Sub-national Response Research Articles

Geographical distribution of the COVID‐19 pandemic and key determinants: Evolution across waves in Spain

AbstractAmidst the COVID‐19 pandemic, most research has examined specific temporal snapshots. This study diverges by offering a comprehensive analysis of COVID‐19 incidence across the Spanish provinces throughout six distinct waves of the pandemic. Using spatial exploratory techniques, we find no single pandemic; rather, there have been waves. Significant differences in the spatial distribution of cases and deaths across six waves show that each has unique characteristics. Homogeneous conclusions cannot be drawn at the national level. Notable regional differences in the pandemic’s spatial distribution suggest a need for subnational responses, reflecting variations in climate, economic dynamism, sectoral specialisation, and socio‐health resources. Spatial regression models show that the main determinants of COVID‐19 incidence depend on stage. Traditional factors commonly associated with epidemiological studies, such as temperature, exerted significant influence during the pandemic’s onset. However, as mobility restrictions were enforced and vaccination campaigns were rolled out, economic conditions, and especially levels of economic activity, emerged as increasingly significant determinants.

Non-pharmaceutical interventions to combat COVID-19 in the Americas described through daily sub-national data

This dataset covers national and subnational non-pharmaceutical interventions (NPI) to combat the COVID-19 pandemic in the Americas. Prior to the development of a vaccine, NPI were governments’ primary tools to mitigate the spread of COVID-19. Variation in subnational responses to COVID-19 is high and is salient for health outcomes. This dataset captures governments’ dynamic, varied NPI to combat COVID-19 for 80% of Latin America’s population from each country’s first case through December 2021. These daily data encompass all national and subnational units in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru. The dataset includes individual and aggregate indices of nine NPI: school closures, work suspensions, public event cancellations, public transport suspensions, information campaigns, local travel restrictions, international travel controls, stay-at-home orders, and restrictions on the size of gatherings. We also collected data on mask mandates as a separate indicator. Local country-teams drew from multiple data sources, resulting in high-quality, reliable data. The dataset thus allows for consistent, meaningful comparisons of NPI within and across countries during the pandemic.

Learning from Latin America: Coordinating Policy Responses across National and Subnational Levels to Combat COVID-19

We provide policy lessons for governments across Latin America by drawing on an original dataset of daily national and subnational non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic for eight Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru. Our analysis offers lessons for health system decision-making at various levels of government and highlights the impact of subnational policy implementation for responding to health crises. However, subnational responses cannot replace coordinated national policy; governments should emphasize the vertical integration of evidence-based policy from national to local levels while tailoring local policies to local conditions as they evolve. Horizontal policy integration across sectors and jurisdictions will also improve coordination at each level of government. The Latin American experiences with policy and politics during the COVID-19 pandemic project glocal health policy recommendations that connect global considerations with local needs.

Governance transformation towards localisation of sustainable development goal 11 in India

Sub-national governments play an essential role in transforming existing governance to deliver on the Sustainable Development Goals (SDGs), with SDG 11 intrinsically linked to SDG localisation. The Indian government is reforming its existing institutional mechanisms, and a research gap exists in assessing these reforms and sub-national responses to changes at the national level. Drawing from a transition management approach, this study focuses on the localisation of SDG 11 in India through a systematic evaluation of the national-level changes, which are then used as a reference to examine sub-national responses. Our findings indicate that the governance transformation for SDG 11 localisation in India is optimistic but has yet to generate deep transformational reforms given its developing stages. First, the Indian governance system attempts to make cooperative and competitive federalism work complementary to SDG localisation. Second, the political impact of the SDGs on sub-national governance has remained primarily discursive. Third, there is an advantage to exerting the overlaps between SDG 11 and existing government schemes to discern governance adaptiveness and reflexiveness in monitoring and evaluation systems. Four, there are limitations to the usage of the SDG India Index and risks of over-reliance on scheme-based monitoring and evaluation frameworks. In analysing different governance changes around India's SDG localisation across its cyclical process (strategic, tactical, operational, reflexive), this study provides a nuanced understanding of the transition of the governance system in India towards a governance model for achieving the SDGs.

