National Reform Programmes Research Articles

Characteristics of the health districts in Italy and their implication in primary health care policies: an analysis of socio-demographic trends.

The Health District (HD) is a critical component of Italy's National Health Service, responsible for ensuring Primary Health Care (PHC) services in response to community health needs. The Italian government established a national strategic reform program, the National Recovery and Resilience Plan (PNRR), starting in 2022, with a series of health interventions to reorganize the PHC setting, the main reform being the Ministerial Decree 77/2022 (DM77). Our study aimed to provide a description of socio-demographic data and to assess the correlation between HDs, in order to suggest health intervention priorities in PHC reforms. We conducted our analysis using a cross-sectional record linkage of data from multiple sources to compare organizational and socio-demographic variables. A dataset was created with each of the 21 Italian Regions' HDs data of population, land area, mean age, ageing index, old-age dependency ratio, birth rate and death rate. The Inland Areas Project data was integrated for a socio-economic perspective. Our study identified comparable groups of HDs, considering demographical, socio-economic and geographical aspects. The study provides a baseline understanding of the Italian situation prior to the implementation of DM77. It also highlights that inhabitants number cannot be the only variable to take into account for the definition of Italian HDs organisation and PHC reform, providing intercorrelated variables that take into account geographic location, demographic data, and socio-economic aspects. By acknowledging the interplay of demographic, socio-economic, and geographic factors, policymakers can tailor interventions to address diverse community needs, ensuring a more effective and equitable PHC system.

Progress and Institutional Challenges on Local Governments Performance Accountability System Reform in Indonesia

This study analyses, firstly, the achievement of local governments’ reform based on their Performance Accountability System (SAKIP) as part of the national administrative reform program in Indonesia. Secondly, this paper examines factors that have been affecting reform output. The study uses a mixed method perspective by analyzing the whole population of local governments from SAKIP data (2016–2019; quantitative) and applies the qualitative method of in-depth interviews with key informants. The study finds that, although there were improvements in the performance accountability system, the improvement processes have been slow and dominated by formalism at provincial and regency/city levels. Several determining factors affected the implementation of the local government performance accountability system, that is, the regulations’ arrangements, the norms, the cognitive culture, and management problems. Thus, this study confirms the theory of institutional change that considers cultural factors, political commitment, and organizational aspects that influence the dynamic of bureaucratic reform implementation.

Organ donation by children in Australia, 2000-2019: impact of the 2009 National Reform Program. Apopulation-based registry data study.

To assess the impact of the 2009 National Reform Program for organ donation in Australia on the number and characteristics of organ donors under 16 years of age. Retrospective observational time series study; analysis of Australia and New Zealand Organ Donation (ANZOD) registry data for all consented potential deceased organ donors under 16 years of age during 2000-2019, and of numbers of donors aged 16 years or more reported in ANZOD annual reports. Difference between 2000-2008 (pre-reform) and 2009-2019 (reform period) in annual organ donor rates (donors per million population), by age group (under 16 years, 16 years or more), reported as incidence rate ratio (IRR). Differences in child donor characteristics during 2000-2008 and 2009-2019. During 2000-2019, 400 children under 16 years of age were consented potential deceased organ donors, of whom 374 were actual deceased donors (94%): 146 during 2000-2008, 228 during 2009-2019. The median annual rate was 3.3 (interquartile range [IQR], 3.0-4.3) actual donors per million population during 2000-2008 and 4.2 (IQR, 3.6-5.2) donors per million population during 2009-2019 (IRR, 1.15; 95% confidence interval [CI], 0.93-1.42). In contrast, the difference between the two periods was statistically significant for donors aged 16 years or more, rising from 11.7 (IQR, 11.2-11.8) to 19.9 (IQR, 18.3-24.4) actual donors per million population (IRR, 1.75; 95% CI, 1.66-1.85). The median age of actual organ donors under 16 was similar during 2000-2008 (11 years; IQR, 7-14 years) and 2009-2019 (10 years; IQR, 4-14 years), as was the proportion of donors in this age group under 10 kg (2000-2008: four of 146, 3%; 2009-2019: 14 of 228, 6%). Despite its overall effect on organ donation rates, the National Reform Program was not effective in increasing the numbers of donors under 16 years of age. Relying on broad initiatives for adult donors may not be appropriate for achieving this aim.

О приоритетах качества и интернационализации реформы высшего образования в КНР

The article analyzes the content and directions of higher education reforms in China. The authors consider tasks, strategies of reforming higher education and present the key aspects of the content of national education reform programs. The article formulates the conclusion of the transition to innovative trajectories for the development of academic education in China, the development of university infrastructure, interaction with business in order to meet professional deficit both at the provincial level and in the national labor market. The authors present the results of international rankings, which secure the leading positions for higher educational institutions in China, fix the positive dynamics and trajectory of movement.

