Effective Policy Implementation Research Articles

How do industry and other actors undermine tobacco control policies post-adoption? A scoping review

Abstract Background Over recent decades, many countries have strengthened their tobacco control policies. To be effective, full implementation is needed. Tobacco industry interference is widely recognised as a key barrier to tobacco control progress and evidence-based models like the policy dystopia model (PDM) list industry strategies, focusing on those avoiding and undermining policy adoption. While prior research highlighted industry activities post-adoption, these have not been captured systematically. This review aimed to map the efforts of industry, front groups and other actors to undermine the implementation of policies, including marketing, packaging, smokefree and flavour measures. Methods We searched six literature databases, relevant bibliographies and grey literature, and consulted experts. We included articles describing one or more attempts to undermine adopted policies, including marketing, packaging, smokefree and flavour. The PDM served as starting point for coding; additional strategies were identified inductively. Strategies were charted against aims and policies. Results Several aims and strategies were identified which were similar across policies. Following policy adoption efforts to 1) overturn and 2) weaken measures, and 3) delay implementation continued. Legal strategies were utilised and there were attempts to influence stakeholders. In addition, tobacco industry and other actors sought to 4) undermine policy effectiveness by creating confusion, circumventing policies, and noncompliance, and 5) use implementation as an opportunity to enhance industry reputation. Conclusions Interference from tobacco industry and other actors threatens effective tobacco control policy implementation. The public health community must continue to monitor, expose and counter industry conduct after policy adoption. More research is needed to enhance our understanding of how industry interferes in policy implementation, and how this can be pre-empted and countered. Key messages • The interference from tobacco industry and other actors following policy adoption threatens effective tobacco control, and needs to be monitored, exposed and countered by the public health community. • Policymakers and civil servants need to be wary of efforts to undermine tobacco control policies and act to ensure effective policy implementation.

Revealing the influence of food industry actors in relation to nutritional policies in Belgium

Abstract Unhealthy food is one of the prevailing risk factors of NCDs and cancers, making the food industry a key player in their prevention. However, evidence-based public health policies aimed at reducing consumption of unhealthy food, may threaten industry sales. In response, food industry actors try to influence the development and implementation of these nutritional policies by engaging in corporate political activities (CPA). As part of the Joint Action PreventNCD, the CPA of relevant food industry actors in relation to public health nutritional policies will be assessed. In Belgium, strategies of Fevia, the umbrella organization of the food industry, are examined. This study analyses publicly available information collected from Fevia’s website, social media accounts (i.e. X and LinkedIn), newsletters and newspapers. A thematic qualitative analysis is conducted using established frameworks to categorize both framing and action strategies used by the industry. The categorization of framing strategies reveals how the food industry presents the actors, problems, and solutions. The framework of action strategies categorizes the CPA of the food industry under the following six strategies: information and messaging; financial incentives; constituency building; legal action; policy substitution; opposition fragmentation and destabilization. Preliminary results indicate that the industry often frames itself as ‘the good actor’ and primarily uses strategies such as ‘information and messaging’, ‘constituency building’ and ‘policy substitution’ to influence policies in Belgium in their favor. In the next phase, interviews with stakeholders (e.g. policymakers, politicians,...) will be performed to collect undocumented information. Overall, this research sheds light on the ongoing CPA of the food industry and will increase transparency in their influence on the development and implementation of effective nutritional policies aimed at reducing the burden of NCDs and cancers. Key messages • This study reveals how the umbrella organization of the food industry in Belgium influences public health nutritional policies through various corporate political action and framing strategies. • Identifying these CPA increases awareness of the industry’s influence, but also promotes their transparency and accountability, which is crucial for reliable and effective nutritional policy.

