Service Delivery Arrangements Research Articles

Advancing collaborative social outcomes through place-based solutions—aligning policy and funding systems

Abstract More collaborative and human-centered approaches to tackle social problems of entrenched disadvantage have been introduced in many countries, including Australia, but with mixed results. Traditional programs that reinforce existing political and bureaucratic processes have been seen as blockers to collaborative modes of policymaking, governance, and delivery. Drawing on collaborative governance perspectives, this paper reports new research undertaken in conjunction with a not-for-profit organization (Collaboration for Impact) involved in supporting place-based collaborative community change efforts. Research findings, based on stakeholder perspectives, highlight not only the potential benefits of a more collaborative model (i.e., placed-based and community driven) but also the significant unresolved challenges for “backbone” coordination bodies, which have recently been established to achieve more “joined-up” policy, funding, and service delivery arrangements. The paper concludes by proposing a practice-driven focus on policy and funding systems, together with implications for policy learning and program design.

Maternal health in cities: analysis of institutional maternal mortality and health system bottlenecks in Kampala City Uganda, 2016-2021

Background Recent estimates have shown a stagnation in maternal mortality reduction globally. Levels and trends in maternal mortality in urban settings in Africa are of interest due to health system challenges posed by rapid urbanisation. Given the high percentage of births occurring in city health facilities, tracking the institutional maternal mortality ratio (IMMR) can reveal key performance issues. We described the trends in IMMR between 2016 and 2021, and the causes and characteristics of maternal deaths in Kampala, Uganda. Methods This retrospective study utilised routine data from all facilities in Kampala that provided childbirth services from 2016 to 2021. Three key variables were used: number of deliveries, live births, and maternal deaths. Additionally, from medical records in three purposively selected hospitals, we extracted information on characteristics of women recorded as maternal deaths and their causes for the period 2016-2021 from death notification and review forms. We conducted descriptive analysis and assessed time trends in IMMR. Results For the six-year period, the Kampala-level IMMR was 189/100,000 deliveries (194/100,000 livebirths). The IMMR declined from 213 (2016) to 109/100,000 deliveries in 2019 (p=0.04) and then increased to 258 in 2021 (p=0.12). A review of 358 maternal death records showed that 65% of deaths were women referred from other health facilities, and 47% lived in the surrounding district (Wakiso). Obstetric haemorrhage (44%) and hypertensive disorders in pregnancy (28%) were the most commonly recorded causes of death. Health system factors such as lack of blood and other supplies contributed to 65% of the deaths reviewed. Conclusions IMMR in Kampala increased from 2019-2021. Health infrastructure changes and maternal health initiatives potentially accounted for the observed trend by affecting data quality. Referral and facility readiness were underlying reasons for maternal deaths. Addressing bottlenecks in emergency referral processes may contribute to mortality reduction. Further research should determine the relative contribution of key influences on mortality levels and examine the dynamics between women’s care-seeking pathways and service delivery arrangements for emergency obstetric care in urban settings.

Managing transitions from external assistance: cross-national learning about sustaining effective coverage.

The often-prominent role of external assistance in health financing in low- and middle-income countries raises the question of how such resources can enable the sustained or even expanded coverage of key health services and initiatives even after donor funding is no longer available. In response to this question, this paper analyses the process and outcomes of donor transitions in health-where countries or regions within countries are no longer eligible to receive grants or concessional loans from external sources based on eligibility criteria or change in donor policy. The comparative analysis of multiple donor transitions in four countries-China, Georgia, Sri Lanka and Uganda-identifies 16 factors related to policy actors, policy process, the content of donor-funded initiatives and the broader political-economic context that were associated with sustained coverage of previously donor supported interventions. From a contextual standpoint, these factors relate to favourable economic and political environments for domestic systems to prioritize coverage for donor-supported interventions. Clear and transparent transition processes also enabled a smoother transition. How the donor-supported initiatives and services were organized within the context of the overall health system was found to be critically important, both before and during the transition process. This includes a targeted approach to integrate, strengthen and align key elements of the governance, financing, input management and service delivery arrangements with domestic systems. The findings of this analysis have important implications for how both donors and country policy makers can better structure external assistance that enables sustained coverage regardless of the source of funding. In particular, donors can better support sustained coverage through supporting long-term structural and institutional reform, clear co-financing policies, ensuring alignment with local salary scales and engaging with communities to ensure a continued focus on equitable access post-transition.

