Governing the transition: bridging the commitment - implementation gap

Background: Globally in 2021, there were an estimated 247 million malaria cases in 85 malaria-endemic countries which accounted for over 619,000 deaths worldwide. In every 1000 live births, 84 die before attaining 5 years in Kenya. Nonetheless, presently, there is a malaria vaccine which an affordable intervention for children under 5 years of age. However, there is low uptake of 3rd and 4th doses with very limited information on the gaps in the implementation of this vaccine to inform strategies to improve the uptake. Materials and Methods: Study design: The study employed an exploratory study design. Purposive sampling method was used to select participants for focus group discussions (FGDs) and key informant interviews (KIIs). Four FGDs were conducted, 3 of them were 25 parent/guardian whose children either completed or didn’t complete the recommended 4 doses of RTS, S or didn’t receive the vaccine at all, and one with 11 community health volunteers (CHVs). The KII involved 11 healthcare providers(nurses) in charge of maternal and child health (MCH) clinics. Open ended interview guides were used for the FGDs and KIIs. Data was analyzed thematically using NVIVO software version 12. Results: The gaps in malaria vaccine implementation are inadequate information/knowledge about the vaccine to both parents/guardians and healthcare providers, less confidence in the vaccine due to side effects and high number of doses. Others are the poor attitude of health care providers, vaccine unavailability, understaffing of the health providers resulting in long waiting times, and migration to non-implementing sub-counties. Conclusion: The gaps in the implementation of the malaria vaccine; Inadequate knowledge about the vaccine, less confidence about the vaccine, poor attitude of health care providers, migrations, vaccine unavailability, long waiting queue due to staff understaffing, economic activities, cultural beliefs and inadequate trainings of health care providers. Recommendation: Adequate health education, adequate support of the vaccine implementation program, adequate staffing and continuous training of healthcare provider. There’s need to develop strategies for implementation of the vaccine in specific settings in malaria-endemic areas for improved and sustainable RTS, S vaccine uptake.

This study is a study of the evaluation of gaps in the implementation of the School Literacy Movement program in two high school in the South Jakarta area. As an intervention program launched by the government to assist learners in developing critical, creative, innovative, entrepreneurial attitudes, social empathy behavior, and love for knowledge, it is necessary to know the extent to which the program has an impact in improving reading skills understanding in learners and what gaps in running GLS programs through the gap evaluation model (The Discrepancy Evaluation Model). The model developed by Malcolm Provus with this qualitative approach generally aims to obtain information about gaps in the implementation of the GLS program. Research data is obtained through observations, interviews, and document studies. Data analysis is carried out with three flow of activities that occur simultaneously, namely: data reduction, data presentation, data withdrawal or verification. results showed that the positive impact of gls program implementation can be monitored even though academic measurement has not been done. One of the related to the success of KBM is the increased readiness of students in attending KBM, increased confidence when speaking in public and writing. Gaps in program implementation in both high schools appear in the design of the target and installation of the program implementation, although both boil to the development of language skills and literacy of learners. In addition, there needs to be a firmer emphasis in the master design that the establishment of a literate environment is the responsibility of all school residents. Despite the gaps that occur in the implementation of school conditions have allowed the formation of a literate environment.

Discursive gaps in the implementation of public health policy guidelines in India: The case of HIV testing

Opportunities to study and explain academics' responses to the growth of external quality monitoring and the extension of institutions' own quality systems have remained largely unexploited. Based on a single-site case study of a university sector college (NewColl), the paper highlights the merits of close-up study in enabling questions to be posed that other approaches are not as well placed to address. With the aid of interview data, the 'implementation gap' between the intentions underpinning 'quality policy' and the actual outcomes is examined. A number of dimensions of the 'implementation gap' are identified, each deriving from situational factors affecting how academics view external and internal quality monitoring systems and frameworks. It is argued that if academics are to remain pivotal in efforts to improve the quality of teaching and learning, then more attention needs to be paid, by institutions and external quality bodies, to the importance of the conditions and context of academics' work. Otherwise, quality monitoring is liable to be invested with a 'beast-like' presence requiring to be 'fed' with ritualistic practices by academics seeking to meet accountability requirements.