A monitoring framework for reinforcing policies against antimicrobial resistance in Europe

Abstract In an attempt to overcome barriers to the effective implementation of policies against antimicrobial resistance (AMR) in the EU Member States, Norway and Iceland, One Health national action plans (NAPs) need to show improvements in both their formulation and their implementation. Research conducted by Tetra Tech, funded by the EU4Health Programme, has identified shortcomings to One Health national policies across all countries, such as limited political focus and awareness of the challenges brought by AMR; lack of operational plans for delivering on the NAPs; and lack of harmonised indicators and inadequate information systems for monitoring the implementation of plans. On this last issue, subsequent reseach by Tetra Tech has supported the design and development of monitoring indicators for reinforcing the expected improvements of NAPs and the implementation of policies aimed at EU Member States in the 2023 “Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach”. While drawing on existing data sources at EU and global level, the study has also worked with Member States representatives in identifying indicators for the monitoring framework and proposed new data collection activities at the national level. Key messages • EU countries face common barriers to the effective implementation of One health policies against AMR, and need to reinforce their national action plans. • Stepping up the fight against AMR in the EU requires a strong monitoring framework for following up on EU recommendations.

Collaborative efforts of the Joint Action PreventNCD and the WHO Europe to protect children from harmful marketing

Abstract Control and counter the effects of advertisements and online marketing is one of the policy actions that will be explored within the JA Prevent NCD that has the overall aim to “reduce the burden of cancer and other NCDs and common risk factors, both at a personal and societal level, and support member states by taking a holistic approach for the prevention of cancer and other NCDs, through coordinated action”. The work that will be building on the JA Best-ReMaP sustainability framework recommendations to improve the effective implementation of policies to reduce harmful marketing of unhealthy food, would at the same time comprehensively address also tobacco and alcohol maketing. Thirteen different countries are involved in the work package on regulation and taxation that has the overall objective to “improve compliance, coherence, wider implementation and enforcement of fiscal and regulative measures targeting major NCD-risks factors.” This includes a broad range of tasks from mapping existing policies and frameworks, accumulating knowledge on health taxes and fiscal policies, promoting the use of joint nutrient profile models, assessing the impact of labelling on products to create healthier behaviors, supporting the implementation of policies to reduce the impact of harmful marketing, strengthening regulations towards hazardous substances and developing monitoring indicators for policies for prevention of NCD. An overview of the concrete collaborative actions to support the implementation of the marketing regulation will be given: (1) on JA work with the MSs and especially presidency countries, to allow for the discussions on the development of the EU regulation for reduction of the harmful marketing; (2) on the EU stakeholders positions regarding marketing regulation; (3) on the collaborative actions in scaling up the KidAd app. (5) the development of an algorithm to detect alcohol, tobacco and nicotine-containing products will be jointly developed and piloted.

4.X.1. Health literacy policies – how can they be developed and implemented?

Abstract In Europe and beyond, there is political recognition of health literacy being an important factor for good health and well-being. As health literacy is considered critical to achieving health and as limited health literacy is still a widespread phenomenon, the topic is steadily attracting more attention among policy and decision makers. To meet growing demand from decision makers, a policy guide was initiated by M POHL, the World Health Organization (WHO) Action Network on Measuring Population and Organizational Health Literacy. The guide aims to support awareness-raising, the building of commitment and the implementation of effective policies to improve health literacy. It mainly addresses decision-makers in health policy and administration, but may also inspire researchers and other relevant stakeholders in the health literacy area. Objectives of the workshop This skills building seminar seeks to contribute to capacity building and to offer time for exchange and discussion on health literacy policy work. More specifically, the objectives of the workshop are to: - provide an overview on national health literacy policy implementation; - increase the knowledge of participants on what countries are doing already and identify needs for further support; - support participants in reflecting, initiating, developing and implementing effective measures to improve population and organizational health literacy. Methods of the workshop The workshop will start off by a presentation introducing the guide “Health literacy policies - how can they be developed and implemented?’ and sharing some national experiences in implementing health literacy policies, strategies, and interventions. After these impulses attendees will be divided into groups to enable exchange. A checklist for self-assessment will be provided as a tool to guide the discussion and to identify and address potential challenges in implementing health literacy policies and interventions. The input and identified needs will be captured. They will support M-POHL’s continuing efforts to support policy makers and administrators in their work. Key messages • Health literacy is steadily gaining more interest from policy- and decision-makers. • In this seminar, participants will learn on how evidence-informed policies and practice can be supported.

