Policy Outcomes Research Articles

The challenges of harmonising anti-doping policy implementation

ABSTRACT The policy-implementation gap conceptualises how policy intentions and outcomes often differ due to a failure to consider the realities of implementation. The World Anti-Doping Agency (WADA) directs Olympic anti-doping policy, seeking to harmonise anti-doping policy globally; however, the realisation of consistent implementation has proven challenging. A major cause of inconsistent policy implementation is inter-signatory variation, but the mechanisms of variation are poorly understood. WADA provides an excellent example to explore why policy gaps occur in international sport governance. Consequently, we aimed to analyse the different types of inter-signatory variation in anti-doping policy and identify practical solutions to address inter-signatory variation in anti-doping. Data were collected from the Regional Anti-Doping Programme (RADO), a group of organisations tasked with increasing the capacity of NADOs globally. Semi-structured interviews were conducted with 22 RADO staff and board members who were sampled as key informants to discuss how inter-signatory variation affects anti-doping policy compliance. Following reflexive thematic analysis, we identified four thematic categories explaining inter-signatory variation in anti-doping implementation: (1) socio-geographic, (2) political, (3) organisational, and (4) human resources. Based on our analysis, we theorise why the policy-implementation gap occurs and provide recommendations to improve anti-doping policy implementation.

Patient-tailored platelet transfusion practices for children supported by extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) serves as cardiopulmonary therapy in critically ill patients with respiratory/heart failure and often necessitates multiple blood product transfusions. The administration of platelet transfusions during ECMO is triggered by the presence or risk of significant bleeding. Most paediatric ECMO programmes follow guidelines that recommend a platelet transfusion threshold of 80-100 × 109/L. To reduce exposure to platelets, we developed a practice to dynamically lower the threshold to ~20 × 109/L. We describe our experience with patient-tailored platelet thresholds and related bleeding outcomes. We retrospectively evaluated our platelet transfusion policy, bleeding complications and patient outcome in 229 ECMO-supported paediatric patients in our unit. We found that more than 97.4% of patients had a platelet count <100 × 109/L at some point during their ECMO course. Platelets were transfused only on 28.5% of ECMO days; and 19.2% of patients never required a platelet transfusion. The median lowest platelet count in children who had bleeding events was 25 × 109/L as compared to 33 × 109/L in children who did not bleed (p < 0.001). Our patients received fewer platelet transfusions and did not require more red blood cell transfusions, nor did they experience more haemorrhagic complications. We have shown that a restrictive, 'patient-tailored' rather than 'goal-directed' platelet transfusion policy is feasible and safe, which can greatly reduce the use of platelet products. Although there was a difference in the lowest platelet counts in children who bled versus those who did not, the median counts were much lower than current recommendations.

Assessing the contributions of an urban population health initiative to shift political priority towards cardiovascular health: three case studies from Brazil, Mongolia and Senegal

BackgroundThe urban population health initiative was designed as a multidisciplinary, multisector programme to address cardiovascular (CV) disease, specifically hypertension and its underlying causes in the cities of Ulaanbaatar, Mongolia; Dakar, Senegal; and São Paulo, Brazil. This article aims to provide an overview of the history and dynamics of CV disease policy making in the three countries, to present the policy reform contributions of the initiative and its role in the policy agenda-setting framework/process in each country and to identify the enablers and challenges to the initiative for doing so.MethodsA qualitative case study was conducted for each setting from November 2020 to January 2021, comprised of a document review, semi-structured in-depth interviews and unstructured interviews with stakeholders involved in the initiative. The literature review included documents from the initiative and the peer-reviewed and grey literature with a total of 188 documents screened. Interviews were conducted with 21 stakeholders. Data collection and thematic analysis was guided by (i) the Kingdon multiple streams conceptual framework with the main themes being CV disease problems, policy, politics and the role of policy entrepreneurs; and (ii) the study question inquiring on the role of the urban population health initiative at the CV disease policy level and enabling and challenging factors to advancing CV disease policy. Data were thematically analysed using the Framework Method.ResultsEach setting was characterized by a high hypertension and CV disease burden combined with an aware and proactive political environment. Policy outcomes attributed to the initiative were updating the guidelines and/or algorithms of care for hypertension and including revised physical and nutritional education in school curricula, in each city. Overall, the urban health initiative’s effects in the policy arena, were most prominent in Mongolia and Senegal, where the team effectively acted as policy entrepreneur, promoting the solutions/policies in alignment with the most pressing local problems and in strong involvement with the political actors. The initiative was also involved in improving access to CV disease drugs at primary health levels. Its success was influenced by the local governance structures, the proximity of the initiative to the policy makers and the local needs. In Brazil, needs were expressed predominantly in the clinical practice.ConclusionsThis multi-country experience shows that, although the policy and political environment plays its role in shaping initiatives, often the local priority needs are the driving force behind wider change.

