The impact of central government steering and local network dynamics on the performance of mandated service delivery networks: the case of the Primary Health Care networks in Flanders

This paper focuses on the impact of central – local relations on the performance of local service delivery networks set up by central government. Analyzing network literature leaves us with some questions about the impact of coordination strategies of central government as a possible determinant of network-level effectiveness for this type of network and the possible interaction between central government coordination (as part of the network context) and internal network dynamics and the combined effects hereof on the effectiveness of mandated service delivery networks in particular. Our analysis shows that both levels are important to explain the outcomes of the Primary Health Care networks in Flanders. Our study also leads to some important observations about the meaning of ‘central government coordination’ in this context

Rescaling the state in Flanders: new problem or old solution?

The rescaling of state emphasizes the rise of the regional and the city-regional scale in particular, as a new unit for policy making. The new governing strategy is referred to as regional governance, were both governmental and / or nongovernmental entities work together for the purpose of joint policy making or service delivery. This paper focuses on the operationalization of regional governance and links those findings to the actual debates surrounding the institutional organization of Flanders. A quantitative analysis of regional arrangements in Flanders and in the area of Mid-West Flanders, helps to clarify the nature of the rescaling of the state: the rescaling is the result of bottom – up and top – down initiatives and covers as well joined government arrangements as collaborative governance arrangements integrating public and private organizations. Further, we notice different roles of the Flemish government, as she is present at the regional level both as a meta-governor, actor and financier. By showing the nature and the content of regional governance, this paper helps to clarify the political debate that is going on now in Flanders. A debate dominated by classical institutional discussions and related to the issue of institutional fuzziness, efficiency and accountability. It is argued however that the political discussion and the organization of the public sector in Flanders should be renewed and should be inspired by this relatively new phenomenon. The rescaling of the regional state should be understood by using concepts, theories and instruments inspired by the literature on networks and collaborative governance

Poor Performance of Health and Population Welfare Programmes in Sindh: Case Studies in Governance Failure

Over the past few years, the issue of what is meant by “good governance” has generated increasing attention and debate both at the national and international level [Streeten (1997)]. The role of state and how that role is to be exercised is appearing high on the agenda of politicians, policy-makers and academicians in the developing world. Governance has been defined by the World Bank as “the manner in which power is exercised in the management of the country’s economic and social resources” [World Bank (1994)]. The somewhat narrow scope of this definition has been broadened in recent years to “the sum of the many ways individuals and institutions, public and private, manage their common affairs” [Commission on Global Governance (995)] The Human Development Report [UNDP (1999)] goes beyond these definitions and gives a much more radical notion of good governance, underpinning the importance of peoples’ participation in shaping their own governance and development. This type of governance has been labeled as “humane governance”. A review of existing literature thus shows that governance has been interpreted to have different elements such as management of economic and social resources for development, formulation and implementation of policies, discharging of functions, accommodation of diverse interests towards cooperative action and above all, accountability to people and ownership by the people of the governance process. In view of the above, one may ask what constitutes good governance for the health sector? Management of resources pertains to the concept of efficiency, a term appearing with increasing frequency in global literature on health care reforms; policy formulation and discharging of functions allude to the objective of effectiveness which itself has a wide scope encompassing relevance, quality and availability of health care; while “humane governance” brings in the notion of community participation and accountability with regards to decision-making and delivery of health care.

Integration and Continuity of Primary Care: Polyclinics and Alternatives, a Patient-Centred Analysis of How Organisation Constrains Care Coordination

Background An ageing population, increasingly specialised of clinical services and diverse healthcare provider ownership make the coordination and continuity of complex care increasingly problematic. The way in which the provision of complex healthcare is coordinated produces – or fails to – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational, relational). Care coordination is accomplished by a combination of activities by: patients themselves; provider organisations; care networks coordinating the separate provider organisations; and overall health system governance. This research examines how far organisational integration might promote care coordination at the clinical level. Objectives To examine: 1. What differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical coordination of care. 2. What difference provider ownership (corporate, partnership, public) makes. 3. How much scope either structure allows for managerial discretion and ‘performance’. 4. Differences between networked and hierarchical governance regarding the continuity and integration of primary care. 5. The implications of the above for managerial practice in primary care. Methods Multiple-methods design combining: 1. Assembly of an analytic framework by non-systematic review. 2. Framework analysis of patients’ experiences of the continuities of care. 3. Systematic comparison of organisational case studies made in the same study sites. 4. A cross-country comparison of care coordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics. 5. Analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute in-patient care. Results Starting from data about patients' experiences of the coordination or under-coordination of care we identified: 1. Five care coordination mechanisms present in both the integrated organisations and the care networks. 2. Four main obstacles to care coordination within the integrated organisations, of which two were also present in the care networks. 3. Seven main obstacles to care coordination that were specific to the care networks. 4. Nine care coordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than were care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care coordination because of its impact on GP workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care coordination, and therefore continuities of care, than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings

A Monitoring Network for Spectrum Governance

Dynamic Spectrum Access (DSA) is an exciting new technology, which has introduced a paradigm shift in spectrum access. As a result it also changes the role of the regulator. On one hand the scarce radio spectrum should be used in an optimal way, so that society is best served. On the other hand interference between users and between networks should be avoided. For that reason rules have to be defined for spectrum use. This topic is called spectrum governance. For evaluation and to check whether devices obey the rules, a monitoring system is needed. In this paper, we propose to use a fleet of mobile monitoring vehicles for this purpose.\u

A Framework for Integrating Transportation Into Smart Cities

In recent years, economic, environmental, and political forces have quickly given rise to “Smart Cities” -- an array of strategies that can transform transportation in cities. Using a multi-method approach to research and develop a framework for smart cities, this study provides a framework that can be employed to: Understand what a smart city is and how to replicate smart city successes; The role of pilot projects, metrics, and evaluations to test, implement, and replicate strategies; and Understand the role of shared micromobility, big data, and other key issues impacting communities. This research provides recommendations for policy and professional practice as it relates to integrating transportation into smart cities

A systems approach to evaluate One Health initiatives

Challenges calling for integrated approaches to health, such as the One Health (OH) approach, typically arise from the intertwined spheres of humans, animals, and ecosystems constituting their environment. Initiatives addressing such wicked problems commonly consist of complex structures and dynamics. As a result of the EU COST Action (TD 1404) “Network for Evaluation of One Health” (NEOH), we propose an evaluation framework anchored in systems theory to address the intrinsic complexity of OH initiatives and regard them as subsystems of the context within which they operate. Typically, they intend to influence a system with a view to improve human, animal, and environmental health. The NEOH evaluation framework consists of four overarching elements, namely: (1) the definition of the initiative and its context, (2) the description of the theory of change with an assessment of expected and unexpected outcomes, (3) the process evaluation of operational and supporting infrastructures (the “OH-ness”), and (4) an assessment of the association(s) between the process evaluation and the outcomes produced. It relies on a mixed methods approach by combining a descriptive and qualitative assessment with a semi-quantitative scoring for the evaluation of the degree and structural balance of “OH-ness” (summarised in an OH-index and OH-ratio, respectively) and conventional metrics for different outcomes in a multi-criteria-decision-analysis. Here, we focus on the methodology for Elements (1) and (3) including ready-to-use Microsoft Excel spreadsheets for the assessment of the “OH-ness”. We also provide an overview of Element (2), and refer to the NEOH handbook for further details, also regarding Element (4) (http://neoh.onehealthglobal.net). The presented approach helps researchers, practitioners, and evaluators to conceptualise and conduct evaluations of integrated approaches to health and facilitates comparison and learning across different OH activities thereby facilitating decisions on resource allocation. The application of the framework has been described in eight case studies in the same Frontiers research topic and provides first data on OH-index and OH-ratio, which is an important step towards their validation and the creation of a dataset for future benchmarking, and to demonstrate under which circumstances OH initiatives provide added value compared to disciplinary or conventional health initiatives

The technical efficiency of Public Libraries in the Czech Republic

The purpose of this article is to define and evaluate the development of the aggregated technical efficiency of public libraries in the Czech Republic from 1993 to 2014. To simulate technical efficiency, the Data Envelopment Analysis Model (The BCC model) was chosen. To evaluate the production units (the unit of the Czech Republic from 1993 to 2014 and its production is given by the sum of real homogenous units, i.e. the public libraries operating in a given area and in a given time), two input variables (the recalculated number of employees and the library collection) and two output variables (the number of registered readers and the number of loans) were analysed. Two basic models were simulated – the M1 model oriented to inputs and the M2 model oriented to outputs. Correlation between the input and output variables was researched using Pearson’s coefficient. Within the range of the M1 and M2 basic models, partial models were simulated. All of the basic and partial models identically showed eight efficient periods of public libraries in the Czech Republic (1995, 1997, 1999–2000, 2002–2005). Public libraries were, according to the chosen variables, inefficient in the remaining 16 observed years