Institutional quality as a catalyst for structural transformation in African countries: What role does foreign direct investment play?

The socio-economic development of African countries is strongly influenced by the impact of foreign direct investment (FDI) flows and the quality of these countries' institutions. This paper examines the role played by the quality of these countries' institutions as a pillar in the process of structural transformation (ST) in African countries considering the relationship between FDI and institutional quality. This led to the completion of a thorough econometric analysis that estimated two Panel Auto Regressive Distributed Lag (ARDL) models and concentrated on the complex relationships between the study's variables. The econometric results obtained showed a negative and significant effect of FDI on the quality of institutions in the long term as reflected by two dependent variables: the degree of freedom from corruption and the degree of freedom of ownership. Thus, the results show the major constraints African countries faced in terms of property rights, corruption and the implementation of good governance practices, underscoring the need for radical institutional reform to foster these crucial dimensions of socio-economic functioning. In addition, the study’s result demonstrated the crucial role that institutional quality within the African continent can play in the success of its ST process. Indeed, the positive impact of institutional quality on FDI attractiveness and the implementation of effective development policies could foster an environment conducive to achieve inclusive growth. Finally, the results of the study can help decision-makers define the policies essential to the success of the ST process in African countries.

Addressing Nursing Resignation: Insights From Qualitative Studies on Nurses Leaving Healthcare Organisations and the Profession.

The aim of this study is to explore the experiences of nurses who resigned from healthcare organisations or abandoned the profession and explore the reasons behind them. A systematic review of qualitative studies and meta-summary. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase (Ovid), MEDLINE (Ovid), Social Science Citation Index (Web of Science), and Scopus. The search was conducted up to May 2024. Primary qualitative studies focused on nurses who had resigned or left the profession were included. The meta-summary was conducted using method: findings were extracted from the reports, edited, grouped, abstracted into key meta-findings, and finally, their frequency effect sizes were calculated. A total of 282 findings were extracted from 12 studies, generating 49 statements of findings that were aggregated into nine key meta-findings. Poor management practices presented a frequency effect size of 100%. Other key meta-findings included excessive workload, teamwork hurdles, health issues related to work shifts and difficulty in maintaining work-life balance, a lack of career growth opportunities and promotion chances, disillusionment with nursing, dissatisfaction due to salary, bullying and horizontal violence, and moral distress over ethical dilemmas. The findings can help support the development of targeted strategies and the implementation of effective policies aimed at reducing nursing turnover. The major impact of these findings is the recognition of rising factors that negatively affect nurses' quality of life, including workload pressures and poor management strategies, which significantly lower job satisfaction. To address these challenges, the profession should prioritise tools that value nurses in their roles, implement strategies to manage workloads more effectively and advocate for policies promoting flexible scheduling. Additionally, investing in professional development and fostering a supportive work environment can help retain skilled nurses and nurture the growth of new talent. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). No patient or public contribution.

Balancing economic efficiency and national security: Industrial policy at the nexus of geopolitics and globalisation

This article examines the resurgence of industrial policy in the EU, with a particular focus on its evolving rationale in the context of geopolitical fragmentation and economic security concerns. It explores how recent global events, including the Covid-19 pandemic and Russia’s invasion of Ukraine, have intensified debates about government intervention in the economy and led to a renewed focus on strategic autonomy. The paper analyses the key EU industrial policy initiatives and their implications, particularly in sectors such as energy, defence and critical technologies. Special attention is given to the challenges and opportunities presented by Ukraine’s reconstruction, including potential adaptations to EU state aid rules. The article concludes by proposing principles for effective industrial policy design and implementation, emphasising the importance of maintaining single-market integrity, ensuring transparency and accountability, and balancing interventions with sound macroeconomic policies.

A qualitative exploration of policy interventions to improve the health-related quality of life of people living with HIV AIDS and co-morbidities of hypertension and/or diabetes in Ghana.