Uncoordinated federalism: Subnational response to the pandemic crisis in Mexico

AbstractThe COVID‐19 pandemic has demanded prompt actions from governments all over the world. In both developed and developing countries, national governments have had to make unprecedented decisions to face the extraordinary challenges posed by the pandemic. In this paper, we explore how, due to the limited intervention from the Mexican federal government (in terms of policy actions, funding mechanisms and acting as a coordinating agent), state governments stepped up to respond to the pandemic. We argue that Mexico's response was relatively decentralized and substantially shaped by individual subnational governments. Based on a new dataset of over 600 subnational governments' responses to the social and economic effects of the pandemic, we show that state governments decided to react to the pandemic with their own policy measures, responding locally to pressing concerns. Furthermore, we demonstrate that state government responses varied widely in their scope and ambition, which exacerbated the pandemic's uneven national effects. We further contend that the structural constraints of Mexico's federalism have had an impact on these reactions, as social policy responsibilities at the state and local levels have historically been opaque and fragmented and state governments lack the funding necessary to implement sufficient and innovative initiatives.

Strengthening Management, Community Engagement, and Sustainability of the Subnational Response to Accelerate Malaria Elimination in Namibia.

ABSTRACT.Leadership and management skills are critical for health programs to deliver high-quality interventions in complex systems. In malaria-eliminating countries, national and subnational health teams are reorienting strategies to address focal transmission while preventing new cases and adapting to decentralization and declines in external financing. A capacity-strengthening program in two regions in Namibia helped malaria program implementers identify and address key operational, political, and financial challenges. The program focused on developing skills and techniques in problem-solving and teamwork, engaging decision-makers, and using financial evidence to prioritize domestic resources for malaria through participatory approaches. Results of the program included an observed 40% increase in malaria case reporting, 32% increase in reporting and tracing of imported malaria cases, 10% increase in malaria case management, integration of malaria activities into local operational plans, and an increase in subnational resources for malaria teams. To promote program sustainability beyond the implementation period, key program aspects were institutionalized into existing health system structures, program staff were trained in change leadership, and participants integrated the skills and approaches into their professional roles. A capacity-strengthening program with joint focus on leadership, management, and advocacy has potential for application to other health issues and geographies.

Strengthening Health Systems To Face Pandemics: Subnational Policy Responses To COVID-19 In Latin America.

Nonpharmaceutical interventions such as stay-at-home orders continue to be the main policy response to the COVID-19 pandemic in countries with limited or slow vaccine rollout. Often, nonpharmaceutical interventions are managed or implemented at the subnational level, yet little information exists on within-country variation in nonpharmaceutical intervention policies. We focused on Latin America, a COVID-19 epicenter, and collected and analyzed daily subnational data on public health measures in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru to compare within- and across-country nonpharmaceutical interventions. We showed high heterogeneity in the adoption of these interventions at the subnational level in Brazil and Mexico; consistent national guidelines with subnational heterogeneity in Argentina and Colombia; and homogeneous policies guided by centralized national policies in Bolivia, Chile, and Peru. Our results point to the role of subnational policies and governments in responding to health crises. We found that subnational responses cannot replace coordinated national policy. Our findings imply that governments should focus on evidence-based national policies while coordinating with subnational governments to tailor local responses to changing local conditions.

Inequalities and the COVID-19 pandemic in Brazil: analyzing un-coordinated responses in social assistance and education

AbstractThis paper contributes to discussions about subnational responses to the coronavirus disease (COVID-19) pandemic in federal countries. In the scholarship on federalism and public policy, few studies seek to understand the factors that shape subnational differences in welfare levels. This article seeks to better understand this issue in Brazil by exploring how, in a context with little national-level coordination, subnational governments tackle the inequalities exacerbated by the COVID-19 pandemic. This study analyzes two social policy areas with distinct national-level coordination mechanisms and federal responsibilities: social assistance and education. Two multi-level cases are examined: the states of Amazonas and São Paulo and the cities of Manaus and São Paulo. This analysis relies on quantitative data, mainly social indicators, and qualitative data collected through documents and in-depth interviews. Social assistance and education policy actors in Amazonas and São Paulo faced at times significant obstacles adapting and/or creating policies to tackle inequalities, resulting in a fend-for-yourself federalism and fragmented subnational policies. Differences in subnational responses can be explained by distinct policy legacies and previous capacity, which were key in organizing a useful response to the pandemic. However, to fully explain subnational responses, the role of actors within institutional contexts must also be taken into account. In social assistance, shared responsibilities among different levels of government led to competition and credit claiming dynamics, reinforcing fragmented and uncoordinated responses. In education, decentralization and more stable funding allowed political leadership to activate and mobilize subnational capacities and other actors at the subnational level, producing more sustainable responses.