Banjarbaru city government's efforts to improve the development of tourist destinations by enacting Banjarbaru City Regional Regulation Number 3 of 2019 concerning the 2019-2034 Regional Tourism Development Master Plan. However, the implementation of the tourist destination development plan has not been fully achieved. The existence of gaps or gaps in the implementation of the development of tourist destinations, especially Kampung Sayur tourism in Banjarbaru City, is influenced by resource factors which include human resources and facility resources, so the needs of tourist destinations have not been fulfilled. Namely attractions, accessibility, facilities and additional services. This study aims to determine the gaps in policy implementation in the development of Kampung Sayur thematic tourism in Banjarbaru City. This research method uses a qualitative approach. The collection technique was carried out through observation in Kampung Sayur and interviews with several informants, including: (1) employees of the Department of Youth, Sports, Culture and Tourism of Banjarbaru City; (2) the Head of Agriculture and Plantation Service of Central Ulin Village. The results of the study stated that the development of Kampung Sayur tourism in the North Ulin District had not been carried out. This is influenced by several inhibiting factors, including the absence of Kampung Sayur tourism center, the absence of vacant land owned by the government village for infrastructure development as a means of supporting tourists, the absence of public transportation access, and the absence of Tourism Awareness Group (POKDARWIS).

BackgroundLarval source management was historically one of the most effective malaria control methods but is now widely deprioritized in Africa, where insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are preferred. However, in Tanzania, following initial successes in urban Dar-es-Salaam starting early-2000s, the government now encourages larviciding in both rural and urban councils nationwide to complement other efforts; and a biolarvicide production-plant has been established outside the commercial capital. This study investigated key obstacles and opportunities relevant to effective rollout of larviciding for malaria control, with a focus on the meso-endemic region of Morogoro, southern Tanzania.MethodsKey-informants were interviewed to assess awareness and perceptions regarding larviciding among designated health officials (malaria focal persons, vector surveillance officers and ward health officers) in nine administrative councils (n = 27). Interviewer-administered questionnaires were used to assess awareness and perceptions of community members in selected areas regarding larviciding (n = 490). Thematic content analysis was done and descriptive statistics used to summarize the findings.ResultsA majority of malaria control officials had participated in larviciding at least once over the previous three years. A majority of community members had neutral perceptions towards positive aspects of larviciding, but overall support for larviciding was high, although several challenges were expressed, notably: (i) insufficient knowledge for identifying relevant aquatic habitats of malaria vectors and applying larvicides, (ii) inadequate monitoring of programme effectiveness, (iii) limited financing, and (iv) lack of personal protective equipment. Although the key-informants reported sensitizing local communities, most community members were still unaware of larviciding and its potential.ConclusionsThe larviciding programme was widely supported by both communities and malaria control officials, but there were gaps in technical knowledge, implementation and public engagement. To improve overall impact, it is important to: (i) intensify training efforts, particularly for identifying habitats of important vectors, (ii) adopt standard technical principles for applying larvicides or larval source management, (iii) improve financing for local implementation and (iv) improve public engagement to boost community awareness and participation. These lessons could also be valuable for other malaria endemic areas wishing to deploy larviciding for malaria control or elimination.

Current guidelines recommend shifting physician-led care (PLC) for type 2 diabetes mellitus (T2DM) to more effective multidisciplinary health care (MHC). However, few researchers have studied its real-life implementation in Saudi Arabia. Therefore, we aimed to assess the implementation and compare the outcomes of an MDC diabetes management program (DMP) among T2DM patients to a PLC at a general hospital after one year of follow-up in a real-world practice setting. We conducted this comparative patient files review study by analyzing medical records of all T2DM patients at two private care centers. Both were compared for their effectiveness in achieving two outcomes: the glycated hemoglobin (HbA1c) <7% and low-density lipoprotein-cholesterol (LDL-c) <70 mg/dl at the end of the first year.Additionally, we assessed the implementation of the DMP. Eight hundred thirty-four medical records were reviewed, 537 from DMP, and 279 from the PLC center. The personal health coordination was almost complete (97.8%) in the DMP, but the implementation was incomplete regarding nutrition (65.7%), dental exam (64.8%), and foot care (58.3%). Both care groups were matched for age (p = 0.056), gender (p = 0.085), duration of diabetes (p = 0.217), and basal glycemic control (p = 0.171). The DMP showed a significant net decrease in HbA1c (-0.5 [IQR 1.47%] vs-0.2 [IQR 3.05%], p = 0.0001) and LDL-c (-10 [IQR 50]vs -5 [IQR 60.5] mg/dl, p = 0.004) compared to PLC.A higher percentage of patients achieved glycemic control in the DMP than in the PLC (49.4% vs38.7%, p = 0.038). However, bothprograms demonstrated similar outcomesin lipid control (28.7% vs. 30%, p = 0.695). Despite some gaps in implementation, one year of DMP showed better glycemic control among T2DM patients compared to PLC. Both programs were comparable in terms of lipid control. Further studies identifying the gaps in care implementation could improve sustainability, future replication, and generalizability of similar programs to other healthcare systems in Saudi Arabia.