The Objectives of the Europe 2020 Strategy and Romania’s Achievements

Abstract The Europe 2020 strategy comes amid a deep economic crisis and long-term challenges: globalization, pressure on resource use and climate change. The Europe 2020 strategy seeks solutions to the 2008 crisis through action at an European level, based on the broad coordination of economic and fiscal policies among member states. The solutions adopted by the European Commission involve a number of common objectives, which do not take into account the level of development of each Member State. However, the Commission leaves it to Member States to set a national level of targets which may differ from what has been set at the European level, depending on their needs. This strategy has been implemented at Member State level with the help of the National Reform Programs and monitored throughout the European Semester. Romania has established its own values for all the objectives of the “Europe 2020” Strategy, and the results it obtained require an analysis.

Whose voice counts? Examining government-donor negotiations in the design of Ethiopia's large-scale education reforms for equitable learning.

SummaryMotivationThe Government of Ethiopia has a long‐standing commitment to improving the quality of education. In recent years, this has shifted to include a more explicit focus on equity in learning outcomes. In this paper, we examine the education reform design process in the context of Ethiopia’s political environment which is widely recognised as a strong developmental state.PurposeThe article examines how federal, regional, and international donor actors negotiate their interests in relation to Ethiopia’s national quality education reform programme, the General Education Quality Improvement Programme for Equity (GEQIP‐E).Methods and approachWe conducted 81 semi‐structured, key informant interviews with federal and regional government officials and international donors who were involved in the design of GEQIP‐E.FindingsWe find that federal government was able to leverage considerable political influence over high‐level priorities and the framing of GEQIP‐E. Large donors leveraged financial influence to exclude some specific priorities, while smaller donors were able to draw on social influence and technical expertise to include priorities aligned with their interests. Regional governments—which are responsible for policy implementation—were largely excluded from the reform design process.Policy implicationsOur analysis highlights the importance of recognizing and understanding different forms of influence in the dynamic process of negotiating reform between government and donors. It identifies that both government and donor voices counted in the process of negotiations, but in different ways and to varying degrees. Understanding how different actors draw on their relative political, financial, and social influence is vital for ensuring successful implementation and sustainability. Importantly, we identify that voices of local actors are left out.

“These are people just like us who can work”: Overcoming clinical resistance and shifting views in the implementation of Individual Placement and Support (IPS)

PurposeIndividual Placement and Support (IPS) is a recovery-based approach to support people with mental health difficulties back into employment. Embedding of IPS within the mental health Multi-Disciplinary Team (MDT) is a key component of IPS fidelity; however, few studies have examined how those involved with IPS implementation navigate this process. This article explores how IPS Employment Specialists (ES) and Occupational Therapist (OT) Managers integrated and embedded IPS within traditionally-oriented MDTs as part of a national reform program in the Republic of Ireland.MethodsThe study design was qualitative, descriptive with data collected through three focus groups with 17 IPS ESs and 11 OT Managers. Data were analyzed using thematic synthesis.ResultsThree key themes emerged from analysis. The first characterizes the context into which IPS landed, described as one marked by clinical resistance, doubt, and fear of risk. The second explores the strategies and factors that helped with the introduction of IPS into Irish mental health services. These included strategies, such as providing education and information about IPS and reassuring the MDT about IPS governance and IPS ES’ competencies. The evidenced-based nature of IPS and its attached accountabilities through IPS fidelity measures were perceived to be an important factor in its acceptance. The final theme encapsulates perceptions of how IPS impacted on the MDTs’ views of people with mental health difficulties. Findings suggest a shift in the ways in which MDTs view their clients. Initial fears about work capacity and risk shifted towards seeing people beyond the label of ‘service user’ and their diagnosis.ConclusionsIt is contended that IPS is an approach that allows practitioners to engage with real recovery-practice and may be one key to unlocking how a recovery approach can truly trickle down and embed itself within mental health service provision and support mental health system reform.