The complex interplay of causal narratives in public policy and political discourse

The study builds on Deborah Stone’s foundational work exploring the mechanics of causal narratives and their implications for framing problems, assigning responsibility, and guiding policy solutions. The purpose of this research is to unravel the complexities of causal narratives in contemporary politics and understand their profound influence on public policy and society at large. In the digital age, where information is abundant and the traditional gatekeeping role of media has diminished, causal narratives have become increasingly multifaceted. The study aims to explore how these narratives, influenced by the intersections of natural phenomena, human actions, politics, risk, and media, shape public understanding and policy directions. The study employs an extensive review of existing literature, covering works from political science, media studies, and public policy. This includes analyzing seminal texts like Deborah Stone’s “Policy Paradox” and recent studies on media’s evolving role in political discourse. Today’s causal narratives are multifaceted, influenced by a myriad of factors including political agendas, scientific findings, and media portrayals. In conclusion, the research highlights the dynamic nature of causal narratives in the digital age and their significant impact on public policy and societal outcomes. It underscores the need for nuanced understanding and strategic approaches in crafting and interpreting these narratives.

Few Bad Apples? Criminal Charges, Political Careers, and Policy Outcomes

Few Bad Apples? Criminal Charges, Political Careers, and Policy Outcomes

A Few Bad Apples? Criminal Charges, Political Careers, and Policy Outcomes

A Few Bad Apples? Criminal Charges, Political Careers, and Policy Outcomes

A Few Bad Apples? Criminal Charges, Political Careers, and Policy Outcomes

A Few Bad Apples? Criminal Charges, Political Careers, and Policy Outcomes

Strategies Used by the Teachers who are in Inclusion Classrooms Regarding the Students with Special Educational Needs

Integrating children with special educational needs in ordinary schools has been a central aspect of providing educational rights to every child. Sri Lanka is a country that values education, and the government schools provide free education facilities to every student concerning special educational opportunities for disabled students as well. Children with disabilities in Sri Lanka are educated through inclusion in mainstream or specialized schools. Teachers are the most important persons contributing to achieving the expected outcomes of inclusive education policy. They are the people who take action and implement educational reforms at the school level. A key element in the successful implementation of inclusive education is teachers’ ability to maintain and teach a classroom with an inclusive background. Therefore, the present research inquired about the strategies used by teachers in inclusive classrooms regarding students with special educational needs. The main objectives of the study are to find out the awareness about inclusive education among the teachers who are in inclusive classrooms, to identify the motivational strategies used by the teachers who are in inclusive classrooms, and to find out the teaching methods used by the teachers who are teaching in inclusive classrooms. Qualitative methods were used to collect data with classroom observations and semi structured interviews. A purposive sampling method was used to select the sample, and gathered data were analyzed thematically. Evidently, the teacher’s awareness of inclusive education was insufficient, and they were not provided with proper training regarding teaching in an inclusive classroom. Teachers used motivational strategies like reinforcement methods, assisting the issues of the SEN students, arranging the classroom environment according to the needs, and giving equal opportunities to the students. Most teachers used the lecture method in the classroom. Brainstorming and role-play were also visible. Less use of student-centred methods was visible. Proper awareness and training are needed to uplift the quality of teaching in inclusive classrooms in Sri Lanka.

