Policy Engagement Research Articles

The paradoxical surplus of healthcare workers in Africa: the need for research and policy engagement

Abstract Background In many countries in Africa, there is a paradoxical surplus of under and unemployed nurses, midwives, physicians and pharmacists which exists amidst a shortage of staff within the formal health system. By 2030, the World Health Organisation Africa Region may find itself with a shortage of 6.1 million healthcare workers (HCWs) alongside 700,000 un- or underemployed health staff. This study aims to bring the nature and consequences of an existing paradoxical surplus of HCWs in low income countries into the HCW migration debate and to explore novel solutions. Methods The study draws on a rapid review of the literature and deeper insights from expert information, using examples from Uganda, Kenya and Niger. Results In Niger, between 2010-2014, 55% of health graduates were unable to find permanent work in the sector leaving 15 000 HCWs unemployed or in precarious jobs. In Sudan, an 8-fold increase of the number of places at medical colleges (between 1996-2012) was not accompanied by a commensurate investment in physician positions leading to increased unemployment and brain drain. In Kenya, in 2021, 27243 HCWs were un or under-employed. In Uganda, 20590 nurses and midwives were reported as unemployed in 2023. Despite this, the emphasis in policy debates about the healthcare workforce crisis in most national and global levels is on staff shortage and the need to train more HCWs. In contrast, an existing surplus HCWs and their association with patterns of migration are largely unknown. Little time is given over to understand the economic, political and social factors that have driven their emergence and the governance challenges and potential interventions to improve employment rates. Conclusions The results highlight the complexity of migration, labour market conditions and health systems, in particular in low income countries in Africa. Both qualitative and quantitative data is necessary for policy makers to find effective solutions to the problem.

Loneliness in Baltic-Nordic Older Adults Amid COVID-19

Abstract Background The study investigates loneliness among older adults in the Baltic-Nordic region, particularly in the context of the COVID-19 pandemic. It aims to understand how loneliness varies across cultural and socio-economic contexts in these areas, which is critical for developing public health strategies tailored to the specific needs of older populations. Methods We employed a comprehensive comparative analysis, leveraging data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the HL20 study from Iceland, focusing on individuals aged 67 and above. The study encompassed a diverse sample from Sweden, Denmark, Estonia, Lithuania, Finland, Latvia, and Iceland, totaling 5,313 participants. This research is part of a bilateral EEA FM2021/23 initiative to enhance methodological approaches to analyzing older populations by coding and standardizing variables for comparability across different countries. Results Significant regional differences in loneliness were observed. The Baltic regions reported a higher prevalence of loneliness compared to the Nordic countries, which displayed lower levels, attributed to strong social welfare systems and community engagement. Factors such as employment, marital status, and educational attainment varied across regions, affecting loneliness levels. Conclusions The findings highlight the importance of considering regional cultural and social contexts in public health interventions aimed at reducing loneliness among older adults. The study underscores the need for targeted strategies that address the unique social dynamics of the Baltic and Nordic regions. Innovative public health actions, such as community engagement programs and policy development, are recommended to alleviate loneliness in these populations. Key messages • Significant regional differences in loneliness in the Baltic-Nordic region underscore the need for tailored public health interventions. • Employment and social welfare are key factors in mitigating loneliness among older adults, highlighting the importance of socio-economic support systems.

Adoption of smart energy apps and household energy practices: empirical insights from Norway

ABSTRACT This study examines the adoption and usage patterns of household energy apps among a sample of Norwegian households to explore their potential in visualising and controlling home energy consumption and influencing sustainable energy practices. Through a questionnaire survey of 150 respondents using energy apps, this study gathers empirical insights into adoption motivations, user perceptions and factors associated with self-reported changes in household energy practices. Findings indicate that app-related factors, such as perceived app insights applicability, ease of use, and appealing user interface, are more positively associated with self-reported changes in daily energy habits than demographic factors. This research underscores the importance of prioritising user experience and data security in app development to foster sustainable energy practices. It also offers practical recommendations for targeted engagement strategies and policy interventions to promote the wider adoption of smart energy apps and maximise their potential to facilitate household energy transitions.