Paediatric Organ Donation in Australia, 2000-2019: Analysis of the Impact of the 2009 National Reform Program

Paediatric Organ Donation in Australia, 2000-2019: Analysis of the Impact of the 2009 National Reform Program

Challenges to the utilization of Community-based Health Planning and Services: the views of stakeholders in Yendi Municipality, Ghana

BackgroundThe Community-based Health Planning and Services (CHPS) is a national health reform programme that provides healthcare at the doorsteps of rural community members, particularly, women and children. It seeks to reduce health inequalities and promote equity of health outcomes. The study explored implementation and utilization challenges of the CHPS programme in the Northern Region of Ghana.MethodsThis was an observational study that employed qualitative methods to interview key informants covering relevant stakeholders. The study was guided by the systems theory. In all, 30 in-depth interviews were conducted involving 8 community health officers, 8 community volunteers, and 14 women receiving postnatal care in four (4) CHPS zones in the Yendi Municipality. The data were thematically analysed using Atlas.ti.v.7 software and manual coding system.ResultsThe participants reported poor clinical attendance including delays in seeking health care, low antenatal and postnatal care visits. The barriers of the CHPS utilization include lack of transportation, poor road network, cultural beliefs (e.g. taboos of certain foods), proof of women’s faithfulness to their husbands and absence of health workers. Other challenges were poor communication networks during emergencies, and inaccessibility of ambulance service. In seeking health care, insured members of the national health insurance scheme (NHIS) still pay for services that are covered by the NHIS. We found that the CHPS compounds lack the capacity to sterilize some of their equipment, lack of incentives for Community Health Officers and Community Health Volunteers and inadequate infrastructures such as potable water and electricity. The study also observed poor coordination of interventions, inadequate equipment and poor community engagement as setbacks to the progress of the CHPS policy.ConclusionsClinical attendance, timing and number of antenatal and postnatal care visits, remain major concerns for the CHPS programme in the study setting. The CHPS barriers include transportation, poor road network, cost of referrals, cultural beliefs, inadequate equipment, lack of incentives and poor community engagement. There is an urgent need to address these challenges to improve the utilization of CHPS compounds and to contribute to achieving the sustainable development goals.

School principals making sense of a national reform agenda: the case of Sierra Leone

ABSTRACT This article investigates how school principals in Sierra Leone interpret and enact a national education reform program. Through a sense-making lens, this qualitative study explores how the principals perceive and enact a reform program while maintaining their leadership role within the schools and communities they serve. In this study, we collect data from twelve school principals from three localities in Sierra Leone. The research suggests that in an environment where money and the resources money can purchase are consistently in short supply, the involvement of school principals in the design and communication of a national reform program is critical to the implementation of said program. School principals’ sense-making of the reform program is centered on three primary themes, all of which are linked to the lack of funding for quality education in Sierra Leone and the noninvolvement of the school principals in the design of the program: (1) teacher compensation and commitment, (2) unfunded mandates, and (3) mismatched expectations. These themes, linked to the underlying context of managing schools in low resource environments, influence the principals’ interpretations and willingness to enact the reform program.

Answers to the questionnaire on the role of national parliaments in the recovery and resilience plans and the draft budgetary plans in the framework of the COVID-19 recovery measures

The author replies to the questionnaire devoted to the involvement of the Sejm in a recovery plan for Europe after the crisis caused by the COVID-19 pandemic, including the preparation of the National Recovery and Resilience Plan (RRP), which should constitute an annex to the National Reform Program. The author points to the issues of consulting EU documents on these plans, both at the parliamentary and governmental levels. In the latter case, she also presents the work schedule on the RRP and information on the activities of working groups at the Ministry of Funds and Regional Policy on the submitted projects.

Politicile sociale în perioada post-criză financiară: România încotro? Contribuția Semestrului European în dirijarea măsurilor de politică socială în domeniile ocupării și incluziunii sociale

After implementing one of the toughest austerity programs in the European Union during the financial crisis, Romania returned to continuous economic growth for eight years (2012−2019), not before concluding between 2011−2013 two preventive agreements with Troika to reduce its macroeconomic imbalances. This continuous economic growth was also reflected in the achievement of the national targets under the Europe 2020 Strategy. In order to better coordinate economic and budgetary policies, the European Union has launched the European Semester. Although the main objective of the latter was to coordinate Member States' efforts to implement fiscal budgetary policies aimed at preventing macroeconomic imbalances and controlling public finances, after 2015, the European Semester began to incorporate social policy objectives, especially in the area of employment and social inclusion policies. By using the index of commodification/ decommodification of social policies developed by Paul Copeland, I illustrate, by analyzing the National Reform Programs and Country Specific Reports, that half of the policies taken in the two areas were towards partial commodification or commodification, and other significant measures towards commodification and decommodification, e.g. types of policies addressed to vulnerable groups trying to (re)integrate them into the labor market, even if in conditions that do not necessarily lead to social inclusion. Keywords: social policies; European Semester; Europe 2020; de/comodification; neoliberalism.

