Implementing healthy food environment policies in New Zealand: nine years of inaction

Background The INFORMAS [International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring and Action Support] Healthy Food Environment Policy Index (Food-EPI) was developed to evaluate the degree of implementation of widely recommended food environment policies by national governments against international best practice, and has been applied in New Zealand in 2014, 2017 and 2020. This paper outlines the 2020 Food-EPI process and compares policy implementation and recommendations with the 2014 and 2017 Food-EPI. Methods In March–April 2020, a national panel of over 50 public health experts participated in Food-EPI. Experts rated the extent of implementation of 47 “good practice” policy and infrastructure support indicators compared to international best practice, using an extensive evidence document verified by government officials. Experts then proposed and prioritized concrete actions needed to address the critical implementation gaps identified. Progress on policy implementation and recommendations made over the three Food-EPIs was compared. Results In 2020, 60% of the indicators were rated as having “low” or “very little, if any” implementation compared to international benchmarks: less progress than 2017 (47%) and similar to 2014 (61%). Of the nine priority actions proposed in 2014, there was only noticeable action on one (Health Star Ratings). The majority of actions were therefore proposed again in 2017 and 2020. In 2020 the proposed actions were broader, reflecting the need for multisectoral action to improve the food environment, and the need for a mandatory approach in all policy areas. Conclusions There has been little to no progress in the past three terms of government (9 years) on the implementation of policies and infrastructure support for healthy food environments, with implementation overall regressing between 2017 and 2020. The proposed actions in 2020 have reflected a growing movement to locate nutrition within the wider context of planetary health and with recognition of the social determinants of health and nutrition, resulting in recommendations that will require the involvement of many government entities to overcome the existing policy inertia. The increase in food insecurity due to COVID-19 lockdowns may provide the impetus to stimulate action on food polices.

Importation and distribution of unregistered medicines in the public sector: similarities, differences and shared challenges among Southern African Development Community (SADC) countries

BackgroundThe purpose of the study was to assess the requirements for approval of the importation of unregistered medicines for use in the public sector in the Southern African Development Community (SADC) countries.MethodsThe study reviewed the legal provisions and requirements to be fulfilled when importing unregistered medicines for the public sector in SADC countries relative to two comparators drawn from countries with stringent regulatory systems through extant document analysis. The relative implementation index score was calculated and used to measure the level of implementing legal provisions and requirements to be fulfilled. Analysis was performed using the STATA software package. ResultsApproximately 13 out of 16 SADC countries had a relative implementation index below 50%. The aggregated implementation index across all SADC countries was 44%, ranging from 4% to 54%, while the two comparators had a relative implementation index of 81% and 85%, respectively.ConclusionImplementing the minimum requirements for importing unregistered medicines for the public sector was deficient compared to the jurisdictions with stringent regulatory systems, and wide implementation gaps also existed within the SADC region.

The future of education equity policy in a COVID-19 world: a qualitative systematic review of lessons from education policymaking

Background: COVID-19 had a major global impact on education, prompting concerns about its unequal effects and some impetus to reboot equity strategies. Yet, policy processes exhibit major gaps between such expectations and outcomes, and similar inequalities endured for decades before the pandemic. Our objective is to establish how education researchers, drawing on policy concepts and theories, explain and seek to address this problem. Methods: A qualitative systematic review (2020-21), to identify peer reviewed research and commentary articles on education, equity, and policymaking, in specialist and general databases (ERIC, Web of Science, Scopus, Cochrane/ Social Systems Evidence). We did not apply additional quality measures. We used an immersive and inductive approach to identify key themes. We use these texts to produce a general narrative and explore how policy theory articles inform it. Results: 140 texts (109 articles included; 31 texts snowballed) provide a non-trivial reference to policymaking. Limiting inclusion to English-language produced a bias towards Global North articles. Our comparison with a review of health equity research highlights distinctive elements in education. First, education equity is ambiguous and contested, with no settled global definition or agenda (although some countries and international organisations have disproportionate influence). Second, researchers critique ‘neoliberal’ approaches that dominate policymaking at the expense of ‘social justice’. Third, more studies provide ‘bottom-up’ analysis of ‘implementation gaps’. Fourth, more studies relate inequity to ineffective policymaking to address marginalised groups. Conclusions: Few studies use policy theories to explain policymaking, but there is an education-specific literature performing a similar role. Compared to health research, there is more use of critical policy analysis to reflect on power and less focus on technical design issues. There is high certainty that current neoliberal policies are failing, but low certainty about how to challenge them successfully.

Child Contact Case Management—A Major Policy-Practice Gap in High-Burden Countries

The 2021 Global Tuberculosis (TB) report shows slow progress towards closing the pediatric TB detection gap and improving the TB preventive treatment (TPT) coverage among child and adolescent contacts. This review presents the current knowledge around contact case management (CCM) in low-resource settings, with a focus on child contacts, which represents a key priority population for CCM and TPT. Compelling evidence demonstrates that CCM interventions are a key gateway for both TB case finding and identification of those in need of TPT, and their yield and effectiveness should provide a strong rationale for prioritization by national TB programs. A growing body of evidence is now showing that innovative models of care focused on community-based and patient-centered approaches to household contact investigation can help narrow down the CCM implementation gaps that we are currently facing. The availability of shorter and child-friendly TPT regimens for child contacts provide an additional important opportunity to improve TPT acceptability and adherence. Prioritization of TB CCM implementation and adequate resource mobilization by ministries of health, donors and implementing agencies is needed to timely close the gap.