The intersection of infectious diseases, such as HIV, with chronic conditions like hypertension and diabetes poses a significant challenge in global health. While advancements in antiretroviral therapy have transformed HIV into a manageable chronic condition, a growing number of individuals with HIV now grapple with coexisting non-communicable diseases, impacting their Health-Related Quality of Life (HRQoL). Despite strides in HIV care, there is a notable policy gap that undermines efforts to address HIV-associated co-morbidities, particularly hypertension and diabetes, especially efforts to improve access, early detection, and ultimately HRQoL for individuals with HIV and co-morbidities. This study seeks to explore policy interventions aimed at improving the quality of life of HIV patients with hypertension or diabetes. The study utilized a qualitative descriptive design to explore the experiences and perspectives of healthcare professionals and support staff regarding policy interventions for managing HIV patients with hypertension and/or diabetes co-morbidities in three regions of Ghana. The research was conducted in the Upper West, Ashanti, and Greater Accra regions among 11 participants, chosen purposively from professions involved in HIV patient care to understand their views on the implementation of policy interventions to HRQoL for individuals with HIV and co-morbidities. In-depth interviews were conducted face-to-face and tape-recorded. Thematic analysis approach was used to analyze the data. The study involved 11 participants from three regions with varied years of experience. Implemented policies that potentially improve the HRQoL for individuals with HIV and co-morbidities involve support groups, home visits, provision of free drugs, and counselling. Barriers to policy implementation included non-adherence to medication, stigma, cost of non-communicable diseases (NCDs) medications, accessibility issues to NCDs services, lack of interest or understanding among implementers, and high staff turnover. Facilitators encompassed in-service training, guidelines in common platforms, knowledge sharing, external resources, regular check-ups, and motivational packages for patients. Individuals with HIV and comorbidities face complex challenges impacting their HRQoL, including emotional and financial dimensions. The study identifies critical policies and barriers, underscoring the need for tailored, patient-centered approaches. Facilitators like in-service training and regular check-ups offer actionable insights for effective policy implementation, emphasizing improved health outcomes for those with comorbid conditions. The study recommends integrated care approach and adherence support programs that address the unique challenges faced by people living with HIV.

Impact of dual pilot policies for low-carbon and innovative cities on the high-quality development of urban economies

<p style="margin-top:16px; text-align:justify"><span lang="EN-US" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Based on the panel data of 276 cities in China from 2005 to 2021, the article used a multi-period double-difference model to explore the impact of the dual-pilot policy of low-carbon cities and innovative cities on the high-quality development of urban economy. The study found that (1) the implementation of the dual-pilot policy significantly had significantly promoted the economic high-quality development of the pilot cities, and the dual-pilot policy had a more significant effect on the enhancement of urban economic high-quality development compared with the single-pilot. (2) The mechanism analysis showed that green technology innovation, industrial structure adjustment and entrepreneurial activity played a mediator role in the impact of the dual-pilot on the high-quality development of the urban economy. (3) The spatial effect showed that the dual-pilot policy not only promoted the high-quality economic development of the region, but also had a positive spillover effect on the high-quality economic development of the neighbouring regions. (4) The heterogeneity analysis showed that the dual-pilot policy promoted the high-quality economic development of the eastern cities, large-scale cities, and non-resource-based cities more strongly.This study enriches the research on the impact of policy synergy on high-quality economic development, and provides references and insights for the effective implementation of dual-pilot policies and the promotion of high-quality urban economic development.</span></span></p>

Telework experience, frequency, and knowledge management during COVID-19 in Japan and the United States