The study of the transformation education policy and regulation during the COVID-19 pandemic

The research delves into the repercussions of the COVID-19 pandemic on Indonesia’s education sector, notably the transition from conventional face-to-face teaching to distance learning policies (Haqien &amp; Rahman, 2020). It centres on identifying challenges and appraising government policies responding to the crisis, focusing on effectively implementing distance learning, especially in remote regions grappling with network constraints and inadequate facilities. Employing a qualitative case study methodology rooted in Dunn’s (2003) analytical theory, the research scrutinises the outcomes of Indonesian government policies during the pandemic, emphasising their impact on the shift to distance learning. The findings underscore the rapid governmental responses to the pandemic, particularly in education, necessitating a shift to distance learning for safety. However, challenges persist, notably in remote areas with connectivity and infrastructure limitations. The study advises reevaluating zoning policy’s impact on learning modes. Research highlights challenges, urging policy reassessment and increased support in Indonesia. The paper is crucial for policymakers, educators, and stakeholders, providing vital insights to enhance the resilience and adaptability of the education system in unforeseen crises.

Assessing the effectiveness of agricultural policies on development: A systematic literature review from diverse countries

This research strives to evaluate the efficacy of farm-related policies in promoting development by conducting a global analysis across diverse nations. The assessment seeks to distill invaluable insights through a comparative examination of agricultural policies implemented in various countries. The research employs a systematic literature review as its methodology. This comprehensive review systematically scrutinizes the impact of agricultural policies on development, with a specific focus on a carefully chosen set of countries: Mali, Cameroon, South Africa, Indonesia, Vietnam, the United States, European nations, and Brazil. The study encapsulates the lessons gleaned from these nations' experiences in bolstering their agricultural sectors to achieve objectives such as economic advancement, food security, environmental responsibility, poverty reduction, and rural community development. By synthesizing and contrasting findings from a multitude of studies, this research strives to furnish a holistic comprehension of the outcome of agricultural policies on development outcomes. Through a nuanced analysis pertaining to the strengths and weaknesses of these countries' agricultural policies in the context of development, this research seeks to offer useful understandings to shape future policy decisions and further the cause of agricultural development on a global scale.

Production networks and resilience: How dense production networks shield economies in financial crisis.

The research delves into the underexplored area of how production network structures influence the severity of economic downturns, particularly during the last financial crisis. Utilizing the RSTAN database from the OECD, we meticulously derived critical measures from the input-output matrices for 61 economies. Our methodology entailed a panel analysis spanning from 2008 to 2010, which is a period marked by significant recessionary pressures. This analysis aimed to correlate economic performance with various production network metrics, taking into account control factors such as interest rates and the prevalence of service sectors. The findings reveal a noteworthy positive correlation between the density of production networks and economic resilience during the crisis, which remained consistent across multiple model specifications. Conversely, as anticipated, higher interest rates were linked to poorer economic performance, highlighting the critical interplay between monetary policy and economic outcomes during periods of financial instability. Given these insights, we propose a policy recommendation emphasizing the strategic enhancement of production network density as a potential buffer against economic downturns. This approach suggests that policymakers should consider the structural aspects of production networks in designing economic stability and growth strategies, thus potentially mitigating the impacts of future financial crises.

Towards a Coherent Trade-Environment Nexus? The EU’s Critical Raw Materials Policy