Nurses as UN champions: Increasing nursing presence and influence at the United Nations.

Representing half of the global health workforce, nurses are critical to health promotion, disease prevention, and the economic and social needs of populations. However, nursing expertise is underutilized in the UN System, and nurses are underprepared for roles in policy to influence global health and sustainable development. Innovative education strategies are necessary to address the sidelining of nursing expertise in these spaces and build nursing literacy in shaping global policy. This quality improvement project aimed to develop and evaluate a model to build a USA-based school of nursing's literacy and engagement with the United Nations (UN) System. A Doctor of Nursing Practice (DNP) student developed an innovative educational model, the United Nations Essentials for Global Nursing Leadership, in partnership with a school of nursing (SON), to build faculty knowledge and skills on initiating and sustaining bidirectional engagement with the UN. In 2023, SON faculty piloted the model, and pre-/post-intervention survey data were utilized for improvement. Participants reported increased knowledge, awareness, and confidence related to the UN System and their ability to engage as policy influencers, health diplomats, and global citizens. In total, 100% of participants volunteered to hold the role of UN champion for the SON. This innovative model advances nursing knowledge and coherence in the UN System and key areas of policy, diplomacy, and global governance for meaningful UN engagement. CONCLUSION AND IMPLICATIONS FOR NURSING, HEALTH, AND SOCIAL POLICY: Models that invest in closing the global nursing leadership preparation gap can raise the profession's visible UN presence and strategic policy influence at a critical time for people and theplanet.

How policy satisfaction affects residents’ low-carbon behavior: the mediating role of place attachment

ABSTRACT Policy interventions can effectively promote the public’s low-carbon behaviors (LCBs), provided the public already understands and perceives the policy. The extent to which the public gets to know the policy is easily overlooked in relevant studies. Based on a survey conducted in Hangzhou, China, this paper compares the residents’ satisfaction with the policies promoting LCBs. Furthermore, the impact of different levels of policy satisfaction on the willingness to engage in LCBs with place attachment as a mediator is also investigated. The results show that respondents’ policy satisfaction is moderately high, with female respondents (3.479) slightly higher than males (3.430). The policy satisfaction, from high to low, is administrative regulations (3.515), technical interventions (3.463), information tools (3.457), and economic incentives (3.384). Policy satisfaction has a significant effect on willingness to engage in LCBs and place attachment, and place attachment has a positive effect on willingness to engage in LCBs. Place attachment plays a partial mediating role in the influence path of policy satisfaction on the willingness of LCBs. The study provides insights for policymakers on enhancing policy dissemination and engagement, particularly in the context of gender differences, and offers a comprehensive view of the dynamics driving sustainable behavior change in urban China.

Synergy Analysis between Environmental Awareness, Student Participation, and Campus Policies in Waste Reduction and Energy Efficiency at Bina Sarana Informatika University

This research aims to analyze the synergy between three key elements of environmental awareness, student participation, and campus policy in the context of waste reduction and energy efficiency at Bina Sarana Informatika University. The method applied is descriptive observation, where data is collected through field notes in various campus locations as well as in-depth interviews with students. The results indicate that high environmental awareness among students contributes significantly to their active participation in waste management programs and efficient energy use practices. In addition, campus policies that support environmental initiatives were shown to play an important role in increasing student involvement. This synergy between environmental awareness, student participation, and campus policies contributes to the creation of a more sustainable campus environment. The findings also provide strategic recommendations to strengthen environmental education programs and increase student engagement in sustainability-focused campus policies, thereby encouraging more environmentally responsible behavior in the future.