Purpose This study investigates the relationship between telework frequency and knowledge management (KM) activity in Japan and the USA. By examining how telework impacts KM activity differently across these two countries, this study aims to provide insights into the design and implementation of effective telework policies tailored to specific cultural contexts. Design/methodology/approach Linear and quadratic regression analyses were conducted to explore the relationship between telework frequency and KM activity. Data was collected from samples in Japan and the USA, with respondents categorized based on prior telework experience. Various KM activities such as knowledge acquisition, sharing and application were measured using established scales. Findings In Japan, an inverted U-shaped relationship between telework frequency and KM activity was observed, with optimal activity occurring at four days of telework per week. Conversely, the USA demonstrated a linear relationship, indicating sustained KM activity across different telework frequencies. Notably, individuals with prior telework experience showed higher levels of KM activity compared to those without experience. Originality/value This study contributes to the understanding of how cultural differences influence the relationship between telework and KM activity, and ultimately learning. By highlighting the nuanced patterns observed in Japan and the USA, it emphasizes the importance of tailored telework policies and support mechanisms for effective KM in diverse cultural contexts. Future research could further explore additional explanatory variables and their impact on telework-related outcomes.

Are natural resources a blessing or a curse for renewable energy? Uncovering the role of regulatory quality and government effectiveness in mitigating the curse

This study examines whether the capacity of the government to formulate and implement sound policies effectively (regulatory quality and government effectiveness) can improve the relationship between natural resource rents and renewable energy consumption. We analyze 96 countries from 2000 to 2020 using a panel threshold regression estimation method and divide these countries into three income groups for heterogeneity analysis. The results show that (i) The correlation between natural resource rents and renewable energy consumption exhibits a non-linear pattern, which shows a "U-shaped." (ii) When regulatory quality and government effectiveness are enhanced, the negative influence of natural resource rents on renewable energy consumption is attenuated or even reversed. This indicates that the formulation and effective implementation of sound policies by the government are conducive to mitigating and even reshaping the curse of natural resources on renewable energy. (iii) Regulatory quality and government effectiveness have the most significant influence in high income countries and the smallest impact in countries with low incomes, while there is some uncertainty about the impact in middle income countries.

Representative CO2 emissions pathways for China's provinces toward carbon neutrality under the Paris Agreement's 2 °C target

China has committed to achieving carbon neutrality by 2060. It is essential to develop representative CO2 emissions pathways at the provincial level that align with the national target to facilitate effective policy implementation and scientific research. To address inconsistencies between provincial aggregate emissions and national estimates, this study compares the 2021 CO2 emissions estimates of China's provinces from the bottom‒up emissions factor method and the top‒down atmospheric CO2 concentration inversion method. We find that these methods yield comparable results for the emissions from energy combustion and industrial processes at the provincial level. Based on a review of existing research on CO2 pathways for China's provinces, we propose a set of representative pathways for China's provinces. These pathways align with past practices of allocating national emissions intensity reduction targets to provinces and are consistent with the national Tsinghua‒CMA pathway. The proposed pathways require provinces to sequentially peak their emissions by 2030, followed by rapid emissions reduction. Compared to a reference scenario without the carbon neutrality target, these pathways would incur an estimated cumulative GDP loss of about 1% between 2020 and 2060. However, there are notable regional variations, with some regions in the northwest potentially experiencing higher economic growth due to the availability of high-quality low-carbon resources. We recommend that China enhance provincial-level CO2 emissions accounting by cross-validating bottom‒up and top‒down methods. Additionally, careful consideration should be given to aligning provincial targets with national and global commitments when updating pathways toward carbon neutrality.

Enhancing teacher status in Kazakhstan: The role of school leaders and policy support

This article investigates the role of school leaders in enhancing the status of teachers in Kazakhstan using a mixed-methods approach with data from questionnaires and semi-structured interviews. Findings show a positive attitude towards legislative measures but highlight a gap between policy and practice as school leaders often neglect their legal duties. The study emphasizes the critical role of school leaders in providing support and professional growth opportunities, significantly affecting teachers' perceptions of their status and job satisfaction. It also reveals that the school's built environment and academic rankings influence teachers' social status. The results stress the importance of effective policy implementation, increased administrative support, and a focus on teacher welfare to elevate professional status, offering valuable insights for policymakers, school administrators, and educators.