An assessment of implementation gaps and priority recommendations on food environment policies: the Healthy Food Environment Policy Index (Food-EPI) in Japan

Objective: This study aimed to evaluate policies and actions for food environments by the Japanese Government using the Healthy Food Environment Policy Index (Food-EPI). Design: Public health experts rated the extent of implementation of food environment-related the Policy and the Infrastructure-support components, compared to international best practices. Subsequently, the experts proposed and prioritized future actions to address implementation gaps in an online workshop. Setting: Japan Participants: A total of 66 experts rated policy implementation by the Japanese Government, and 23 participated in the workshop on future actions. Results: The implementations of regulations on unhealthy foods and non-alcoholic beverages were rated low in the domains of Food composition, Food labelling, Food promotion, Food prices, and Food retail in the Policy component. The implementations of several domains in the Infrastructure-support component were, overall, rated at a higher level, specifically for monitoring and intelligence systems. Based on the rating, reducing health inequalities by supporting people, both economically and physically, was the highest priority for future actions in both components. Conclusions: This study found that Japan has a robust system for long-term monitoring of population health but lacks regulations on unhealthy foods and non-alcoholic beverages compared to international best practices. This study confirmed the importance of continuous accumulation of evidence through national monitoring systems. Developing comprehensive regulations to restrict food marketing, sales, and accessibility of unhealthy foods and non-alcoholic beverages are needed to improve the health of food environments in Japan.

Implementation Gaps in Human Resource Performance Management Practices in the Ministry of Health and Child Care, Zimbabwe.

Any performance management (PM) practice implemented by an organisation has a direct impact on organisational performance and development; this paper therefore discusses challenges based on primary and secondary research findings, with the aim to explore how these findings correlate with how the successful implementation of PM practices is perceived and applied in the Ministry of Health and Child Care (MOHCC) in Zimbabwe. A qualitative research approach was used to collect data. The findings confirm that the implementation of PM has been marred by various challenges, which have, in turn, greatly affected performance results. Challenges identified by this study were, and continue to be, experienced at different levels of PM implementation strategies (e.g., at the formulation stage versus the implementation stage), and hence may hinder the effective implementation of PM practices in the MOHCC. The paper offers recommendations for consideration at political, policy, organisational, departmental, individual, and stakeholder levels.

Urban water conundrums in Zimbabwe – the role of water policy and its implementation gaps

Zimbabwe's urban areas are experiencing a dearth of water services which is epitomized by acute water shortages and high morbidity due to waterborne diseases. The possible contribution of failures of water policy implementation to this state of affairs is explored. This review identifies and assesses 122 studies in Zimbabwe and in other countries that have analyzed water policies, in order to understand the factors which create gaps in policy implementation. It was found that these implementation gaps are mainly a result of capacity limitations in institutions; finances; social and technical/human resources. There is currently very limited literature available that analyses water policy in Zimbabwe. In order to overcome the water conundrums in Zimbabwe's urban areas it is recommended that a literature review combined with an empirical study of both qualitative and quantitative gaps between the ZNWP and its implementation be undertaken. In particular, the review and study should focus on capacity limitations in institutions; finances; social and technical/human resources in Zimbabwe.

Systematic Assessment of COVID-19 Pandemic in Bangladesh: Effectiveness of Preparedness in the First Wave

Background: To develop an effective countermeasure and determine our susceptibilities to the outbreak of COVID-19 is challenging for a densely populated developing country like Bangladesh and a systematic review of the disease on a continuous basis is necessary.Methods: Publicly available and globally acclaimed datasets (4 March 2020–30 September 2020) from IEDCR, Bangladesh, JHU, and ECDC database are used for this study. Visual exploratory data analysis is used and we fitted a polynomial model for the number of deaths. A comparison of Bangladesh scenario over different time points as well as with global perspectives is made.Results: In Bangladesh, the number of active cases had decreased, after reaching a peak, with a constant pattern of death rate at from July to the end of September, 2020. Seventy-one percent of the cases and 77% of the deceased were males. People aged between 21 and 40 years were most vulnerable to the coronavirus and most of the fatalities (51.49%) were in the 60+ population. A strong positive correlation (0.93) between the number of tests and confirmed cases and a constant incidence rate (around 21%) from June 1 to August 31, 2020 was observed. The case fatality ratio was between 1 and 2. The number of cases and the number of deaths in Bangladesh were much lower compared to other countries.Conclusions: This study will help to understand the patterns of spread and transition in Bangladesh, possible measures, effectiveness of the preparedness, implementation gaps, and their consequences to gather vital information and prevent future pandemics.