Policy engagement as ‘empowered representation’: democratic mediation through a participatory research project on climate resilience

Background: The article analyses the policy engagement component of a research project on climate resilience in vulnerable communities that took place in Cape Town, South Africa. Conducted in 2022, the engagement included community and stakeholder events in three research sites, and a cross-cutting policy event with municipal officials, held at the end of the project. Importantly, this policy engagement process occurred in a context of political marginalisation, that is, one characterised by low trust, and little meaningful representation or even communication between these vulnerable communities and the city. Aims and objectives: This article examines the impact of policy engagement on political relations between local government and vulnerable communities. Methods: The overall methodology of the article is qualitative, using an illustrative case-study research design to unpack the subjective experiences of both government officials and residents of vulnerable communities. Primary data included many primary documents, direct observation of the engagements and post-event interviews. Findings: First, the engagement process created new ‘invented’ spaces for the representation of community perspectives to the city, and the city’s perspective to the community. Second, the engagement facilitated community self-representation through educating community members to advocate for their ideas in these new invented spaces. Third, this engagement tended to be more constructive and deliberative than polarising and confrontational. Discussion and conclusions: Drawing on the theoretical framework of ‘political mediation’, the policy engagement process is characterised as a positive instance of democratic mediation through ‘empowered representation’, with some specified limitations.

Applying Bourdieu’s Theory to Public Perceptions of Water Scarcity during El Niño: A Case Study of Santa Marta, Colombia

This study investigated the sociological dimensions informing public perceptions of water scarcity during the El Niño drought period in Colombia. We conducted this study in Santa Marta, Colombia, and surveyed 405 urban and rural residents to understand their perceptions of water scarcity, management, and the impacts of the El Niño phenomenon. The survey used a Likert scale to measure responses and employed a multivariate analysis of variance to analyze the data while considering factors such as location (urban versus rural) and gender. The study results indicated that urban residents often experience an irregular water supply all year, whereas most rural respondents noted a more consistent availability of water. The perception of water scarcity also differed notably between urban and rural areas due to their different historical and cultural experiences (habitus). Urban respondents mostly recognized the presence of water, while rural perspectives were less conclusive, likely influenced by their direct access to natural water sources. Participants across various demographics consistently reported that poor management by local, regional, and national governments contributes to the water scarcity crisis, highlighting the importance of improving communication about climate events like El Niño and water management to increase community engagement in public policies. Our research suggests that better understanding the social foundations of such perceptions using Bourdieu’s concepts of social fields, habitus, and capital forms can significantly enhance water management strategies.

Gamification for Sustainable Management Education: Prosper Management Edition's Role in South Africa's Climate Policy Engagement

The escalating climate crisis necessitates inventive strategies to engage diverse stakeholders in sustainable management and policy-making, particularly in regions like South Africa. "Prosper Management Edition," developed under the GREAT project, leverages gamification to foster communication between future corporate leaders, citizens, and policy stakeholders. This educational game connects sustainability principles with their practical application in management and policy, focusing on the integration of Sustainable Development Goals (SDGs) into business operations. This paper presents the initial design stages, implementation strategy, expected outcomes, and theoretical underpinnings of the game, aiming to enhance participants' awareness of sustainability and strategic thinking.

A figurational analysis of Health and/or Physical Education teacher educators’ conceptualisations of policy, and their sociogenesis

ABSTRACT Policy engagement is key to promoting quality physical education yet it has been identified as a ‘grand challenge’ for Health and/or Physical Education (H/PE) internationally. All H/PE professionals, including teacher educators, have a collective responsibility to engage with policy but existing research tells us little about how H/PE teacher educators (H/PETEs) understand and engage with policy. It is important to examine H/PETEs conceptualisations of policy for a few reasons, not least because teacher educators play a crucial role in supporting future generations of teachers who themselves will need to engage with policy as a core feature of their professional lives. Drawing on figurational sociology, and the concept of assemblage, this paper offers insights into the nature and development – or sociogenesis – of teacher educators’ conceptualisations of policy. The data shared in this paper was generated through semi-structured interviews with 12 H/PETE from 7 countries. Inductive-deductive analysis – drawing largely on figurational concepts such as interdependence, power, habitus and sociogenesis – revealed that H/PETEs conceptualised policy as: (i) informing intended action and change; (ii) a way to govern practice; (iii) imposition and possibility. In terms of how these conceptualisations came to be, key features of the H/PETE figuration that were identified as influential include: (i) interdependence with human and non-human elements; (ii) balances of power and (iii) social and individual habitus. It is concluded that capitalising on these elements through professional learning, for example, could support H/PETEs in engaging with policy in productive and meaningful ways. Given that engaging with policy is viewed as a collective responsibility of H/PETEs, and many – if not all – of the H/PETEs felt they needed support in this regard, this should be a key focus for the field.

