Health Governance Review Volume 31, Issue 1

Background To address health threats and promoting health of all, One Health is an important approach. To foster the implementation of One Health, a framework proposed by Blankart et al. (2024) postulates a reinforcing relationship between One Health literacy and governance after being triggered by an external event. We build on this model and aim to explore how the postulated mechanism differs among health policy and practice leaders across the UK, Germany, and Switzerland after the external triggering event of the COVID-19 pandemic. Methods We developed an online survey instrument for each of the 5 elements of the framework and conducted it in April 2024. We targeted mid- and end-career leaders and senior experts from the Sciana network that reported about their personal experiences and perceived changes (scale from -5 to + 5). We performed descriptive and inferential statistics to analyse the data. The survey was complemented by structured interviews to gather contextual information. Results Leaders and experts (N = 30, response rate: 30%) increased their One Health literacy (mean: 2.2), increasingly engaged with One Health principles (mean: 1.0), which resulted in more calls for optimized One Health governance (mean: 2.4). The interviewees reported that they adopted and implemented a more consistent One Health governance (mean: 2.6), which led to more familiarity with One Health principles (mean: 2.3). According to the results, the average effect on One Health literacy and Governance was stronger in Germany, followed by Switzerland and the UK. Conclusions We have demonstrated that triggering events such as the COVID-19 pandemic have led to improvements in One Health literacy and subsequently One Health governance. We therefore suggest that the postulated framework holds in practice and have showed that there are important differences in uptake between leaders in the three countries. Further research may build on these findings and develop more effective health policy. Key messages • We have contributed to the understanding of how pandemics improve One Health literacy and subsequent One Health governance using the example through a survey of leaders in health policy and practice. • Based on the understanding of triggering events’ effect on One Health literacy and governance specific recommendations for the implementation of One Health in public health can be developed.

Regional organisations can effectively promote regional health diplomacy and governance through engagement with regional social policy. Regional bodies make decisions about health challenges in the region, for example, the Union of South American Nations (UNASUR) and the World Health Organisation South East Asia Regional Office (WHO-SEARO). The Southern African Development Community (SADC) has a limited health presence as a regional organisation and diplomatic partner in health governance. This article identifies how SADC facilitates and coordinates health policy, arguing that SADC has the potential to promote regional health diplomacy and governance through engagement with regional social policy. The article identifies the role of global health diplomacy and niche diplomacy in health governance. The role of SADC as a regional organisation and the way it functions is then explained, focusing on how SADC engages with health issues in the region. Recommendations are made as to how SADC can play a more decisive role as a regional organisation to implement South–South management of the regional social policy, health governance and health diplomacy agenda.

The impacts of health care investments in developing and transition countries are typically measured by inputs and general health outcomes. Missing from the health agenda are measures of performance that reflect whether health systems are meeting their objectives; public resources are being used appropriately; and the priorities of governments are being implemented. This paper suggests that good governance is central to raising performance in health care delivery. Crucial to high performance are standards, information, incentives and accountability. This paper provides a definition of good governance in health and a framework for thinking about governance issues as a way of improving performance in the health sector. Performance indicators that offer the potential for tracking relative health performance are proposed, and provide the context for the discussion of good governance in health service delivery in the areas of budget and resource management, individual provider performance, health facility performance, informal payments, and corruption perceptions. What we do and do not know about effective solutions to advance good governance and performance in health is presented for each area, drawing on existing research and documented experiences.

PurposeThis study aimed to examine (1) whether confidence in political and health authorities predicted intention to adopt recommended health-protective behaviours and (2) whether age, gender and education level moderated the relationship between confidence in political and health authorities and health protective-behaviours (download the COVIDSafe app, wear a face mask and stay at home).Design/methodology/approachThis study assessed 1,206 Australians using an online survey. Participants answered questions regarding their confidence in political and health authorities and intention to adopt health-protective measures.FindingsConfidence in health and political authorities predicted intention to stay home and intention to download the COVIDSafe app, but not to wear a face mask in public spaces. Age moderated the relationship between confidence in authorities and intention to stay home (i.e. among respondents with less than 54 years old, confidence in authorities was associated with higher intention to stay home). Further, age and education level moderated the relationship between confidence in authorities and intention to download the COVIDSafe app (i.e. among older respondents and those with a university degree or higher, confidence in authorities was more strongly associated with higher intention to download the COVIDSafe app). The interaction between confidence and education predicted adoption of mask-wearing (i.e. among participants with a university degree or higher, more confidence in authorities was associated with higher intention to wear a mask in public spaces).Originality/valueOur findings can inform the development of targeted communications to increase health-protective behaviours at early stages of future pandemics.