Pandemic Policymaking in Presidential Federations: Explaining Subnational Responses to Covid-19 in Brazil, Mexico, and the United States

Why do COVID-19 social distancing policies vary so widely across states in federal countries? This mixed-methods study of Brazil, Mexico, and the United States finds that state-level variation in the stringency of social distancing policies is driven not by the epidemiological, demographic, or socioeconomic factors commonly emphasized in previous research, but largely by political factors. Introducing a novel framework for explaining pandemic policymaking, the study shows the central importance of political parties, presidential power, and governors’ coalitions in determining state-level policy stringency. In the United States and Mexico, statistical and qualitative evidence indicates that interstate collaboration among governors, combined with top-down pressures from national party elites and presidents, led to greater policy alignment among coordinated states. In Brazil, in contrast, where there is little evidence of either policy coordination or alignment, state-level policies resulted instead from intrastate factors and diffusion. Together, these findings highlight how a multilevel framework attuned to varied combinations of intra-unit, cross-unit, and cross-level causal factors strengthens our understanding of pandemic policymaking.

Subnational response differences on the Belt and Road Initiative policy and firm internationalization: A longitudinal and multi-level approach

Subnational response differences on the Belt and Road Initiative policy and firm internationalization: A longitudinal and multi-level approach

Multi-Level Governance, Policy Coordination and Subnational Responses to COVID-19: Comparing China and the US

The study adopted the multi-level governance theory for a comparative analysis of how the structure and modes of policy coordination shaped subnational policy responses to COVID-19 in Hubei Province, China, and New York State, USA. It was found that both countries showed a hybrid form of vertical and horizontal coordination in COVID-19 responses despite different political systems. Hubei depended more on vertical steering and horizontal support whereas New York took the primary coordinating role while a nationwide strategy was missing. Contingent upon each country’s political legacy, effective multi-level governance in crisis responses should balance national leadership with local autonomy and societal engagement.

The role of a national-emergency operations center in 2016/2017 meningitis outbreak response

Introduction : outbreaks of bacterial Cerebrospinal Meningitis are known to result in high morbidity and mortality. Outbreaks with such a high impact attract a multi-level, multi-partner response. While the accompanying deployment of human and material resources is beneficial for response, effective utilization may be compromised without a central coordinating structure. Activating an Incident Management System (IMS) is therefore vital. This paper describes the role of an IMS in coordinating response to the 2017 CSM outbreak, which resulted in 14,280 cases with CFR of 8%. Methods : on the 3rd of April, 2017, a national IMS led by the Nigeria Centre for Disease Control (NCDC) was activated coinciding with the peak of the outbreak (Epi-week 14, 2017). Terms of Reference and an emergency response plan was defined based on five response pillars- Coordination, Case management, Surveillance and Epidemiology, Risk Communications and Vaccines management. Activities implemented include: Bi-weekly CSM EOC meetings and situational report development, deployment of rapid response teams (RRT) to affected States, technical support to States to support reactive vaccination campaigns. Other activities included sensitization of stakeholders, monitoring of epidemiological trends using dashboards, development and review of SOPs, weekly feedbacks to affected States as well as multi-layered advocacies. Results : the IMS activation enhanced coordination of all response activities by the Government and partners. A long tail of the epidemic prior to EOC activation was shortened and CFR reduced from 11.2% to 8.0%. Reactive vaccination campaigns were better coordinated yielding high coverage rates in Zamfara (97%), Sokoto (97%) and Yobe (105%) States. Multi-level mapping and strategic deployment of all partners’ resources was achieved. Development and dissemination of bi-weekly situational reports aided response decisions and kept stakeholders and the general public abreast of outbreak status. Decision making was evidence-based as outbreak dashboards were used to review epidemic trends. Engagement with stakeholders (media, traditional and religious institutions) helped in social mobilization. Guidelines and SOPs development improved sub-national response by eliminating the use of multiple guidelines on same thematic area. Conclusion : the containment of CSM outbreak is partly attributable to the activation of the IMS, which aided timely identification of response gaps and proffering solutions. Although the IMS was activated only at the peak of the outbreak, a drastic reduction in new cases was recorded. The use of an IMS for coordinating future outbreaks is highly recommended.