Integrating international policy standards in the implementation of postnatal care: a rapid review

IntroductionInternational legal and political documents can assist policy-makers and programme managers in countries to create an enabling environment to promote maternal and newborn health. This review aimed to map and...

E-public Service Delivery as an Innovative Paradigm-shift in Indian Governance System: An Analysis of Haryana State Model

A paradigm shift in the governance process is being observed because the Central and state governments have started working on Citizen’s Charters to deliver services within a time-frame. Information Communication Technology is playing a great role in fulfilling the service-delivery timelines according to the provisions of Right to Services Act, 2014. The Haryana government has come up with an innovative thesis for the SARAL platform ( Simple All-inclusive Real-time Action-oriented and Long-lasting), which intends to simplify and transform public-service delivery system. The objective of this article is to provide a platform for academic discourse by comparing the different public service delivery arrangements as citizens’ rights with the e-service delivery model of Haryana. The author analyses the e-services delivery process, grievances-redressal mechanisms, operational arrangements, working procedure of e-service delivery platform, e-seva scheme for Common Service Centres as prescribed in the Right to Services Act and e-service delivery model of Haryana.

Toward a better understanding of local service provision: Implications for studying the determinants of production choice

AbstractResearchers studying local governance, especially alternative service delivery arrangements, have long relied on the ICMA ASD survey to examine the scope and nature of service provision and production at the local level. Building upon Lamothe et al. (Public Administration Review, 2018, 78: 613) findings that raise questions concerning the accuracy of the ASD survey and resulting misconceptions about service provision, this paper refines how provision can be conceptualized and measured to promote a better understanding of local governance. Utilizing a unique survey design that incorporates, but also extends the ASD format, we demonstrate that service provision is multifaceted, and jurisdictions participate in varying degrees of provision activities based on the sector of the producing entity. Our findings highlight the importance of properly accounting for provision activities and call into question the efficacy of the conventional contracting framework as the primary theoretical underpinning of most studies of local service delivery arrangements.

Volunteers in Public Service Production: Modeling the Contributions of Volunteers to Organizational Performance

Abstract Volunteer use as an alternative service delivery arrangement entails public organizations directly incorporating volunteers in service production through a quasi-employment relationship. However, research evaluating the contributions of volunteer labor to organizational performance are relatively few. This article fills this gap by drawing from two theoretical insights. First, this study tests a linear model based on the traditional human resource management approach of interchangeability in which volunteers constitute a one-on-one substitute for paid employees. Second, this study draws insight from critical mass theory to explore a nonlinear model based on the assumption that the productivity of one volunteer may not be equal to that of one paid employee due to the systematic limitations of volunteer labor. Analyzing a five wave panel dataset of 484 local law enforcement agencies in the United States that utilize sworn volunteers with general arrest powers, the findings indicate that an increase in the number of sworn volunteers has a linear negative effect on clearing violent crimes in sheriffs offices. However, the results also indicate evidence of curvilinear effects on clearing violent crimes in police departments. This article suggests the need to account for the systematic limitations of volunteer labor when measuring performance and to explore multiple indicators. This study contributes to theory building and testing by enabling a two-way understanding of the relationship between volunteer involvement and organizational performance in the public sector.

Contracting Out and Its Outcomes in Public Health: A Case of New York Counties

Previous studies have reported a positive relationship between local government spending and health outcomes. However, there is limited scholarly research on how the different policy tools used for delivering public health services affect the health of local residents. This study adopted a comprehensive model, widely utilized in health policy and management research, to control for health behaviors, socioeconomic factors, physical environment, and clinical care. It provides evidence that a county with higher health spending through contracting has a higher health ranking among New York counties, indicating that service provision arrangements affect health outcomes. Thus, county efforts to improve health outcomes should consider the effects of differing service delivery arrangements.