Implementation of PPDB Policy for State Middle Schools in Cirebon City

This research examines the implementation of the zoning-based New Student Admissions (PPDB) policy in State Middle Schools in Cirebon City, which is regulated by Minister of Education and Culture Regulation Number 44 of 2019. The aim of this research is to evaluate the effectiveness of zoning policies in equalizing access to education, identify the challenges faced, and provide recommendations for improvement. This research used a qualitative descriptive approach, involving school principals, teachers, students and parents as respondents. The research results show that zoning policies have succeeded in increasing equitable access to education, but face challenges in communication, information consistency and socialization. Recommendations include increased coordination, ongoing training, and intensified outreach to support more effective policy implementation in the future.

Assessing Infrastructure Development in Kedungrejo Village Work Plan

Background: Effective policy implementation is essential for achieving developmental goals, particularly in rural areas. Specific Background: This study examines the implementation of the Government Work Plan (RKP) in Kedungrejo, Jabon District, Sidoarjo. Knowledge Gap: There is limited research on the operational challenges of RKP implementation in rural Indonesia. Aims: The research analyzes RKP implementation, focusing on communication, resources, disposition, and bureaucratic structure per Edward III’s framework. Results: Findings reveal that village officials engage in monitoring infrastructure projects but lack Standard Operating Procedures (SOPs) and dedicated oversight teams. Novelty: This study offers empirical insights into the practical challenges faced in RKP implementation. Implications: Establishing SOPs and dedicated teams is recommended to improve coordination and accountability, enhancing governance and community participation in rural development efforts. Highlights : Lack of SOPs: Absence of Standard Operating Procedures hinders effective project oversight. Community Engagement: Village officials emphasize the importance of involving the community in development efforts. Bureaucratic Structure: The existing bureaucratic framework influences the coordination and success of RKP implementation. Keywords: RKP, rural development, governance, implementation, community participation

Levels of Social Participation among Silver-Age Citizens and Factors of its Activation in the Region of Russia (Case of the Sverdlovsk Region)

Introduction. The quality of life of silver-age people is associated not only with psychological, economic and physical well-being, but also with the peculiarities of interpersonal relations and the diversity of their social activity. The widespread ideology of active or “delayed aging” actualizes the study of the nature of inclusion of elderly citizens in various practices of social participation that fill their daily lives. The aim of the study is to reveal the level characteristics of social participation of citizens of silver age in the Sverdlovsk Oblast and the factors that determine them. Materials and Methods. The article analyses the data from the survey of residents of the Sverdlovsk Region over the age of 60, the sample is structured by gender, age, and place of residence of the respondents (type of settlement). The authors’ survey method was used to determine the nature and frequency, level and type of social participation of the Urals elderly, to identify factors that contribute to or impede activity in old age. Results. The study showed that socio-consumer participation characterized by activities “for oneself” and collective participation aimed at social integration “together with others” constitute the main content of social participation of the studied cohort. The participation of the elderly in the practices aimed at helping and caring (“for others”) is significantly lower, and a radical decrease in the activity of the elderly Urals residents is revealed when they switch to “civic participation”. It has been proved that the intensity of social participation of silver-age citizens living in cities is higher than in rural areas. The only exception is participation in civic activities. The same influence on the intensity of the different practices of social participation at all levels is exerted by the status of residence (independent or in a residential institution), the presence of close relatives and the frequency of Internet use. Discussion and Conclusion. The identification of the levels and factors of social participation of older citizens creates an evidence base on the processes of active aging in a typical Russian region. The results of the study demonstrate the relevance of focusing regional social policy on aging and the non-profit sector on increasing the social participation of people and groups of the “silver” age. The article may be of interest to regional authorities, social protection and service institutions, the regional non-profit sector, offering tools for the development and implementation of effective social aging policies aimed at implementing resources and supporting the social participation of the older generation.