Objective: The objective of this study was to investigate the gaps in the implementation of integrity laws and policies in government-linked companies (GLCs), and to study the correlation of written guidelines, law enforcement and the promotion of integrity. Theoretical Framework: This article covers important theories that are relevant to the implementation and enforcement of GLCs integrity. It emphasizes the importance of documentation, such as codes of ethics and anti-corruption measures, for positively impacting organizational behavior and motivating adherence to integrity rules. Method: This study employs a qualitative research design derived from a case study approach using Government-Linked Companies (GLCs) integrity departments staff's experience. Thus, with a combination of the literature review and case studies approach, this study aims to derive an in-depth understanding towards the respective legislative measures taken so far to strengthen the integrity of the employees involved in these GLCs. Results and Discussion: The findings show differences in knowledge and application of integrity legislation, where it is evident that higher employees have more awareness of integrity laws than lower-level employees. The research illuminates the need for a dual approach that is to enforce the rigorously and enjoin preventative measures to establish deep seated culture of integrity. These insights further support GLCs in strengthening accountability and fostering the embedment of integrity across the organization, consistent with SDG 16. Research Implications: This study explores approaches to better communication, training, and alignment of operations to increase integrity. It emphasizes their indispensable role in promotion of ethical conduct and serves as a compass for policy makers and leaders engaged in governance and anti-corruption efforts. It supports initiatives to enhance transparency and accountability in Government-Linked Companies (GLCs) in alignment with SDG 16. Originality/Value: The originality of this research lies in its focus on the integration of written guidelines, law enforcement, and integrity cultivation within GLCs, exploring the gaps in understanding and implementation between management and staff. It offers unique insights into building effective ethical governance structures and aligning legislative frameworks with internal practices.

Urban, rural and First Nations communities across the country face a growing infrastructure deficit. Sustainable community planning processes provide an opportunity to address this deficit in a way that both improves the quality of life for citizens and reduces environmental impact. However, there remains a gap between planning processes infused with sustainability principles and implementation. The purpose of this article is to explore this 'implementation gap' from a First Nations perspective. First Nations communities face particular capacity barriers and opportunities to conducting innovative and integrated planning. Using data drawn from a case study of Rolling River First Nation in Manitoba, the article illustrates how the community identified cultural traditions and the land base as critical components of their planning process. Both served to build the social infrastructure that provided the necessary capacity to bridge the planning - implementation gap.

This study examines the efforts made by the Indian government to improve the health and socio-economic conditions of tribal communities through five-year plans, focusing on the challenges and gaps that persist. The subject is India’s tribal population, historically marginalized and vulnerable, and the evolving strategies employed to enhance their welfare. The research employs a qualitative approach, analyzing secondary data from government reports, Five-year plan documents, and scholarly literature. Primary data, including expert interviews and field surveys in tribal areas, complement this analysis. A thematic framework evaluates the historical evolution of health interventions, policy impacts, and implementation challenges across various plans. Findings reveal that while substantial progress has been made, tribal communities continue to face significant barriers to health and well-being. Key achievements include disease eradication initiatives, improved health infrastructure, and nutrition programs under integrated tribal development strategies. However, issues such as geographical isolation, inadequate infrastructure, socio-cultural barriers, and limited health literacy persist. Constitutional safeguards and welfare schemes have often fallen short due to ineffective implementation and resource gaps. Seventy-eight years’ post-independence, the health disparities among tribal populations remain pronounced. Future development strategies must prioritize inclusive, culturally sensitive policies, strengthen health infrastructure, and actively involve tribal communities in program design. Bridging policy and implementation gaps is essential for achieving equitable development and sustainable health improvements for India’s tribal populations.