This article contributes to the debate on the policy coherence of the trade-environment nexus by analysing the recent critical raw materials (CRM) policy of the European Union (EU). Critical raw materials are crucial for the green and digital transitions but face significant risks in their supply. This raises the question to what extent the EU can ensure a coherent approach in an era of geopolitics. The analysis proceeds in three steps: what does coherence mean (problem definition), how coherent are the EU’s policy objectives, and how coherent are its policy instruments designed for CRMs? The article finds that the EU’s problem definition of the trade-environment nexus has over the past two decades become more coherent. However, the rise of geopolitics has added foreign policy considerations to the understanding of this nexus. As the case of CRMs shows, open strategic autonomy, which aims to reduce strategic dependencies, generates incoherence among the policy objectives. The many existing or proposed EU policy instruments can, so far, be assessed as being relatively more coherent yet also with a mixed record. Future research will have to confirm this preliminary finding and also address the coherence of the policy implementation and outcomes of the EU’s CRMs policy. critical raw materials, European Union, geopolitics, Green Deal, open strategic autonomy, policy coherence, sustainability, trade-environment nexus, trade policy, twin transition

Adherence to Standard Precautions and Associated Factors Among Healthcare Workers at Public and Private Hospitals in Northeast Ethiopia.

Standard precautions are crucial for infection control in healthcare. Studies show public hospitals' adherence, but data on private hospitals are scarce. Understanding this disparity is vital for safety, policy, and better patient outcomes. Hence, this study aimed to assess precautions and associated factors among healthcare workers at public and private hospitals in Northeast Ethiopia. A comparative cross-sectional study compared healthcare institutions. A total of 470 workers participated via stratified random sampling. Data collection used a pre-tested questionnaire and observation checklist. Epi data managed entry, while STATA analyzed. Binary logistic regression determined significance (P<0.05) for variables. The overall adherence to standard precautions was 51.6% (95% confidence interval (CI): 46.9-56.2). At public and private hospitals, it was 52.2% (95% CI: 45.6-58.6) and 60.4% (95% CI: 53.9-66.9), respectively. In public hospitals adherence was affected by female sex [adjusted odds ratio (AOR): 2.58; 95% CI: 1.32-5.02], availability of written guidelines [AOR: 3.10; 95% CI: 1.62-5.94], having good knowledge [AOR: 2.05; 95% CI: 1.03-4.11] and favorable attitude towards standard precautions [AOR: 2.21; 95% CI: 1.14-4.27]. In private hospitals, it was affected by the availability of running tape water [AOR: 2.36; 95% CI: 1.10-5.04], personal protective equipment (AOR: 2.22; 95% CI; 1.01-4.93), color-coded dust bins [AOR: 2.33; 95% CI: 1.04-5.21], having good knowledge [AOR: 2.10; 95% CI: 1.07-4.13] and favorable attitude [AOR: 2.63; 95% CI: 1.39-4.97]. The adherence to standard precautions was higher among private than public hospital healthcare workers in Dessie City, Ethiopia. Thus, ensuring adequate availability of personal protective equipment, safety materials, and running tap water in working rooms, particularly in public hospitals is highly recommended. The initiatives aimed at promoting adherence to standard precautions should be designed and put into action for public hospitals.

Sexual and reproductive health research capacity strengthening programs in low- and middle-income countries: A scoping review.

Sexual and reproductive health (SRH) research capacity strengthening (RCS) programs in low- and middle-income countries (LMICs) are needed to foster the discovery of context-specific solutions to improve patient outcomes and population health. There remains a limited understanding of SRH research strengthening programs to raise skill sets, publications, and infrastructure and ultimately influence health policy and patient outcomes in LMICs. More information is needed to understand how SRH research is sustained after program completion. To inform efforts to implement programs that strengthen SRH research and foster sustainability, we conducted a scoping review to identify and synthesize strategies used in SRH research strengthening programs in LMICs. A literature search of nine scholarly databases was conducted. We synthesized data extracted from included articles and presented results highlighting the format, duration, and topics covered of program interventions to strengthen SRH research in LMICs. We organized information about primary outcomes into themes and summarized how SRH research capacity was sustained after program completion. Twenty-four articles were included in the scoping review. The articles generally focused on outcomes within the themes of advocacy/capacity, education, policy, project life cycle, and writing/publication. Few articles reported metrics or other evidence of long-term program sustainability of SRH RCS projects in LMICs. Results from this scoping review can be used to strengthen SRH research programs in LMICs. More energy must be directed toward correcting power imbalances in capacity strengthening initiatives. To address additional gaps, future directions for research should include an exploration of SRH research mentorship, the cost of SRH RCS interventions, and how to foster institutional support.