‘Saving the youth’: Children and young people as moral subjects in the Philippines’ punitive drug regime

Background The Philippines has one of the must punitive drug regimes in the world, as evidenced not just by Rodrigo Duterte’s drug war but previous anti-drug campaigns. This article examines the place of ‘the youth’ in the longstanding moral panic around drugs and drug policy in the Philippines. Methods This article uses critical discourse analysis to analyze figurations of young people across three distinct periods in the Philippines’ contemporary history: Ferdinand Marcos Sr.’s early dictatorship (1972–1975), Gloria Macapagal-Arroyo’s presidency (2001–2010), and Rodrigo Duterte’s administration (2016–2022). Results In all three periods, young people were simultaneously invoked as a group that needs saving) and as a group that needs surveillance and discipline. Further, across the three periods, both the youth and drug use were enfolded into larger socio-political discourses (e.g. Martial Law; corruption and poverty; anti-elite politics). Conclusion The ambivalence in the ways in which young people are treated in drug policy reflects and reinforces their societal construction as passive victims. Interrogating and challenging the ways in which young people figure in ‘morality politics’ can pave the way for meaningful youth engagement in drug policies and programs.

Trends in Government-Initiated Public Engagement in Canadian Health Policy From 2000 to 2021.

Canada has a rich history of public engagement in health policy; however, shifts in engagement practices over time have not been critically examined. We searched for cases of government-initiated public engagement in Canadian health policy from 2000 to 2021 at the federal, provincial (Ontario, British Columbia, Nova Scotia) and pan-Canadian levels. Government databases, portals and platforms for engagement were searched, followed by academic and grey literature using relevant search terms. A coding scheme was iteratively developed to categorize cases by target population, recruitment method and type of engagement. We identified 132 cases of government-initiated public engagement. We found a predominance of feedback and consultation engagement types and self-selection recruitment, especially at the federal level from 2016 onward. Engagements that targeted multiple populations (patients, public and other stakeholders) were favoured overall and over time. Just over 10% of cases in our survey mentioned efforts to engage with equity-deserving groups. Overall, our results identify a heavy reliance over time on more passive, indirect engagement approaches, which limit opportunities for collaborative problem solving and fail to include equity-deserving populations. Those overseeing the design and implementation of government-initiated public engagement will draw valuable lessons from this review to inform the design of engagement initatives.

Whom Do I Trust to Represent Me? Long-Term Care Resident and Family Perspectives on Legitimate Representation.

Public engagement in long-term care policy making in Canada has primarily focused on "intermediary agents" who speak on behalf of long-term care (LTC) residents and their family caregivers. Yet the legitimacy of these intermediaries, as perceived by those they represent, has gone largely unexplored. This study examines LTC resident and family perspectives on who can legitimately represent them in LTC policy making. We used an interpretive description design, drawing on semi-structured interviews with LTC residents and family caregivers in Ontario, Canada. Data were analyzed using inductive thematic analysis. Eighteen interviews were conducted with 19 participants. Three key characteristics of legitimate representatives were identified: (1) willingness to act in the best interests of residents and families, (2) having the necessary skills and capacity to participate in LTC policy making and (3) engaging directly with residents and families. Governments and civil society organizations seeking to establish and maintain legitimacy in the eyes of LTC residents and family members can pursue this goal by supporting intermediaries who mirror the identities or experiences of those they represent, who are dedicated to serving their interests and who routinely and directly engage with them to understand the realities of LTC.

Black Community Health Advocates in Ontario: A Look at Health Policy Engagement From the Ground Up.