6017 Background: Adequate nodal harvest (≥ 12 lymph nodes) in CRC has been shown to optimize staging and proposed as a quality indicator of CRC care. An audit of a single health authority (HA) in Nova Scotia (NS), presented and published in 2002, revealed that adequate nodal harvest occurred in only 22% of patients. The goal of this current study was to identify factors associated with adequate nodal harvest in the entire province of NS, and specifically to examine the impact of the audit and feedback strategy on nodal harvest. Methods: This population-based study included all patients undergoing resection for CRC in NS, Canada, from 1/1/2001-31/12/2005. Linkage of the provincial cancer registry with other databases (hospital discharge, physician billing, and national census) provided clinicodemographic, diagnostic, and treatment data. Factors associated with adequate nodal harvest were examined using multivariate logistic regression. The specific interaction between year and HA was examined to identify any potential effect of dissemination of the previously performed audit. Results: Among the 2,322 patients, the median nodal harvest was 7; overall, 719 (31%) had an adequate nodal harvest. The rate of adequate nodal harvest by year at both the audited and non-audited HAs is shown in the Table. On multivariate analysis, audited HA (p<0.0001), year (p<0.0001), younger age (p<0.001), nonemergent surgery (p=0.001), more advanced stage (p=0.008), and previous cancer history (p=0.03) were associated with an increased likelihood of an adequate nodal harvest. Interaction between year and audited HA was identified (p=0.006) such that the increase in adequate nodal harvest over time was significantly greater in the audited HA. Conclusions: Improvements in CRC nodal harvest did occur over time. A published audit demonstrating suboptimal nodal harvest appeared to be an effective tool, though more so for the audited HA, suggesting a potentially beneficial effect of audit and feedback strategies. Year N ≥ 12 lymph nodes (%) 2001 Audited HA 187 29.4 Nonaudited HAs 295 15.3 2002 Audited HA 157 35.0 Nonaudited HAs 294 20.4 2003 Audited HA 179 47.5 Nonaudited HAs 277 19.5 2004 Audited HA 149 60.4 Nonaudited HAs 325 27.7 2005 Audited HA 146 62.3 Nonaudited HAs 313 30.0 No significant financial relationships to disclose.

BackgroundMigration among persons living with HIV (PLWH) seeking HIV care is common; however its effect on health outcomes in resource-rich settings is not well understood. We conducted a retrospective cohort study to quantify the extent to which PLWH are migrating for care within British Columbia (BC) and its association with virologic suppression and mortality.MethodsEligible PLWH first initiated treatment in BC between 2003 and 2012 (N = 3653). Analyses were performed at the regional Health Authority (HA) level (N = 5). For privacy reasons, we kept the name of these HAs anonymous and we re-named these five regions as 1 to 5. PLWH were classified according to the HA where they resided and received HIV care. We calculated all-cause mortality rates, life expectancies (at age of 20 years), and in, out and net migration rates across HAs using different demographic methods. Virologic suppression (<50 copies/mL) was based on the last viral load available for each PLWH. We also calculated per-capita rates (per 100 PLWH ever on cART) for each HA by dividing the number of PLWH by the number of physicians attending this population.ResultsThere is considerable heterogeneity in physician availability across all HAs, with per-capita rates (per 100 PLWH ever on cART) ranging from 2.2 (HA 1) to 12.7 (HA 3) based on the HA PLWH received care. We observed that in HAs 1, 4, and 5, between 4 and 10 % of PLWH migrated to HA 3 (i.e. the largest urban center) to receive care, and for HA 2 this proportion increased to 21 %. In HA 3, 77 % of its PLWH residents remained in the same HA for their care. Migrating to a larger center for HIV care was not associated with higher rates of viral load suppression; it was significantly associated with lower mortality rates and higher life expectancies.ConclusionsA thorough understanding of the reason(s) for these significant migration rates across BC will be critical to inform resource allocation and optimize the impact of HIV treatment.

In spring 2004 an accumulation of cases of invasive meningococcal disease was observed in the Allgaeu/Bavaria. Investigations of the isolates showed, that four cases in neighbouring municipalities of the district Oberallgaeu were caused by an identical strain of serogroup C. The particular strain was a rare variant of the so called ET-15 clone, which had caused several outbreaks of severe meningococcal disease among young people in the past, for example in Rottal/Inn (1998), Karlsruhe (1999 - 2000) and Schwerte (2003). The involved health authorities had to decide, which intervention strategies were reasonable and appropriate to the given situation. An epidemiological assessment of the situation was made by the Bavarian Health and Food Safety Authority (LGL) using the recommendations of the permanent immunization committee at the Robert Koch-Institute and of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) . The LGL together with the Robert Koch-Institute and the national meningococcal reference centre concluded that the situation fulfilled the criteria for a vaccination indication in accordance with section sign 20 Abs. 5 of the infectious disease control act (Infektionsschutzgesetz, IfSG). On the basis of this assessment the responsible regional health authority issued a public recommendation for vaccination and the district health authority of the Oberallgaeu was assigned to implement a vaccination campaign. The Oberallgaeu health authority offered vaccination sessions to the public in the concerned communities. The target group comprised babies, children, young people and adults up to twenty years, who lived in the concerned communities in the northern part of Oberallgaeu, as well as close contacts of cases and members of the above age group, who had visited communal facilities in the communities concerned. Our report describes the implementation of the vaccination campaign.