Working with local governments to increase access to WASH services: a case of WaterAid's participatory approaches in Nigeria

Abstract Attempts to implement participatory processes are often complicated by realities which make objectives of participation unattainable. Hence, if participation is to mean more than good intentions, it is vital to understand the strategies deployed by international nongovernmental organisations (INGOs) in participatory development. This study employed a qualitative case-study approach to evaluate the participatory processes employed in two WASH projects implemented by WaterAid Nigeria attempting work with Local Government Areas: the Sustainable Total Sanitation project and the HSBC Water programme. WaterAid Nigeria's participatory development approach recognises the responsibility of the various tiers of government for its citizens' wellbeing, especially the need for partnership with the Local Government Area (LGA) towards the delivery of WASH services. The state, as the ‘duty bearer’, is responsible for the provision of WASH services. Thus, both projects centred on government capacity building and community empowerment through the establishment and capacity development of WASH units in LGAs, insistence on counterpart funding and the establishment of water, sanitation and hygiene committees (WASHCOMs). Despite these attempts, findings highlighted the persistence of inefficiencies within the LGA WASH system that rendered partnerships ineffective. At the community level, WASHCOMs were not sustainable. Despite the challenges of implementing partnerships between INGOs and LGAs, such partnership remains a way to improve the provision of WASH services in Nigeria and other low- and middle-income countries. To better work within the participatory model, WASH INGOs should explore how to better use existing LGA arrangements for service delivery. Additionally, the LGA, as a duty bearer, could foster genuine, non-discriminatory spaces for the participation of communities by taking political, socio-economic and cultural differences into account.

Piped water revenue and investment strategies in rural Africa

Abstract Viable pathways to universal safely managed drinking water access in rural Africa involve a blend of infrastructure types, service delivery arrangements, and sources of finance. Priorities are shaped by institutional and economic barriers and are often based on assumptions regarding user demand and revenue sustainability. Improved understanding of how alternative approaches affect revenue generated from user payments can enhance long-term viability and repayment capacity of rural piped water services. We analyse more than 3,900 monthly records from operators in Ghana, Rwanda, and Uganda and model revenue patterns for novel service area archetypes. Results indicate on and off premises connections exhibit complementary revenue patterns, with volumetric revenue determined by tariff level rather than connection type and waterpoints with the greatest dispensing capacity generating the most aggregate revenue. The prepaid credit payment approach, which is increasingly promoted to enhance revenue collection efficiency, is not associated with revenue advantages compared to pay-as-you-fetch and monthly billing approaches when tariff level is controlled. These patterns are recurrent at multi- and single country scales and across service areas where public and enterprise-led investment approaches to infrastructure development are taken, suggesting the findings may be applicable beyond the study domain. Infrastructure investment strategies can promote revenue and equity goals through off-site piped water, but more evidence is needed to understand the trade-offs of prepaid credit systems.

Commentary on Ken Warren’s ‘A new model of collaboration’ and related IGPS working paper

Ken Warren’s central concern is the relative weakness of hierarchical arrangements for service delivery through state agencies whenaddressing poor outcomes for people with complex needs, for which standardised solutions are a poor fit. He says the case is made that these require the collaboration of multiple parties to implement tailored responses to needs, and refers to the evidence from theNew Zealand Productivity Commission’s report on social policy, the Welfare Expert Advisory Group and the review of Whānau Ora. Forreaders familiar with the Productivity Commission report the focus of interest is on the people in ‘Quadrant D’ (Productivity Commission, 2015, p.53). These people have multiple continuing and complex needs combined with low capacity to navigate and coordinate the services they need, either because of their circumstances or because of institutional characteristics of the services that make it hard for them to access them.

Local Government's Resource Commitment to Environmental Sustainability: Capacity, Conservatism, and Contractual Dynamics

Local governments are leading sustainability efforts through a range of initiatives, often voluntarily. While a spate of research exists to explain what drives these voluntary decisions, we are still limited in understanding how localities follow through with the resources to implement their adopted plans. This is particularly the case for environment and climate protection programs that are transboundary in nature and thus require more innovative and longer-term approaches than those that are relatively low-cost and easier to implement with future savings. This research examines local investment in promoting three of these program areas: air quality, biodiversity preservation, and ecological restoration. It investigates how local governments vary according to resource commitment and what factors explain those variations. We find several factors significant, including community capacity, political ideology, and institutional arrangements for service production and delivery. Variations are, however, found across different types of resource commitment, suggesting a more complex picture of local resource availability for advancing sustainability efforts.