Cancer prevention research has produced profound scientific knowledge that has led to the development of several evidence-based prevention strategies. But do these research outcomes lead to preventive action in real life? Many factors contribute to the so-called 'implementation gap' between prevention recommendations and their application and adherence, including individual actions and behaviour, health service structures and political actions. This article discusses factors underlying the implementation gap in both clinical- and population-based prevention. Understanding how these factors contribute to the implementation gap is important for planning successful cancer prevention strategies, as well as generally achieving disease prevention.

ABSTRACTFlood risk is often unequally distributed. These inequalities highly depend on socio‐political decisions. The recognition of the needs of individuals within a floodplain needs to be considered as a precondition for reaching justice in flood risk management, especially as people differ in their vulnerabilities and capacities to deal with floods. This paper addresses the question of how vulnerable population groups are recognized in flood risk management used in the federal state of Upper Austria. We use a qualitative research method, which is based on policy, legal documents and strategies and on 32 semi‐structured interviews conducted at different levels. Even though clearly stating the overall policy goal of reducing social vulnerability and inequality, most risk reduction strategies neglect these aspects, which creates an implementation gap regarding recognition justice. Strict adherence to the principle of equality leads to, among others, uniform design levels and cost contributions that undermine the notion of differentiated vulnerability. By contrast, disaster aid payments do use eligibility criteria that recognize social inequalities. However, even if justice principles are implemented, they lack transparency and accountability, which creates a legitimacy gap. Restricting the role of civil servants in the public administration through hybrid governance may narrow implementation and legitimacy gaps.

As the field of implementation has rapidly evolved, distinct implementation science and practice components have emerged. Siloing based on professional identities is beginning to occur, with a lack of adequate opportunities for implementation intermediaries, practice leaders, policy leaders, and researchers to interact and collaborate. This chapter details how the field of implementation is in danger of following a path reminiscent of the one previously traveled by intervention science – a path that has led to a longstanding divide between science and practice. We present a training agenda intended to curtail the emerging science–practice gap in implementation and argue that the gap can be minimized by opportunities for implementation stakeholders to participate in (a) pragmatic research, (b) team science, and (c) interprofessional education. Recommendations are made for professional development opportunities that include these components to address the science to practice gap in implementation.

This study aims to analyze gaps in the implementation of Law Number 8 of 2016 concerning Persons with Disabilities in Indonesia. This law is an effort by the Indonesian government to provide more comprehensive legal protection for persons with disabilities, in line with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Using a literature analysis approach, this study identified five main gaps in the implementation of the law: limited physical and digital accessibility, lack of participation of persons with disabilities in the decision-making process, disparities in implementation at the regional level, unavailability of accurate data, and ongoing social stigma and discrimination. The research methodology is qualitative descriptive with secondary data sources in the form of literature, laws and regulations, government reports, journal articles, and other credible publications. The results of the study indicate that many public facilities are not yet fully disability-friendly, participation of persons with disabilities in policy forums is still minimal, there are gaps in implementation between regions, data on persons with disabilities has not been integrated, and negative stigma is still strong in society. Based on these findings, this study recommends strengthening accessibility regulation and monitoring, institutionalizing representation of persons with disabilities in policy-making, providing technical and budgetary assistance to reduce regional disparities, developing an integrated national database, and anti-stigma education campaigns. The implementation of these recommendations is expected to realize more effective legal protection and social inclusion for persons with disabilities in Indonesia.

Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, 'in few areas can the gap between political rhetoric and policy on the one hand or between policy and reality in the field on the other hand have been so great'. This paper examines the extent and causes of this 'implementation gap' in respect of services for people with mental handicaps--a consistent priority group for national policymakers. We examine centre-periphery relations in the health and personal social services in the light of Rhodes' power-dependence framework and his concepts of policy networks and policy communities. The NHS has been described as the archetypal professionalised policy network but we conclude that it is possible to account for implementation failures in community care only partly in terms of the dominance of the medical professions' values and interests and the deficiencies of accountability and control due to clinical autonomy. Such failures are due also to the inherently limited power of the centre. Sub-central units are not merely its meek agents. Moreover, the centre must explicitly structure local environments by itself providing a coherent framework of service and resource policies compatible with the national objectives it is seeking to achieve.