Maintenance dialysis is a relatively low prevalence, highly specialized, and labour-intensive treatment, which is usually delivered at regional centres serving many different health authorities. It is unknown whether a patient's health authority, in many ways an accident of birth, influences long-term dialysis outcomes. To study survival patterns in patients starting maintenance dialysis therapy in the north-west of England between 1990 and 1999. Retrospective analysis. We analysed data from quarterly returns submitted to the West Pennine Health Authority from 10 dialysis centres, including health authority, dialysis centre, age, gender, mode of dialysis therapy, postal code and diabetic status. Postal codes were used to compute the distance from residence to dialysis centre and Carstairs index. There were 2458 patients from 18 health authorities. Survival on dialysis therapy differed by health authority (p < 0.0001). Health authorities were then grouped into socioeconomic families, using The Office of National Statistics health authority classification system (ONS1). ONS1 profiles at inception of dialysis therapy were also associated with disparities in survival, with subjects from Urban and Rural health authorities having longer survival than those from Mining and Industrial, Mature or Prospering health authorities (p < 0.0001). Survival on dialysis varies significantly by health authority. The interface between highly specialized, centralized, medical services and the health authorities they serve may be a major outcome determinant.

The main objective of the Healthy Canada by Design CLASP Initiative in British Columbia (BC) was to develop, implement and evaluate a capacity-building project for health authorities. The desired outcomes of the project were as follows: 1) increased capacity of the participating health authorities to productively engage in land use and transportation planning processes; 2) new and sustained relationships or collaborations among the participating health authorities and among health authorities, local governments and other built environment stakeholders; and 3) indication of health authority influence and/or application of health evidence and tools in land use and transportation plans and policies. This project was designed to enhance the capacity of three regional health authorities, namely Fraser Health, Island Health and Vancouver Coastal Health, and their staff. These were considered the project's participants. The BC regions served by the three health authorities cover the urban, suburban and rural spectrum across relatively large and diverse geographic areas. The populations have broad ranges in socio-economic status, demographic profiles and cultural and political backgrounds. The Initiative provided the three health authorities with a consultant who had several years of experience working on land use and transportation planning. The consultant conducted situational assessments to understand the baseline knowledge and skill gaps, assets and objectives for built environment work for each of the participating health authorities. On the basis of this information, the consultant developed customized capacity-building work plans for each of the health authorities and assisted them with implementation. Capacity-building activities were as follows: researching health and built environment strategies, policies and evidence; transferring health evidence and promising policies and practices from other jurisdictions to local planning contexts; providing training and support with regard to health and the built environment to health authority staff; bringing together public health staff with local planners for networking; and participating in land use planning processes. The project helped to expand the capacity of participating health authorities to influence land use and transportation planning decisions by increasing the content and process expertise of public health staff. The project informed structural changes within health authorities, such as staffing reallocations to advance built environment work after the project. Health authorities also forged new relationships within and across sectors, which facilitated knowledge exchange and access of the public health sector to opportunities to influence built environment decisions. By the end of the project, there was emerging evidence of a health presence in land use policy documents. The project helped to prioritize, accelerate and formalize the participating health authorities' involvement in land use and transportation planning processes. In the long term, this is expected to lead to health policies and programs that consider the built environment, and to built environment policies and practices that integrate population health goals, thereby reducing the risk of chronic diseases.

Global health governance and the World Bank

IntroductionThe SARS CoV-2 pandemic poses major challenges not only to patients but also to health care professionals and policy-makers, with rapidly changing, sometimes complex, recommendations, and guidelines to the population. Online forward triage tools (OFTT) got a major boost from the pandemic as they helped with the implementation and monitoring of recommendations.MethodsA multiphase mixed method sequential explanatory study design was employed. Quantitative data were collected first and informed the qualitative interview guides. Video interviews were held with key informants (health care providers and health authorities) between 2 September and 10 December 2020. Audio-recordings were transcribed verbatim, coded thematically and compared with patient perspectives (framework).ObjectivesTo explore the perspectives of health care providers and authorities in Canton Bern on the utility of a COVID-19 OFTT, as well as elicit recommendations for telehealth in future.ResultsThe following themes emerged; (i) accessibility (ii) health system burden reduction (iii) utility in preventing onward transmission (iv) utility in allaying fear and anxiety (v) medical decision-making utility (vi) utility as information source (vii) utility in planning and systems thinking. The health care providers and health authorities further provided insights on potential barriers and facilitators of telehealth in future.ConclusionSimilar to patients, health care providers acknowledge the potential and utility of the COVID-19 OFTT particularly as an information source and in reducing the health system burden. Data privacy, doctor-patient relationship, resistance to change, regulatory, and mandate issues, and lack of systems thinking were revealed as barriers to COVID-19 OFTT utility.