Multi-Stakeholder Partnerships (MSPs) for Health Service Delivery in Ethiopia

The past few decades have witnessed the integration of non-state actors in public service delivery. Partnerships as a form of governance involves state and non-state actors in public policy formulation and implementation. The widespread poverty and severe health problems in Ethiopia demand for an increasing role of a wide range of actors outside of the state. In the past few years, the Ethiopian government has been actively seeking collaborative arrangements for health service delivery that are aimed at ensuring access to basic and quality health service delivery. The paper will focus on studying MSPs for health service delivery as a form of governance, hence we focus on the internal dynamics of the MSPs for health service delivery and provide an understanding of state and non-state interaction in these governance networks. The case analysis is based on a specific MSP for helath service delivery at local level.

Feasibility of Find cases Actively, Separate safely and Treat effectively (FAST) strategy for early diagnosis of TB in Nepal: An implementation research.

Tuberculosis is one of the leading causes of death worldwide. Diagnosing TB in an early stage and initiating effective treatment is one of the best ways to reduce the burden of tuberculosis. Feasibility of Find cases Actively, Separate safely and Treat effectively (FAST) Strategy helps to improve the early diagnosis of tuberculosis cases among inpatient settings as well as out patient department patients and prevent TB transmission in hospital. This study aimed to assess the feasibility of the FAST strategy, organizational factors, technical factors, barriers and enablers for the proper implementation of the FAST strategy in Nepal. A qualitative study was conducted from April 2019 to August 2019. Data was collected by using focus group discussion, key informant interviews, and client exit interviews. A retrospective research was conducted in different hospitals in Nepal where FAST strategy was implemented. The patients, health care workers, province, district, and National level stakeholders were interviewed. Thematic analysis was used to assess the feasibility as well as barriers and enablers of the FAST strategy. Study identified that the 'current setting' of implementation and service delivery arrangement at hospitals were not well arranged as per requirements. The research findings showed hospital ownership is crucial for mobilizing staff and proper space management inside hospitals. Study identified that unavailability of a separate room, limited capacity of GeneXpert machine, irregular supply of GeneXpert cartridge, and insufficient human resources for screening and counseling are the major barriers of FAST implementation in Nepal. FAST strategy is feasible to implement in healthcare settings in Nepal although the technical and organizational factors should be managed to ensure effective function of the strategy as per the approach. Hospital ownership is essential to mobilize health workers, improve client flow system and proper space management for FAST services.

A trauma informed response to COVID 19 and the deteriorating mental health of refugees and asylum seekers with insecure status in Australia.

COVID‐19 brings increased risk to the mental health of asylum seekers and refugees in Australia on temporary visas. Rapid government changes due to the COVID‐19 pandemic are resulting in significant and sustained hardship on this already vulnerable group. This discursive paper is both an explainer and a resource for mental health nurses and health professionals with scope of practice in primary care and emergency departments responding to this population. The aim of this paper is to alert clinicians to the drivers of mental and suicide related distress and to provide recommendations as to how to therapeutically engage and support this group. Drivers include complex intersections between legal uncertainty, economic, social and mental health stress as drivers of entrapment, acute mental distress and suicidal ideation. Information about the COVID‐19 related factors as drivers contributing to worsening states of distress may help guide clinicians to consider protective factors designed to mitigate the onset or worsening of mental distress, plus aid in the development of health policy and service‐delivery arrangements of support and therapeutic engagement.

Economic Aspects of Delivering Primary Care Services: An Evidence Synthesis to Inform Policy and Research Priorities.

The 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. To strengthen primary health care, policymakers need guidance on how to allocate resources in a manner that maximizes its economic benefits. We collated and synthesized published systematic reviews of evidence on the economic aspects of different models of delivering primary care services. Building on previous efforts, we adapted existing taxonomies of primary care components to classify our results according to four categories: coverage, financing, service delivery, and governance. We identified and classified 109 reviews that met our inclusion criteria according to our taxonomy of primary care components: coverage, financing, service delivery, and governance arrangements. A significant body of evidence suggests that several specific primary care arrangements, such as health workers' task shifting and telemedicine, can have positive economic impacts (such as lower overall health care costs). Notably absent were reviews on the impact of increasing primary care funding or the overall supply of primary care services. There is a great opportunity for further research to systematically examine the broader economic impacts of investing in primary care services. Despite progress over the last decade, significant evidence gaps on the economic implications of different models of primary care services remain, which could help inform the basis of future research efforts.

