Evaluate Policy Implementation Research Articles

Engaging sub-national governments in addressing health equities: challenges and opportunities in China’s health system reform

China's current health system reform (HSR) is striving to resolve deep inequities in health outcomes. Achieving this goal is difficult not only because of continuously increasing income disparities in China but also because of weaknesses in healthcare financing and delivery at the local level. We explore to what extent sub-national governments, which are largely responsible for health financing in China, are addressing health inequities. We describe the recent trend in health inequalities in China, and analyse government expenditure on health in the context of China's decentralization and intergovernmental model to assess whether national, provincial and sub-provincial public resource allocations and local government accountability relationships are aligned with this goal. Our analysis reveals that government expenditure on health at sub-national levels, which accounts for ∼90% of total government expenditure on health, is increasingly regressive across provinces, and across prefectures within provinces. Increasing inequity in public expenditure at sub-national levels indicates that resources and responsibilities at sub-national levels in China are not well aligned with national priorities. China's HSR would benefit from complementary measures to improve the governance and financing of public service delivery. We discuss the existing weaknesses in local governance and suggest possible approaches to better align the responsibilities and capacity of sub-national governments with national policies, standards, laws and regulations, therefore ensuring local-level implementation and enforcement. Drawing on China's institutional framework and ongoing reform pilots, we present possible approaches to: (1) consolidate key health financing responsibilities at the provincial level and strengthen the accountability of provincial governments, (2) define targets for expenditure on primary health care, outputs and outcomes for each province and (3) use independent sources to monitor and evaluate policy implementation and service delivery and to strengthen sub-national government performance management.

Mobilisation capacity for agri-environmental management

The integration of environmental concerns into agricultural policies – through agri-environment measures (AEM) – has seen a fast development across Europe. This paper conceives AEM as an evolving instrument, a product that takes shape, gets diffused and taken up in, by and through networks of relations. Success then depends on the mobilisation or active participation of all those who may support and develop it. Using the examples of the Flanders’ and Walloon regions of Belgium, the paper sets out to examine the mechanisms by which mobilisation for agri-environmental management develops, and by doing so, to gain a better understanding of mobilisation capacity as a concept to be used for evaluating policy implementation in this area. The study follows AEM along the various trajectories of implementation (design, distribution, application). The findings reveal how mobilisation capacity is gradually built-up by the interplay between AEM and the networks it connects to. The case illustrates well how such interactions occur all the way from administration offices to farmers’ fields, and that their nature can be very different (e.g., formal and informal, durable and short-lived, expected and unexpected). It is concluded that in evaluating actor-networks, one should look at them in an open and fluid manner, that is, not to privilege any particular configuration or form of attachment over the other, not take intentions and objectives as a starting point but instead address the opportunities for synergies, and be aware that any network built around the instrument may change its content and the way it functions.

Evaluating Policy Implementation: The European Union's Small and Medium Sized Enterprise Policies in Galicia and Sardinia

Evaluating policy implementation involves assessment of the institutional performance of the institutional system in its locale. This paper highlights the importance of local conditions for effective policy implementation. Current literature suggesting that civic culture is an essential precursor to successful institutional performance is rejected, instead it is argued that policies need to be better adapted to local strengths and institutional forms. A mis-match between the policy design, the socio-cultural environment and the institutional structures can lead to problematic institutional performance and implementation outcomes. Insufficient institutional capacity also places strains on institutional performance and implementation capacity. Policies and institutions need to build on the strengths of a locality and be tailored to the prevailing socio-cultural environment for effective policy delivery. Implementation difficulties can be resolved by allowing policy design to better fit the exigencies of local areas, while simultaneously reinforcing regulatory solutions where this can improve implementation capacity. Evaluer la mise en application d'une politique nécessite une estimation de la performance des institutions sur place. Cet article cherche à souligner l'importance des conditions locales nécessaires à la mise en application efficace d'une politique. La documentation actuelle, qui laisse supposer que la culture civique constitue une variable préalable au succès des institutions, est rejetée. On affirme plutôt que les politiques doivent mieux répondre aux atouts locaux et aux formes institutionnelles. Une disparité de la conception de la politique, du milieu socio-culturel et des stuctures institutionnelles pourrait entraîner des problèmes pour ce qui est de la performance des institutions et des résultats de la mise en application. Le manque de capacité institutionnelle risque aussi d'avoir un effet néfaste sur la performance institutionnelle et la capacité de mise en application. Pour une mise en application de politique efficace, les politiques et les institutions ont besoin de tirer parti des atouts du milieu local et de s'adapter au climat socio-culturel qui prévaut. Les difficultés de mise en application pourraient se résoudre en autorisant une conception de politique qui répond mieux aux exigences des zones locales, tout en renforcant des solutions de contrôle là où il en résulterait une amélioration de la capacité de mise en application. Eine Einschätzung der Durchführung politischer Bestrebungen schließt die Beurteilung der institutionellen Leistung des institutionellen Systems an seinem Ausführungsort ein. Dieser Aufsatz hebt die Bedeutung örtlicher Verhältnisse für eine wirksame Durchführung politischer Bestrebungen hervor. Aktuelle diesbezügliche Literatur, die nahelegt, daß Ortskultur ein wesentlicher Vorläufer für erfolgreiche institutionelle Leistung sei, wird verworfen. An ihrer Stelle wird die Behauptung aufgestellt, daß politische Bestrebungen besser an örtliche Stärken und institutionelle Formen angepaßt werden müssen. Politische Planung, gesellschaftlich-kulturelle Umwelt und institutionelle Strukturen, die schlecht auf einander abgestimmt sind, können auf Probleme stoßen, wo institutionelle Leistung und Durchführungsergebnisse verlangt werden. Auch ungenügende institutionelle Kapazität kann zu Spannungen bei institutioneller Leistung und Durchführungskapazität führen. Wenn Grundsatzbestrebungen und Institutionen effektiver werden sollen, müssen sie auf Stärken einer Gegend aufbauen und der vorherrschenden, gesellschaftlich kuturellen Umwelt angepaßt werden. Probleme bei der Durchführung lassen sich lösen, indem man durch bessere Anpassung der Grundsätze den Erfordernissen einer Gegend gerecht wird, doch zugleich behördliche Lösungen stützt, wo dies die Durchführungskapazität verbessert.

The politics of legislative evaluations: Fire-alarm and police patrol as oversight procedures

Oversight is the evaluative function of legislatures. During oversight, legislators monitor policy implementation to detect and remedy problems, or violations of legislative intent. Most oversight, like formative evaluation, is directed at producing information that can be used by legislators and administrators to improve policies during implementation. Indeed, legislators seldom use oversight to decide whether a policy should be discontinued. This article examines how state legislatures practice evaluation by analyzing oversight strategies used to monitor recent education reforms in six states (Arizona, California, Florida, Georgia, Minnesota and Pennsylvania). ’ The central theme of the article is the inextricable link between politics and oversight; the choice of oversight strategy, and, therefore, the methods legislatures use to evaluate policy implementation, are driven largely by politics. The study found that oversight of education reform in the six sample states was conducted in ways that minimized time commitments and maximized political benefits for legislators.