Health Governance Framework Research Articles

The Effect of the COVID-19 Pandemic on Digital Health-Seeking Behavior: Big Data Interrupted Time-Series Analysis of Google Trends.

Due to the emergency responses early in the COVID-19 pandemic, the use of digital health in health care increased abruptly. However, it remains unclear whether this introduction was sustained in the long term, especially with patients being able to decide between digital and traditional health services once the latter regained their functionality throughout the COVID-19 pandemic. We aim to understand how the public interest in digital health changed as proxy for digital health-seeking behavior and to what extent this change was sustainable over time. We used an interrupted time-series analysis of Google Trends data with break points on March 11, 2020 (declaration of COVID-19 as a pandemic by the World Health Organization), and December 20, 2020 (the announcement of the first COVID-19 vaccines). Nationally representative time-series data from February 2019 to August 2021 were extracted from Google Trends for 6 countries with English as their dominant language: Canada, the United States, the United Kingdom, New Zealand, Australia, and Ireland. We measured the changes in relative search volumes of the keywords online doctor, telehealth, online health, telemedicine, and health app. In doing so, we capture the prepandemic trend, the immediate change due to the announcement of COVID-19 being a pandemic, and the gradual change after the announcement. Digital health search volumes immediately increased in all countries under study after the announcement of COVID-19 being a pandemic. There was some variation in what keywords were used per country. However, searches declined after this immediate spike, sometimes reverting to prepandemic levels. The announcement of COVID-19 vaccines did not consistently impact digital health search volumes in the countries under study. The exception is the search volume of health app, which was observed as either being stable or gradually increasing during the pandemic. Our findings suggest that the increased public interest in digital health associated with the pandemic did not sustain, alluding to remaining structural barriers. Further building of digital health capacity and developing robust digital health governance frameworks remain crucial to facilitating sustainable digital health transformation.

Strengthening health system governance in Germany: looking back, planning ahead.

Health system governance has been receiving increasing attention in health system research since the 1980s. The contemporary challenges that the German health system is faced with are often closely linked to governance issues. Although Germany has the highest health expenditure as a share of Gross Domestic Product (GDP) in the European Union (EU), the spending on healthcare is out of proportion to the health outcomes of the population. The reason for this lies mainly in the complexity of the German health system which is hard to steer due to several administrative levels in the country and numerous policy actors to whom the decision-making power on healthcare provision is delegated. In this paper, we present the results of focus group discussions on governance and build upon the insights gained through the Neustart project of the Robert Bosch Foundation. Based on an internationally recognised health governance framework from the World Health Organization (WHO), experts who work in, on or for the German health system addressed health governance challenges. They provided evidence-based recommendations for the new legislative period (2021-2025) on transparency, accountability, participation, integrity and capacity of the German health system.

Value over Volume: Maximizing Resources by Prioritizing Value: The Dubai Healthcare Experience

The mission of the Dubai Health Authority is to transform healthcare delivery by fostering innovative and integrated care models and enhancing community engagement. The Authority’s programs are designed to move the emirate’s healthcare system forward by being mutually supportive, constituency inclusive, accountable and outcomes-based. Dubai’s healthcare policy leadership has adopted a strategy to drive and ensure compliance and accountability through an innovative health governance framework. At its core, Dubai’s healthcare strategy begins with its Care Model Innovation Program. This key initiative is designed to promote innovation and efficiency and ensure that Dubai residents (citizens) and visitors (non-citizen residents) have access to high quality services across the continuum of care.