Health care utilization and affordability among older people following China\u2019s 2009 health reform -- evidence from CHARLS pilot study

BackgroundIn 2009, China unveiled an ambitious national health care reform program, with the goal of providing equitable and affordable basic health care for everyone. This study was intended to partially fill the knowledge gap in understanding of the demand-side impact on health care utilization and affordability among older people in Zhejiang and Gansu provinces of China.MethodsWe used two waves of data from the pilot survey of CHARLS implemented in 2008 and 2012. Chi-square tests and t tests were performed to examine whether out-of-pocket (OOP) and pharmaceutical spending (PS), as a share of total health expenditures (THEs), have significantly changed following the health reform. Two-part model was employed to confirm these changes after controlling for confounding variables. All analyses were weighted and clustered the standard errors.ResultsAfter controlling for confounding variables, older people in 2012 were 2.1 and 6.8% more likely to use outpatient and inpatient care than they did in 2008, respectively. Among those who have at least one outpatient visit, declines of OOP-to- THEs and PS-to-THEs percentage significantly reduced 0.998 (p < 0.1) and 2.324 (p < 0.01) from 2008 to 2012, respectively. However, conditional on having at least one inpatient stay, no significant reduction in terms of the OOP-to-THEs and even increase in terms of the PS-to-THEs percentage observed between 2008 and 2012. Compared to elderly people in Gansu, Zhejiang aged people had obviously better utilization, lighter inpatient OOP burden and lower inpatient PS proportion, but higher outpatient OOP burden and PS proportion.ConclusionsAlthough the OOP burden and PS portion had been reduced following the health reform, these impacts were still limited. Better results can be observed in outpatient care than in inpatient care, which provide a strong foundation for the next stage of reform.

The Research of Blended Learning Model of the “Apple Teacher” Program

The “Apple Teacher” program adopts a mixed learning mode in course teaching, combining network resources with the real environment to form “Online Learning + Teaching Assistant Support; Offline Class + Theme Learning; Exchange Discussion + Summary Reflection” in one of the blended learning modes and “Basic Knowledge—Self-testing—Theme Learning—Self-creation—Summary Reflection” form of learning activities.“The national medium and long-term education reform and development program outline (2010-2020)” since its launch, pays more and more attention to education informatization in our country. In the “Internet+” era, information technology and teaching idea constantly updated. The combination of online blended learning mode has become a trend, and blended learning effect has already become the important direction of teaching reform in education field. In the “Apple Teacher” program, learners take an active part in learning, actively construct and realize the harmonious unity of “Individual Knowledge Construction—Learning Community”.

Improving Chronic diseases management through integration, in Jeddah, Saudi Arabia

Introduction: Prevalence rates of chronic diseases are increasing in Saudi Arabia, contributing almost 60% of all premature deaths in 2016, estimated to rise to 73% by 2020. Of these, diabetes and hypertension are most common with prevalence rates of 23% and 26% respectively. In Jeddah region, at 30% diabetes prevalence is the highest regionally in Saudi Arabia. A key failing of the Jeddah approach to chronic disease management is the disconnect between primary care and secondary/tertiary services. In an attempt to improve care, Jeddah Department of Health Affairs commenced integration of primary and secondary chronic disease care. We discuss progress on the new integrated approach for diabetes management. Short description of practice change implemented A multi-phase integration of chronic disease management through improved co-ordination between primary and secondary care providers and shared case management. Phase 1 aims to improve referral systems and access to specialist care teams for primary care physicians. Aim and theory of change: To improve health outcomes for patients with diabetes in Jeddah through the improvement of case management by providing primary care physicians with specialist support and access to patient information. The is aimed at encouraging shared responsibility, establishing relationships between primary healthcare professionals and related specialties, and taking specialist care closer to the patient. Targeted population and stakeholders: The programme targets the 4000 people living with diabetes in Jeddah, includes primary and secondary care providers, and other stakeholders in the local community. Timeline: Implementation started in May 2017, and it is anticipated that full phase 1 integration will be achieved by December 2018. Highlights: The targeted outcomes access to care, improved patient’s satisfaction, self-management and clinical outcomes with resultant improvements in quality of life and reduced mortality/morbidity. There would also be reduction in emergency department use and readmissions. Comments on sustainability: The current effort sits within a wider national reform programme providing new integrated care models. The aim is to ensure this programme aligns with the national approach. However, the planned changes are poorly understood by local leaders and health care workers, with this consequent lack of local ownership a major barrier for sustainability. Comments on transferability: The current programme sits within the larger national model of care currently being piloted. Formative and (independent) summative evaluations have been built into the approach to allow for transferability through identification of success factors and key learnings. Conclusions: This integrated system has the potential to provide an enabling environment for the improvement of diabetes management. Primary care physicians now function as part of a wider team, with improved access to specialist services. Discussions: Whilst there has been improved interaction with specialists, integration of patient records is still not implemented, and use of shared guidelines and protocols have yet to be addressed. This will be key for the next phase. Lessons learned: Effective integration needs adequate preparation and stakeholder buy-in before the implementation stage. The approach is being amended to empower local stakeholders to own and improve care management.