Pengaruh Implementasi Kebijakan Program Keluarga Harapan Terhadap Kesejahteraan Masyarakat di Kecamatan Cimahi Selatan Kota Cimahi

This research is entitled “The Effect of the Implementation of the Program Keluarga Harapan Policy on Community Welfare in South Cimahi District, Cimahi City”. The research objective is to analyze the impact of the implementation of the Program Keluarga Harapan (PKH) policy on community welfare in Cimahi Selatan District. The method used is a combination (mixed methods) with a sequential explanatory model, involving 154 respondents as samples and informants such as the Head of Linjamsos and PFM, Kasi Linjamsos and PFM, PKH Social Coordinator of Cimahi City, and KPM of South Cimahi District. Data collection techniques include literature study, questionnaires, interviews, and observations, with analysis using product moment correlation techniques. The results showed that the implementation of PKH policy in Cimahi Selatan Sub-district was in the good category, with an average score of 2.64 (88.00%). The dimensions of communication and bureaucratic structure get the highest score (2.67 or 89%), while the resource aspect has the lowest score (2.60 or 86%). For community welfare, the mean score was 2.61 (87.00%), with the prosperous life aspect getting the highest score (2.67 or 89%) and good adjustment getting the lowest score (2.56 or 85%). Hypothesis testing showed a p-value of 0.04 (<0.05), indicating that the research hypothesis is accepted. The magnitude of the effect of PKH policy implementation on community welfare is 0.85 (85%).

Key Determinants of the Comprehensive Neonatal Emergency Obstetric Services Policy

Background: Effective implementation of comprehensive emergency obstetric and neonatal care programs is vital for improving maternal and neonatal health outcomes. Specific Background: At RSU Al-Islam H.M Mawardi, various factors—including communication, resources, disposition, and bureaucratic structure—affect program implementation. Knowledge Gap: Previous research has often neglected how these factors interact and their influence on healthcare policy implementation. Aims: This study evaluates the relationship between these factors and the implementation of the emergency obstetric and neonatal care program using a quantitative survey approach. Results: Analyzing data from 54 respondents revealed significant correlations between effective communication, resource allocation, and successful policy implementation (p < 0.05), with the questionnaire demonstrating high reliability (Cronbach's Alpha = 0.969). Novelty: This research contributes empirical evidence on the specific elements influencing healthcare policy implementation locally. Implications: Strengthening communication and resource management is essential for enhancing policy implementation effectiveness, ultimately improving community health outcomes. Highlights : Factor Influence: Effective communication and resource allocation significantly impact program success. Research Contribution: The study provides empirical evidence on factors affecting healthcare policy implementation locally. Health Outcomes: Strengthening implementation strategies is crucial for improving maternal and neonatal health outcomes. Keywords: obstetric care, neonatal care, policy implementation, communication, healthcare resources

Policy implementation and strategic effects: Assessing the impact of parliamentary thresholds on Indonesia’s political system and governance

This study examines the impact of parliamentary thresholds on the Indonesian political system through the lens of the Routine Policy Implementation Model and the Strategic Policy Implementation Model. The main objective is to evaluate the effectiveness of parliamentary thresholds in managing political fragmentation, assess their impact on stability and representation in the legislative system, and understand their implementation’s technical and strategic implications. Using a qualitative approach supported by interview studies and field observations, this research combines analysis of election data in the 2009, 2014, and 2019 elections with a qualitative assessment of policy changes and political dynamics. The Routine Policy Implementation Model focuses on the technical aspects of threshold implementation, including vote counting procedures and seat allocation efficiency. Meanwhile, the Strategic Policy Implementation Model examines the broader implications of these thresholds for political consolidation, government effectiveness, and the representation of minor parties. The results show that the parliamentary threshold has significantly reduced political fragmentation by consolidating the number of parties in Parliament, resulting in a legislative system that is cleaner and easier to administer. However, this consolidation has also marginalized small parties and limited political diversity. The novelty of this study lies in its comprehensive analysis of how parliamentary thresholds affect administrative efficiency and strategic political stability in Indonesia, compared to democratic countries in transition, such as Slovenia and Montenegro. In conclusion, although parliamentary thresholds have increased political stability and government effectiveness, they have also raised concerns about the reduced representation of small and regional parties. The study recommends maintaining balanced thresholds that ensure stability and diversity, implementing mechanisms to review thresholds periodically, and involving diverse stakeholders in adjusting policies to reflect evolving political dynamics. This approach will help balance the need for a stable legislative environment with broad representation.