SOOP: A Swarm-Optimized Opinion Prediction Model for S-Health Governance

Background: To realize a viable and resilient smart city-smart nation scenario, “peoplecentric” strategic technology components are imperative to eventually create smart outcomes for citizens. Smart health is one such domain where the government is putting incessant effort to ensure social well-being and sustainability. Contemplation of public opinion plays a very significant role in the process of government policy evaluation. The current affordable, ubiquitous generation of Web provides substantial amount of opinionated social big data which facilitates data-driven decision making. But determining the polarity of short-text, a.k.a. sentiment is hard owing to the noisy, ambiguous and heterogeneous use of natural language. Objective: A novel health governance framework using a Swarm Optimized Opinion Prediction model, SOOP Model is proposed to capture netizen views on government policies and figure out the inclination of public about the campaign. The model is investigated for the sentiment classification task on tweets pertaining to ‘Poshan Abhiyaan’, one of the latest healthcare policy, launched by the Government of India to address the issues related to malnutrition in women and children. Methods: The conventional feature extraction using TF-IDF (Term Frequency-Inverse Document Frequency) is done on the pre-processed dataset. Subsequently, Binary bat algorithm, a swarm-based optimal feature selection method is used to improve the sentiment classifier’s performance. Results: The empirical analysis validates that the proposed implementation of the meta-heuristic algorithm for feature subset selection outperforms the baseline supervised learning algorithms with an average 9.4% improvement in accuracy and approximately 39% average reduction in features. Conclusion: The proposed SOOP Model as a policy evaluation strategy within the healthcare setting empowers various stakeholders and enhances their socio-economic environment.

One Health Approach through interactive Urban Health Governance Framework in a Smart city, India

ObjectiveThe present study aims to operationalize one health approach through local urban governance system in a rapidly urbanized Indian city, Ahmedabad, India.In Ahmedabad (proposed Smart city), Gujarat, India:1. To understand the pattern of zoonotic diseases in reference to urban governance system2. To develop a conceptual One Health Governance framework with reference to zoonotic diseases3. To assess the key indicators for convergence for inter-sectorial professional collaborations in One HealthIntroductionSmart governance refers to the emergence of joint action by the health and non-health sectors, public and private actors and citizens. Although, there are growing literature on governance and its potential impact on health, major challenges on collective action across sectors have been witnessed in developing countries like India. In the same line, the current forms of Global Health Governance façades operational issues and does not sufficiently meet the needs at local levels. In light of these perceived shortcomings, the local governance becomes subject of interest and should be debated especially with reference to global urbanization.Rapid and unplanned urbanization followed by the combination of high population density, poverty and lack of infrastructure have more side effects and fostering conditions for communicable diseases to flourish. Evidence suggests that new megacities could be incubators for new epidemic and zoonotic diseases, which can spread more rapidly and become worldwide threats. In India, Ministry of Urban Development initiated the concept of converting few major cities into “Smart City” in 2015-16. However, one of the major critiques of available smart city guideline is that it has no such focus on prevention of emerging and/or re-emerging zoonotic diseases. The emergence and/or re-emergence of zoonotic diseases should be considered as potential threats for these upcoming Smart Cities and hence, should be addressed by one health approach (health and non-health sectors, public and private actors) through an appropriate local governance strategy.With rapid urbanization and healthcare transformation in India, the operationalization of one health approach might become a major challenge, because of, the absence of the systematic effect at the national level and urban cities are riven between central, state and municipal authorities in terms of health policy, planning, health needs etc. There is also lack of information sharing or collaborations between the health and non-health sectors, public and private actors at the city level. Understanding these challenges can offer important lessons for strengthening both local urban governance and One Health.MethodsFor Objective-1: To understand the pattern of zoonotic diseases in reference to urban governance system1. Is there existing literature indicates the importance of governance system in prevention of zoonotic diseases in urban settingsUrban Governance System & Zoonotic diseases (Systematic Review)2. Is prevalence of zoonotic disease vary in accordance with change of local urban governance(Outcome: Prevalence of Zoonotic diseases & Exposure: Governance Index for last 10 years)For Objective-2: To develop a conceptual One Health Governance framework with reference to zoonotic diseases1. Is there evidence of existing One Health Governance framework exists One Health Governance Framework(Systematic Review & SWOT Analysis)2. To map the urban agencies working for zoonotic diseases Institutions for zoonotic diseases (Mapping)3. Is convergence possible for One Health in prevention of Zoonotic diseases (Policy Maker, System-level professionals Qualitative Key Informant Interviews)For Objective-3: To assess the key indicators for convergence for inter-sectorial professional collaborations in One Health1. Is developed governance framework operational at field level- KAP among Healthcare providers, Veterinarians, Environmental specialists2. Is there possibilities of convergence at field level for One health in prevention of zoonotic diseases (Qualitative Key Informant Interviews)ResultsThis is first of kind unique study to come up with a local urban governance convergence approach for “One Health” for the upcoming Smart city Ahmedabad, which may further be scaled up to other smart cities of India.ConclusionsUrban Health governance framework for a smart city to develop an one health approach.

