Governance for Equity in Health Systems : final prospectus report

The prospectus paved the way for a more focused program contributing to strengthening equitable health systems and improved health outcomes. This report is a self-assessment by members of the GEHS team to explain and understand how the program theory of change did or did not unfold. The program made funding and operational decisions explicitly based on the systematic application of the principles of governance, equity, and systems integration. In practice, the projects sought to unpack the dynamics of power and deal with the structural issues of health and development. The evaluation report provides details of numerous projects and outcomes

What can global health institutions do to help strengthen health systems in low income countries?

Weaknesses in health systems contribute to a failure to improve health outcomes in developing countries, despite increased official development assistance. Changes in the demands on health systems, as well as their scope to respond, mean that the situation is likely to become more problematic in the future. Diverse global initiatives seek to strengthen health systems, but progress will require better coordination between them, use of strategies based on the best available evidence obtained especially from evaluation of large scale programs, and improved global aid architecture that supports these processes. This paper sets out the case for global leadership to support health systems investments and help ensure the synergies between vertical and horizontal programs that are essential for effective functioning of health systems. At national level, it is essential to increase capacity to manage and deliver services, situate interventions firmly within national strategies, ensure effective implementation, and co-ordinate external support with local resources. Health systems performance should be monitored, with clear lines of accountability, and reforms should build on evidence of what works in what circumstances

The representativeness of global deliberation: A critical assessment of civil society consultations for sustainable development

During the negotiations of the Sustainable Development Goals, the United Nations consulted worldwide nearly ten million people for their views. Such proliferating megaconsultations are often uncritically accepted as a remedy for an assumed democratic deficit of intergovernmental institutions. We argue, however, that the potential of civil society consultations to democratize global governance is constrained by the limited legitimacy of these consultations in the first place. Global consultations regularly fail to include civil society actors from developing countries, or show other sociodemographic biases. Also, they often fail to strengthen accountability between citizens, international organizations and governments. In this article, we investigate the causes of this phenomenon by exploring the relationship between the design of consultations and their democratic legitimacy. The basis for our argument is an in-depth empirical study of three consultations carried out during the negotiations of the Sustainable Development Goals. We find that design is an important variable to explain the overall legitimacy of consultations. Yet its exact role is sometimes unexpected. Extensive material resources and open access conditions do not systematically enhance the legitimacy of the studied consultations. Instead, developing clear objectives, allocating sufficient time to participants, and formally binding the consultation to the negotiations hold considerably more promise

Adoption of renewable energy technologies in oil-rich countries: Explaining policy variation in the Gulf Cooperation Council states

While the member states of the Gulf Cooperation Council have economically and politically been dominated by the exploitation of fossil fuels, recent years have seen an increasing adoption of renewable energy technologies, the reasons of which are not yet sufficiently understood. This paper argues that the recent adoption of renewable energy technologies in the Gulf and its striking variation can be explained by theories of policy transfer. In addition, we find some support for the alternative hypothesis of endogenous policy development regarding political leadership. Yet there is no support for the alternative hypothesis of a strong direct influence of the international climate regime. Furthermore, the policy transfer hypothesis and political leadership stand as coexisting influences on renewable energy adoption, rather than competing ones. Based on an extensive study of primary and secondary sources, local reports and country analyses of international organizations, and personal interviews with key experts, this paper lays out in detail how transfers of renewable energy policies take place in the Gulf; their drivers; and their impacts. We also discuss the factors that lead countries to lag behind, which can be helpful for prospective research on a more extensive utilization of renewable energy in the region and beyond

Understanding the protein transition: The rise of plant-based meat substitutes

Even though the food system is responsible for a significant part of global greenhouse gas (GHG) emissions and a transition to a sustainable food system is needed, the growing body of literature on sustainability transitions has paid little attention to the food processing sector. We expect transition dynamics in the food processing sector to differ from the typical dynamics portrayed in transitions literature due to particularities in required technological knowledge and government intervention. To better understand dynamics in the food processing sector we apply the Technological Innovations Systems (TIS) framework to an in-depth case study of the plant-based meat substitutes industry in the Netherlands. Results illustrate that, contrary to many other transitions, consumers and changing informal institutions are the driving forces of this process. We show how strengthening cognitive and normative legitimacy can lead to growing markets for sustainable products

Challenging dominant sustainability worldviews on the energy transition: Lessons from Indigenous communities in Mexico and a plea for pluriversal technologies

Little research exists on how alternative understandings of sustainability and societal well-being, such as those developed by marginalized Indigenous populations, can enrich and possibly challenge dominant visions of sustainability anchored in Western discourses on sustainable development and ecological modernization. This paper addresses this research gap in the context of the transition towards low-carbon energy sources by addressing the following question: how do Indigenous worldviews contrast with modernist visions of sustainability in the context of the energy transition? To do so, it first builds a conceptual framework contrasting modernist and Indigenous sustainability worldviews. Second, it applies this framework to the case of wind energy developments within the territory of three Zapotec communities located in southern Mexico, with the discussion relying on 103 interviews with key stakeholders, six focus groups and participant observation. Results show that the Zapotec sustainability worldview contrasts strikingly with wind developers’ modernist propositions, which tend to reproduce the region's past colonial arrangements in terms of cultural domination, non-recognition of Indigenous identities and disrespect for local customs. This contrast has led to many conflicts and misunderstandings around wind energy projects. The paper concludes that different conceptualizations of sustainability must be recognized to ensure an inclusive and just energy transition, and advances the concept of “pluriversal technologies” to emphasize the need for technologies that embrace ontological and epistemological diversity by being co-designed, co-produced and co-owned by the inhabitants of the socio-cultural territory in which they are embedded

Exploring corporate sustainability integration into business activities. Experiences from 18 small and medium sized enterprises in the Netherlands

Although companies have shown a growing awareness of the importance of Corporate Sustainability (CS), integration of CS into their business activities is still problematic. Most of the CS research focuses on large corporations, with limited discussions of Small and Medium Sized Enterprises (SMEs). Research on SMEs has shown that most CS activities have been developed in isolation, and have not yet been totally integrated into the business activities. This research aims to understand how SMEs integrate CS into their business activities. Eighteen SMEs were analysed. These SMEs were, on their explicit request, supported in enhancing the integration of CS into their business activities. The external change agents connected to this consultancy firm applied four CS integration tools, which was based on their own experience in supporting the integration of CS in companies. The data generated through the application of these tools gives this research a specific, external change agent perspective that contributes to the understanding of CS integration. Tables including the tool data of all companies were used to analyse all eighteen cases as well as to enable a cross case comparison. The data showed that a balance proved to be necessary between a physical and social focus in the SMEs' vision on CS, the CS integration activities, the conditions for the CS change agent and the CS assessment. The research also found that although companies in a more advanced CS growth stage have more management system certifications, the management system itself is not used to ensure CS integration

On corporate sustainability integration and the support of tools

Various tools have been developed to support companies integrating Corporate Sustainability (CS) into their organisational system. Research on the use of these tools does not clearly show how these tools support the integration process of CS. This paper focuses on the CS integration support of three tools most often mentioned in the literature. We will question the contribution each tool can make in supporting CS integration, based on six integration process elements. The analysis shows a potential complementarity between the tools. Moreover, companies should be critical on where within the organisation the interventions for CS integration are needed and what improvement should be generated before choosing tools