vol 8 (1) ◽

pp. 34-53 ◽

Cited By ~ 3

Author(s):

Alastair Orr

Keyword(s):

Conceptual Framework ◽

Complex Adaptive Systems ◽

Value Chain ◽

Adaptive Systems ◽

Policy Decision ◽

Content Type ◽

Excise Duty ◽

Interacting Agents ◽

Complex Adaptive ◽

The Government

Purpose The decision by the Government of Kenya in 2013 to increase tax revenue by imposing excise duty of 50 percent on sorghum beer resulted in economic losses for smallholders, the brewery, and the government itself because it effectively killed the value chain. In 2015, the government reversed the policy decision and reduced excise duty to 10 percent. The purpose of this paper is to analyze the impact of this policy decision on the value chain, adaptation by growers and the brewery, and the rationale for this policy change and its reversal. Design/methodology/approach The author analyzes this episode using a conceptual framework derived from complex adaptive systems, focusing on four properties of such systems: sudden, endogenous shocks, interacting agents, and adaptation. Findings The author shows how the nature of politics in Kenya exposed the value chain to endogenous shocks as the result of conflicts between interacting agents, where smallholder farmer organizations were important for successful adaptation. Conflicts between development and political objectives in neo-patrimonial states are sources of complexity and uncertainty in smallholder value chains. Research limitations/implications Complex adaptive systems proved a useful framework to understand decision making by government and business actors in the value chain. Originality/value The paper applies a novel conceptual framework to the analysis of an important value chain in Kenya.

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