Local food environments: Australian stakeholder perspectives on urban planning and governance to advance health and equity within cities

ABSTRACTUrban planning policy has the potential to improve population health outcomes and reduce health inequities within cities. In Australia, however, the pathways for implementing policy approaches are unclear, and responsibilities are contested and dispersed across sectors, portfolios and levels of government. This study investigated government, non-government and private sector perspectives on spatial planning for local food environments and aimed to identify governance opportunities to advance healthy equitable food access. Informed by health governance frameworks, 27 key informant interviews with policymakers and practitioners from urban planning, public health, urban economic and partnership development were conducted in Melbourne, Australia, a city experiencing rapid growth. Stakeholders identified regulation, urban planning policy, finance, coordination and partnerships as key governance processes for the creation of healthy food environments; political leadership as a driver for action; and distributed leadership as essential for implementation. Urban health is a recurring theme in the UN Sustainable Development Goals with targets for health and wellbeing, and sustainable urbanisation. Our study contributes to an understanding of the governance actions required to deliver healthy equitable urban food environments, and demonstrates the importance of comprehensive action, particularly when two of the potentially most powerful levers, regulation and finance, are weak.

New Prospects in Regional Health Governance: Migrant Workers' Health in the Association of Southeast Asian Nations

AbstractThe Association of South East Asian Nations (ASEAN) has potential in creating regional health governance frameworks. Yet in light of the ASEAN Economic Community 2015, pressing challenges remain. Further integration will likely lead to increased movements of migrants. Protecting the health of migrant workers is thus key to ensure that regional integration's objectives of economic growth and political stability are met.With the potentially negative repercussions of unhealthy migration on ASEAN's economic and political integration, much effort should be directed towards further social integration. Why and how should a regional framework to protect migrant workers' health be negotiated through ASEAN? A key to the successful ASEAN regional framework for migrant workers' health, which is also a key challenge for the region, is the effective inclusion of various stakeholders involved in the protection of migrant workers' health. ASEAN will play a crucial role in coordinating initiatives and in creating common standards regarding treatment of migrant workers.

Law as a Social Medicine: Enhancing International Inter-regime Regulatory Coopetition as a Means for the Establishment of a Global Health Governance Framework

Law is, in one sense, a social medicine.1Pierre Lepaulle, The Function of Comparative Law with a Critique of Sociological Jurisprudence, 35 Harvard Law Rev. 838, 838 (1922).In a rapidly globalizing...

From global agenda-setting to domestic implementation: successes and challenges of the global health network on tobacco control.

Global policy attention to tobacco control has increased significantly since the 1990 s and culminated in the first international treaty negotiated under the auspices of the World Health Organization--the Framework Convention on Tobacco Control (FCTC). Although the political process that led to the creation of the FCTC has been extensively researched, the FCTC's progression from an aspirational treaty towards a global health governance framework with tangible policy effects within FCTC member countries has not been well-understood to date. This article analyses the role of the global health network of tobacco control advocates and scientists, which formed during the FCTC negotiations during the late 1990 s, in translating countries' commitment to the FCTC into domestic policy change. By comparing the network's influence around two central tobacco control interventions (smoke-free environments and taxation), the study identifies several scope conditions, which have shaped the network's effectiveness around the FCTC's implementation: the complexity of the policy issue and the relative importance of non-health expertise, the required scope of domestic political buy-in, the role of the general public as network allies, and the strength of policy opposition. These political factors had a greater influence on the network's success than the evidence base for the effectiveness of tobacco control interventions. The network's variable success points to a trade-off faced by global health networks between their need to maintain internal cohesion and their ability to form alliances with actors in their social environment.