Citizen Coproduction and Social Media Communication: Delivering a Municipal Government’s Urban Services through Digital Participation

This study investigated how social media is used by a municipal government agency for communication of citizen coproduction initiatives, through social media content analysis of the government’s official Twitter account. This article identified that the dominant form of social media coproduction in the Bandung municipal government in Indonesia is government-to-citizen (G2C) interaction, focused primarily on informing and nudging (86.62%) citizens, as well as some limited elements of citizen-to-government (C2G) communication, such as citizen sourcing and citizen reporting (8.96%). The municipal government uses various visual tools on Twitter to disseminate G2C information and convey its messages. Regarding the phase of the service cycle, this study found that the majority of social media communications are related to co-assessment (52.26%) and co-designing (42.24%), with a limited number of tweets about co-delivery (3.25%). Based on these findings, this article discusses the shifting relationship between government and citizens brought on by the adoption of this social media platform in its service delivery arrangement.

Evaluation of rare diseases policy performance of oecd countries using mcdm methods

ObjectivesRare diseases affect less than one out of every 2.000 people, which means they are much less visible in the general population than common diseases. It has several negative consequences for both patients and healthcare systems. Because of this negative effect, healthcare programs and policies must be well-structured. Nonetheless, countries' efforts in this area should be assessed to ensure effectiveness. The aim of this study is to assess the policy performance of 18 OECD countries in terms of rare diseases using health policy indicators. MethodsThe outcomes of rare disease policy are identified using multi-objective optimization based on ratio analysis, complex proportional assessment, and technique for order preference by similarity to ideal solution methods, which are among the most efficient selection and ranking methods. ResultsGermany, France, and the Netherlands are among the countries with the strongest rare disease policies. Latvia, Greece, and Turkey are among the lowest-performing countries in the ranking. ConclusionsPerformance evaluation studies for service delivery and policy arrangements in the field of rare diseases are necessary.

Multifaceted intra-city water system arrangements in California: Influences and implications for residents

Some cities directly provide drinking water and other utility services to their residents, whereas others contract out these responsibilities in full or in part, with considerable implications for service and non-service outcomes. There is a robust literature considering reasons for city-private provider binaries, as well as a growing number of studies assessing the rise in special district service provision, mixed service delivery arrangements, and inter-municipal service delivery within metropolitan contexts. On the other hand, there are few studies assessing city-level prevalence of these three main provider types jointly, as well as fully accounting for the diversity of institutional arrangements in drinking water service within individual cities.In this study, we construct an empirical profile of and analyze influences on diverse city-level water service provider arrangements using a dataset compiled for all 482 cities in California. Our analysis shows that 80% of cities are served by either a municipality, a private, investor-owned utility or a special district, with special districts being more common than private providers. Moreover, 20% of cities had more than one service provider, and 68% of these cities were served by more than one system type, including many where municipal and private providers co-existed. Using multivariate regression techniques, we analyze influences on different types of city-level drinking water service arrangements. We find that city incorporation date most profoundly influences the mix of water systems in cities, especially arrangements involving special districts or multiple system types. We also find that cities which run their own water system exclusively are more likely to institute conservation policies, and provide suggestive evidence that residents living in cities served by multiple water systems are exposed to wide variance in water rates. Water system fragmentation within city boundaries thus has implications for resource management policy and equity in intra-city resident essential service outcomes.

Local Government Volunteer Use: A Resource Dependence and Transaction Costs Explanation

Abstract Volunteer use in the United States constitutes a service delivery alternative in which public agencies involve citizens to assist in delivering public services. This article provides a resource dependence and transaction costs explanation for why local governments in the United States may involve volunteers in service delivery. Using a survey of local government service delivery arrangements, we analyze a repeated cross‐sectional dataset derived from four separate years to examine the factors associated with volunteer use. Key findings suggest that fiscal constraints are associated with volunteer use in more municipal government services, while county governments with more resources use volunteers in more services. Contracting out to private organizations is associated with more volunteer use in both municipalities and counties. The findings provide evidence that volunteer use constitutes an effort by local governments in the United States to leverage resources from the environment and to reduce the transaction costs of depending on other organizations. Evidence for Practice To capitalize on resources available in the environment, local governments may use volunteers in service delivery. Local governments confronting fiscal constraints may use volunteers to deliver more services. Local governments that contract out more services to private organizations may use volunteers in more services to lower administrative costs. Volunteer use may serve as a strategy for local governments to leverage resources from the environment and to reduce the transaction costs of depending on other organizations.