The national program on standardized cancer care pathways in Sweden: Observations and findings half way through

In 2015, the Swedish government initiated a national cancer reform program to standardize cancer care pathways. Primary aims included shortened waiting times among patients with suspected cancer, increased patient satisfaction and reduced regional variation. The implementation phase of the program is now more than half way through and both achievements and challenges have been identified.The ongoing evaluation demonstrates that professional engagement and adjustments on the meso- and micro-level of the system are essential to achieving sustainable improvements. Waiting times have shortened for the pathways launched first, and patients are satisfied with a more transparent process. Physicians in primary care are satisfied to inform patients about the pathways but point out problems with comorbidity and complicated diagnostic procedures related to unspecific symptoms. Mechanisms and ethical considerations behind possible crowding-out effects need to be thoroughly highlighted and discussed with staff and management. The results so far appear promising but meso- and micro-levels of the system need to be more involved in the design processes.

National parliaments and EU economic performance policies. Impact defines involvement?

In recent years, decision-making on economic performance policies – macroeconomic stability and structural reforms – has evolved from a system based on Broad Economic Policy Guidelines into a full-fledged part of the European Semester, including the possibility to sanction Member States. This suggests an increased role for national parliaments to ensure the democratic legitimacy of EU decision-making. But this need for democratic legitimacy is qualified by the impacts of economic performance policies in and on the Member States. This contribution assesses these impacts by reviewing arguments derived from (a) the applicable legal framework and prior research that has been carried out and (b) by conducting a comparative analysis of the policy dialogues with Germany, France, the United Kingdom and the Netherlands in 2014 (based primarily on National Reform Programmes and Country Specific Recommendations). Next, an assessment is made of how parliaments in these countries have been involved concretely in economic performance policies.

TRANSPARENCY AND FOREIGN DIRECT INVESTMENT INFLOWS: ANALYSIS OF DIRECT AND INTERACTING EFFECTS ON MARKET CAPITALIZATION IN EMERGING MARKET ECONOMIES

ABSTRACT In current paper, an attempt is made to investigate the role played by transparency in reform outcome and development efforts in societies around the globe. The authors investigate the two sides of the transparency debate—both the conventional view that portray the positive rewards and the contrasting side that is more hesitant about the associated benefits. The paper is based on empirical investigation of four countries—two of them (Hong–Kong and Singapore) representing societies with transparent public policies that have successfully reformed and transitioned to the rank of newly industrialized economies, and the other two (Nigeria and Sudan)—lacking in transparent public policies and still faced with difficult reform and transitional challenges. The results uncover evidence of strong association between transparency and reform outcome/national development efforts. The impact of transparency on reform is monitored through FDI inflows—uncovering evidence that countries with transparent policies are successful in attracting FDI inflows needed for executing national reforms and development programs and, on the contrary, that nations lacking in transparent public policies fail to attract needed FDI inflows. Based on pragmatic data, the results are very insightful and can be used, not only be scholars, but also by policy-makers for guiding the formulation of national reform programs and development blueprints in their societies, as needed. Keywords Corruption; Foreign Direct Investment (FDI) Inflows; Market Capitalization; Emerging Market Economies (EMEs)

Проблемы перехода к модели диспетчера в здравоохранении

Regulation of access to specialist medical care is widely viewed as effective tool for health cost containment. However, the results of the access reforms in well-developed public health systems in practice are often below the expected level. The article provides an overview of structure and outcomes of major national access reform programmes in European countries. Based on the collected data key determinants of successful adoption of gatekeeping model were highlighted in the article. The author proposes the promising ways of the development of the current access model reform in Russia.

The Reform and Harmonization of Commercial Laws in the East African Community

The partner states in the East African Community (EAC) have modernized their commercial laws to claim their post-colonial identity and facilitate development. While law reform and the harmonization of laws are both methods of shaping laws, the national law reform programmes in the EAC mainly aim to ensure that the laws reflect the domestic socioeconomic circumstances, in contrast to the harmonization of national commercial laws, which focuses on the attainment of economic development. This article observes that the reformed and harmonized commercial laws in the EAC are mainly legal transplants of the principles of transnational commercial law that have been adapted to meet domestic needs and aspirations.