Combating healthcare corruption and fraud with improved global health governance

Corruption is a serious threat to global health outcomes, leading to financial waste and adverse health consequences. Yet, forms of corruption impacting global health are endemic worldwide in public and private sectors, and in developed and resource-poor settings alike. Allegations of misuse of funds and fraud in global health initiatives also threaten future investment. Current domestic and sectorial-level responses are fragmented and have been criticized as ineffective. In order to address this issue, we propose a global health governance framework calling for international recognition of “global health corruption” and development of a treaty protocol to combat this crucial issue.

The international politics of disease reporting: Towards post-Westphalianism?

Since the outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003, there has been much discussion about whether the international community has moved into a new post-Westphalian era, where states increasingly recognize certain shared norms that guide what they ought to do in responding to infectious disease outbreaks. In this article I identify this new obligation as the ‘duty to report’, and examine competing accounts on the degree to which states appreciate this new obligation are considered by examining state behaviour during the H5N1 human infectious outbreaks in East Asia (since 2004). The article examines reporting behaviour for H5N1 human infectious cases in Cambodia, China, Indonesia, Thailand and Vietnam from 2004 to 2010. The findings lend strong support to the claim that East Asian states have come to accept and comply with the duty to report infectious disease outbreaks and that the assertions of sovereignty in response to global health governance frameworks have not systematically inhibited reporting compliance.

Governance challenges in China’s urban health care system – the role of stakeholders

The article at hand aims at contributing to a deeper understanding of problems in China’s urban health system governance by comparing levels of influence and the roles of different stakeholder groups – government bodies, public, private and illegal health care providers, patients and their social networks, paying institutions, social organizations, and the civil society – in the production and reproduction of the layout of the health care system in the city of Guangzhou. Primary data was collected in several fieldwork studies in Guangzhou City between December 2006 and January 2009 and includes 27 in-depth interviews with administrative officials, health care providers and NGO representatives as well as 70 in-depth interviews and a quantitative survey with 450 rural-urban migrants. We use the actor-centred institutionalism approach by MaYnTz and scharpF (1995) and scharpF (2000) which we combine with archer’s (1995) morphogenetic approach in order to develop an analysis tool. The findings show that although hierarchical steering by the municipal administrative units in Guangzhou is officially still in place, new corporate agents have emerged, such as influential hospital managers, social organizations and NGOs that, together with the multiple adaption and circumvention strategies of primary agents, patients and health care providers, are significantly reshaping the health system. Considering China’s current debate on the general type of health system that should be put in place we argue that it is necessary to restructure the functions and influences of stakeholders in the health system if any such reforms should be successful in improving public health. The basis for this should be the establishment of an all-embracing health governance framework, which should include independent third-party supervision and monitoring and which requires overall reforms of the general state governance structures as well as a more profound integration of interests and collaboration of all stakeholders.

An alternative approach to evaluating, measuring, and comparing domestic and international health institutions: Insights from social science theories

Objectives This article introduces the benefits of applying social science theories discussing institutional stasis and change to better measure, explain, and compare elite behavior within health administration and decentralization processes. A new comparative method based on these theories is introduced, as well as methods for collecting and analyzing data. Methods A literature review of health governance, health system governance, and path dependency and institutional change theory was conducted to reveal the limitations of health governance approaches explaining elite behavior. Next, path dependency and institutional change theory was applied to case studies in order to demonstrate their utility in explaining institutional stasis and change. Results Current approaches to analyzing and comparing elite behavior in the health governance frameworks are limited in their ability to accurately explain the willingness of elites to pursue more efficient institutional and policy designs. Current indicators measuring elite behavior are also too static, failing to account for periodic resistance to change and the conditions for it. Conclusions By applying path dependency and institutional change theory, the policy community can obtain greater insight into the willingness and thus capacity of institutions to pursue innovations while developing alternative analytic frameworks and databases that better measure and predict this process.