Disproportionately negative pandemic outcomes, lack of race-based data collection and poor engagement of Black communities in policy decision making have been widely documented for Black Canadians. We examine this to understand how formal public engagement processes might be more inclusive of Black peoples to inform more responsive policies. The study employed an asset-based lens to examine how Black communities have engaged in health policy and advocacy in Ontario. In-depth interviews were conducted with eight participants who self-identify as Black, recruited using purposive and intensity sampling to (1) identify information-rich cases, including people who have been at the forefront of high-impact work in this space and (2) participants whose mission and mandates represented diverse approaches and sub-populations. Our findings suggest that while Black community advocates face systemic and contextual barriers, they also embody deep and multifaceted knowledge, training and experience, which inform the rich ways that they approach advocacy. Despite its Ontario focus, this study adds breadth and depth to the existing literature on health policy and historically marginalized populations, offering broader lessons for policy makers across jurisdictions. Our findings encourage policy makers to better recognize, make space for and cultivate fertile advocacy foundations, cultural knowledge and community-driven systems already present in Black communities.

"You Can't Let Go" - A Black Community Leader's Perspective on Engagement and Advocacy.

Lanre Tunji-Ajayi is president and CEO of the Sickle Cell Awareness Group of Ontario (SCAGO). This charitable organization focuses on ameliorating the lives of those living with sickle cell disease by providing evidence-based support to patients and supporting clinical and psychosocial research, health promotion and the development of best practice guidelines. Lanre's passion for this work is personal. Following the death of her brother Sunday Afolabi from preventable and treatable complications of sickle cell disease, Lanre immersed herself in advocacy for community health and quality patient care. In this oral history narrative, Lanre reflects on her decades-long journey advocating for those living with sickle cell disease - a disease which disproportionately affects Black people. Her reflections focus acutely on the challenges she has faced in raising awareness and visibility, including through formal public engagement policy processes. Lanre also speaks to the personal costs she has encountered engaging in this advocacy work and the subtle and institutionalized forms of anti-Black racism that have punctuated this already difficult effort to bring about change.

Student-Related Factors & Adoption of E-learning in Higher Educational Institutions

The adoption of e-learning in public higher education institutions has become essential, driven by technological advancements and the global pandemic (COVID-19). This research article examines student-related factors that influences e-learning adoption in the institutions of higher learning, with special reference to the Masinde Muliro University of Science and Technology. A correlational research design, framed within the Unified Theory of Technology Adoption, was employed. Further, logistic regression analysis was conducted on data from 322 fourthyear students across 10 faculties. Findings reveal that mature students, aged 31-35 and above, were 56% and 12% more likely to adopt e-Learning than younger students. Male students were twice as likely to adopt e-Learning as their female counterparts, while students from the School of Computer and Information were twice as likely to adopt it compared to those from the School of Education. Practical implications include promoting peer-to-peer tutoring and fostering a positive attitude toward e-learning. These findings offer valuable insights for enhancing the uptake of e-Learning, providing institutions with knowledge to support student engagement and inform policy development.

Pediatric Firearm Deaths and State Policies on Social, Emotional, and Academic Development

Objective: To determine whether state-level SEAD policies are associated with pediatric firearm homicides and suicides. Summary Background Data: Firearm deaths continue to rise among United States (US) children. School-based efforts to promote social, emotional, and academic development (SEAD) may be a means to reduce such deaths, but state-level policies vary and the effect on firearm deaths is unknown. Methods: We used Education Trust data regarding state-level SEAD policies, averaging 6 domains to create a cumulative score and investigating each domain individually. The primary outcomes were pediatric firearm homicides and suicides, using covariates from the American Community Survey and State Firearm Laws database. We mapped SEAD policies and pediatric death rates. Poisson regression was used to investigate associations between SEAD policies and pediatric firearm deaths. Results: Annual statewide pediatric firearm deaths ranged from 0.85 to 7.81 per 100,000; homicides from 0.64 to 5.69, and suicides from 0.21 to 4.75. Univariate analyses demonstrated associations between SEAD scores and both homicides (P=0.003) and suicides (P=0.032), but these were nonsignificant after adjustment. Professional Development and Engagement policies were associated with lower rates of pediatric firearm homicides after adjustment (IRR=0.33, P=0.004 and IRR=0.46, P=0.014, respectively). There was no significant association between any domain and pediatric firearm suicide. Conclusion: Professional Development and Student, Family and Community Engagement policies are associated with lower rates of pediatric firearm homicides, however, there was no significant association between pediatric firearm deaths and summary SEAD measures after adjustment. Certain SEAD policies may be helpful in decreasing pediatric firearm deaths.

