Abstract
Joined-up governance (JUG) approaches have gained attention as mechanisms for tackling wicked policy problems, particularly in intersectoral areas such as child health, where multiple ministries that deliver health and social services must collaborate if they are to be effective. Growing attention to the need to invest in early childhood to improve health and developmental trajectories, including through developmental screening, illustrate the challenges of JUG for child health. Using a comparative case study design comprised of the qualitative analysis of documents and key informant interviews, this work sought to explain how and why visible differences in policy choices have been made across two Canadian jurisdictions (Ontario and Manitoba). Specifically, we sought to understand two dimensions of governance (structure and process) alongside an illustrative example—the case of developmental screening, including how insiders viewed the impacts of governance arrangements in this instance. The two jurisdictions shared a commitment to evidence-based policy making and a similar vision of JUG for child health. Despite this, we found divergence in both governance arrangements and outcomes for developmental screening. In Manitoba, collaboration was prioritized, interests were aligned in a structured decision-making process, evidence and evaluation capacity were inherent to agenda setting, and implementation was considered up front. In Ontario, interests were not aligned and instead decision making operated in an opaque and siloed manner, with little consideration of implementation issues. In these contexts, Ontario pursued developmental screening, whereas Manitoba did not. While both jurisdictions aimed at JUG, only Manitoba developed a coordinated JUG system, whereas Ontario operated as a non-system. As a result, Manitoba’s governance system had the capacity to stop ‘rogue’ action, prioritizing investments in accordance with authorized evidence. In contrast, in the absence of a formal system in Ontario, policy ‘entrepreneurs’ were able to seize a window of opportunity to invest in child health.
Highlights
Preventive child health care is understood as a wicked policy problem because it involves complex social policy absent of definitive solutions [1,2]
We first review the two provinces’ governance arrangements for child health, and second, how they responded to the specific policy issue of developmental screening
Type of Document (a) National and provincial reports and professional position statements related to developmental screening and early child development (e.g., Canadian Pediatric Society, Canadian Task Force on Preventive Health Care, Canadian Medical Association, Ontario Medical Association)
Summary
Preventive child health care is understood as a wicked policy problem because it involves complex social policy absent of definitive solutions [1,2]. Policy effort to enhance early child development (ECD), including reducing health inequities, requires involvement from multiple sectors (i.e., medicine, public health, community and social services, education, justice, etc.). Because of this need for intersectoral collaboration, ‘joined-up’ (JUG) approaches to the governance of child health policy making may be required. Governance refers to patterns of rule, including the arrangements, institutions and norms that influence how decisions are made [3] This is not solely about the actions of public authorities, but of how these authorities work together and with non-governmental actors to coordinate policy attention and activity. Scholarship from public administration has examined theories of institutional change, including the concept and value of JUG since the late 1990s [10], yet there is little in terms of applied literature examining implementation or effectiveness, with relevance to child health
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