Outsourcing Policy and Worker Outcomes: Causal Evidence from a Mexican Ban

Outsourcing Policy and Worker Outcomes: Causal Evidence from a Mexican Ban

Regulating Platform Work in the UK and Italy: Politics, Law and Political Economy

The advent of the platform economy gives rise to an important challenge for existing systems of labour law across the world. Different countries are reacting to this common challenge with various legislative measures, ranging from accommodation to re-regulation. This paper analyses the policy response to the spread of platform work in the UK and Italy, countries with quite different labour law frameworks as well as contrasting political and regulatory institutions. These two countries have responded differently to the advent of the platform economy. Adopting an interdisciplinary approach, the paper draws on theories from political science and comparative political economy to explain the different regulatory outcomes observed. Specifically, it is argued that policy and legislative outcomes can be explained by the relative power of political actors and interest groups which are shaped, in turn, by the national system of political parties and the existing industrial relations frameworks. Platform or Gig Economy, Platform Work, Law and Political Economy, Power Resources

Informed Enforcement: Lessons from Pollution Monitoring in China

Government regulations are often imperfectly enforced by public officials. In this study, we exploit the introduction of air pollution monitors in China to investigate whether real-time monitoring of policy outcomes affects the enforcement of existing regulations. Using assignment criteria established by the central government and new georeferenced data on local enforcement activities, we show that monitoring (i) increases enforcement against local firms, (ii) improves the targeting of enforcement, and (iii) reduces aggregate pollution. These effects are driven by officials facing performance incentives and are stronger when there is limited scope for data manipulation, suggesting that real-time monitoring improves top-down accountability. (JEL K32, L51, O13, P25, P28, Q52, Q53)

Harnessing Technology and Entrepreneurship for Sustainable Crop Burning Remediation in India

This study explores the intersection of sustainability, technology, and entrepreneurship in addressing crop burning in India. Crop residue burning is a significant contributor to air pollution and environmental degradation, posing severe health risks and economic challenges. This research investigates the environmental and socio-economic impacts of crop burning, while also analysing current technological solutions such as the Happy Seeder and Pusa decomposer, which have shown promise in reducing residue burning. It also examines policy outcomes and entrepreneurial initiatives that aim to scale these solutions, driving adoption among farmers. Through a comprehensive review of relevant literature, data, and case studies, this paper highlights the real-world challenges faced during implementation, including financial barriers, awareness gaps, and policy constraints. It underscores that while subsidies, technological incentives, and policy directives are crucial, they must be complemented by sustained on-ground efforts through a collaborative CRM model that unites government initiatives, external agencies, entrepreneurial contributions, and grassroots-level farmer engagement.

Enhancing Agricultural Policy Outcomes: The Influence of Local Stakeholders Participation and Institutionalized Participatory Decision-Making – A Case Study of the Coalition for African Rice Development Initiative

Enhancing Agricultural Policy Outcomes: The Influence of Local Stakeholders Participation and Institutionalized Participatory Decision-Making – A Case Study of the Coalition for African Rice Development Initiative

The Evolution of China’s Policy for Family Planning

It is imperative to understand factors of demographic and social issues, economic development, and global influences which have influenced China’s family planning policy implementation through time from the one-child to three-child policy. To further explore how such factors influenced the evolution of China’s family planning policy and to predict future policy outcomes, this research has extensively discussed demographic challenges, economic development, social issues, and global influences. The research has also analyzed how these factors influence China’s family planning policy direction towards the future. For sustainability, in relation to family planning, this research has identified that the Chinese government could implement targeted and flexible approaches to childbirth control, implement social support and services to help couples meet their family goals, and enhance social awareness via education and family therapy. In sum, this research is important because it provides an elaborate discussion of the evolution of China’s family planning policy and predicts the future direction of such policing to ensure sustainable family planning in China.