Sustainable Intensification of Smallholder Farming Systems

Sustainable intensification of smallholder farming systems has emerged as a crucial strategy for addressing the dual challenges of food security and environmental sustainability in developing regions. This approach seeks to increase agricultural productivity on existing farmland while minimizing negative environmental impacts and ensuring the social and economic well-being of smallholder farmers. This article explores the principles, practices, and potential benefits of sustainable intensification within smallholder farming systems. By integrating improved agricultural techniques, such as agroecology, precision farming, and integrated pest management, with local knowledge and resources, sustainable intensification aims to enhance crop yields, soil health, and resource efficiency. The study also examines the barriers to adopting these practices, including limited access to technology, market constraints, and policy gaps, while highlighting the role of community engagement, education, and supportive policies in overcoming these challenges. Furthermore, the article discusses the implications of sustainable intensification for climate resilience and biodiversity conservation, emphasizing its potential to contribute to global efforts to achieve sustainable development goals. The findings suggest that with the right support and adaptation to local conditions, sustainable intensification can play a vital role in transforming smallholder farming systems into more productive, resilient, and sustainable sources of food and livelihoods.

Navigating the Intersection of Input Tax Credit Restrictions and Corporate Social Responsibility in India

CSR is an important dimension of ethical and sustainable business practices, recent restrictions in the input tax credit under the GST regime pose important issues in the implementation of CSR. The article estimates the financial, operational, and reputational implications of the restrictions on ITC for the CSRs, calling on firms to adapt and innovate. They are strategies crucial for dealing with challenges concerning financial planning, prioritizing of only those initiatives with the best impact, collaboration, and advocacy can be done. Several strategic approaches can be applied by business to operate with the ITC provision on restrictions for CSR spending such as, enhanced financial planning, collaborative efforts, Innovating on CSR Approaches, Advocacy and Policy Engagement, Stakeholder Engagement and Communication, Business Strategy Integration with CSR, Diversification of Alternative Revenue Streams. Despite constraints in the regulatory environment, the commitment to CSR is very high, and it therefore brings about a positive influence on Indian society and sustainable development. The finding demonstrates that business implementing strategies for navigating ITC restrictions not only mitigate the financial strain due to ITC restrictions but also enhance operational efficacy to maintain competitive edge, improve financial health and strategic position.

Impact of e-government on citizen engagement: the role of government reputation and digital divide

Purpose Citizen engagement (CE) in public policy is increasingly considered to be an important feature of governance worldwide. The aim of this study is to explore the impact of e-government usage (EGU) on citizens’ engagement. In addition, the study investigates the mediating effect of government reputation (GR) and the moderating role of digital divide (DD) in EGU and citizens' engagement relationship. Design/methodology/approach Data were collected from 938 respondents in Vietnam with a random method. This study used the partial least squares – structural equation modeling method to examine hypotheses. Findings The results show that e-government and GR are critical determinants of CE. Furthermore, GR plays a mediating role in the relationship between e-government and CE. The results also show how DD moderates this nexus. Practical implications The findings of this study provide valuable evidence and implications. Public officials must improve the GR and administrative capacity as the determination for the CE. Moreover, the government should continually carry out policies to reduce the DD. Originality/value By investigating the mediating and moderating effects of GR and DD, this study has significantly contributed to advancing the body knowledge of e-government.