The Commons Public Accounts Committee dearly loves to take a look at the National Health Service, and its latest report returns to an old sore-the excessive cost of repairs to some of what were alleged to be NHS showpiece hospitals, almost before they had been put to use.The Sick Children's Hospital in Glasgow was a classic instance, but it was only one of 13 examples ofcrumbling showpiece hospitals.The report (16th report of the Committee of Public Accounts, 1983-4; House of Commons paper 113) notes that to date health authorities have recovered only £400 000, or about 1%, of the total rectification costs of £30m from the consultants responsible for the buildings, and serves notice that progress had better be reported at the end of the present financial year, or else.

By the time the present study was completed, Brazil had been the second epicenter of COVID-19. In addition, the actions taken to respond to the pandemic in Brazil were the subject of extensive debate, since the Federal Government diverged from most recommendations from health authorities and scientists. Since then, the resulting political and social turmoil showed conflicting strategies to tackle the pandemic in Brazil, with visible consequences in the numbers of casualties, but also with effects on the resilience of the overall health system.This article explores the actions taken in Brazil to cope with the pandemic from a systems analysis perspective. The structure of the domain was analyzed using work domain analysis, and the activated functions were analyzed using the Functional Resonance Analysis Method, identifying the potential variability resulting from the conflicting strategies carried out and the consequences to the capacity of the Brazilian health system to respond to the pandemic.Results of the study show that some government authorities introduced functions that overlapped the operation of the overall system as recommended by health authorities, causing the health system to operate under conflicting objectives, in which functions were created to restrict the outcomes of each other during the entire COVID-19 crisis.

Regulatory Agilities in the Time of COVID-19: Overview, Trends, and Opportunities

Infectious diseases have tremendous impact on the society. It is a complex health problem that poses a massive challenge in identifying solutions to tackle it effectively. Researchers feel that digitally mediated civic engagement (DMCE), which is a fast-developing field of research within health communication, can potentially help to enhance the health of a community (Boulos et al., 2011). DMCE makes the system faster and efficient by acting as proper bridge between the authorities and the public. The general public could reporting incidents, ask doubts and health authorities can respond to it without time delay. However, the motivators behind individuals’ attitude towards and use of digitally mediated civic engagement for health communication are under studied. The major contribution of this Ph.D thesis is to understand the DMCE drivers in the context of infectious diseases based on grounded theory, protection motivation theory and social capital elements. Dengue has been selected for studying the effect of DMCE, as it is a major health problem, especially in tropical countries such as Singapore, India and Sri Lanka (MOH, 2013, 2014a; Halasa, 2011; Epidemiology Unit, 2017). This thesis has three main objectives: first, to understand the public’s view, use and motivators of DMCE; second, to develop and assess a conceptual model to understand the key factors driving DMCE and third, to understand how digital media designers, medical professionals and developers view strategies that enable DMCE. A series of studies were undertaken to meet these objectives. First, a preliminary study is undertaken to provide a detailed understanding of general public’s opinions and views towards DMCE. This study also provides an in-depth knowledge of the motivating factors and barriers of DMCE. Using the results from this study and existing literature, a second study is planned and executed. A conceptual model is developed based on protection motivation theory and social capital elements to explain the motivators of DMCE, which is tested with a survey study in two countries- India and Singapore. The results of the study show the significant influence that individuals' social capital, beliefs towards disease protection such as self-efficacy and response efficacy, media use, etc., have on their DMCE. Finally, it is vital to understand and examine the facets that are being considered by developers and health authorities in encouraging DMCE in health communication applications behind the app development process. This is the bedrock of the researcher’s third study, which was conducted during an international workshop that brought health and IT professionals together to develop health communication apps for DMCE. Another key outcome of this final piece of research was the identification of other factors that need to be weighed in is the understanding the successful utilization of the tools for health interventions. A significant contribution of this research is in the understanding of DMCE for infectious disease preparedness in the Asian context. This work is one of the first attempts to construct a conceptual model combining PMT variables with social capital elements to understand the motivators of DMCE in health communication context based on empirical findings and previous literature. The study also provides insights into the factors that are considered by the health developers and authorities while developing health application for encouraging public participation. The findings resulting from this body of research will be valuable in the design of social marketing strategies, educational interventions and framing health messages to motivate public to take part in DMCE.