Local Climate Governance under the Shadow of Hierarchy: Evidence from China’s Yangtze River Delta

This study examines the making of local climate governance in the Chinese setting where central-local inter-governmental relations continue to play critical part in almost every policy domain. Through analysing the climate responses of the three provincial-level governments at the Yangtze River Delta (YRD), the paper argues that the process of “experimentation under hierarchy” is relevant to understanding the evolving of the subnational climate regime in the YRD region. We find the preponderance of the central authorities in initiating national climate strategies and galvanising responses at the local level. Meanwhile, provincial governments have been able to leverage climate plans and actions to achieve their own gains. These findings suggest that any optimism about subnational climate activism in a Chinese setting has to be mixed with caution. In fact, the shadow of hierarchical authority structure lingers and plays important part in the initiation of subnational response and spurring climate responses and innovations from below.

Subnational Responses to Fracking in Canada: Explaining Saskatchewan's “Wild West” Regulatory Approach

AbstractThis article assesses the regulatory response to fracking by Saskatchewan, Canada's second largest oil‐producing province. Public officials and industry representatives claim fracking regulations are “comprehensive” and “robust”; however, there has been no comparative assessment of this claim. To address this gap, we outline the dominant regulatory pathways of U.S. states and Canadian provinces, ranging from applying existing regulations with minimal revisions, to enacting broader revisions or bans. We account for this variation using a framework from Davis () emphasizing governments’ dependence on the oil sector, the level of support for fracking among elected officials and policy makers, and the influence of key “constituencies.” The article then traces the growth and impact of fracking in Saskatchewan and analyzes new trends in the province's regulation of fracking. Given the province's application of existing regulations with minimal revisions and active weakening of enforcement, we identify Saskatchewan as taking Rabe and Borick's () “conventional” regulatory approach, typical of Davis's “energy dominant” states.

Multilevel governance and urban climate change mitigation

Cities worldwide have taken the lead in addressing climate change; however, this does not tell the full story in understanding the puzzle of local climate action. Rather than in isolation, city actions occur in the context of a complex of other government arrangements. Whereas the majority of the literature concerning subnational responses to climate change in the US is addressed in the literatures of federalism and diffusion, we offer an explanation of climate actions through a multilevel governance approach. Multilevel governance allows us to consider the horizontal city-to-city influences on climate action while also considering the vertical influences of state-to-local action. We conduct a large quantitative study of climate actions in all US cities with populations greater than 50,000 people. We find that cities' and states' climate action efforts are complementary, rather than attenuating; however, we note that horizontal influences are generally stronger than vertical influences in motivating climate action at the local level. We conclude that, in spite of the potential for an increased role of federal and state governments in climate action in the United States, city-to-city networks are likely to remain important in motivating cities to mitigate climate change.

Sub-national Responses to Climate Change in England: Evidence from Local Area Agreements

The machinery of governance to address climate change at the sub-national level in England continues to evolve. Drawing on documentary evidence and the views of civil servants and local authority officials from the English West Midlands, this article explores the process through an examination of the inclusion of climate change indicators in the recent round of Local Area Agreements (LAAs), negotiated between central government and local authorities and Local Strategic Partnerships. Considerable popularity has been accorded these indicators nationally, but there are important variations in the pattern of take up. Moreover, significant uncertainties surround the contribution of local measures to reduce CO2 emissions and the targets attached to measures to adapt to climate change are seen as undemanding. Conversely, the impending Carbon Reduction Commitment will act as a powerful incentive for public bodies to cut CO2 emissions from their estates. Although potentially contributing to greater coherence in tackling climate change, achieving collective action through LAAs will prove problematic.

A review of monitoring and evaluation in support of orphans and vulnerable children in East and Southern Africa

Monitoring and evaluating national and subnational responses in support of children orphaned or made vulnerable by AIDS (OVC) present a number of challenges. Most OVC programmes require multiple interventions across different sectors. In most countries, targeting parameters for identifying ‘vulnerable’ children are fluid and difficult to define or measure concretely. Along with weak national monitoring systems and a lack of development partner or government interest and funds, these factors make the monitoring and evaluation (M&E) of OVC programmes difficult. Of the 15 countries in East and Southern Africa (ESA), which have developed national plans of action (NPAs) in support of OVC, nine have M&E plans. In their early periods of implementation, most countries are piloting the development of data collection systems and tools at community, district and national levels. Along with a desk review, semi-structured consultations were held with over 100 national OVC M&E stakeholders from 10 countries in ESA as part of a regional capacity-building exercise. This paper reviews their progress, constraints and lessons learnt, before making recommendations. Most countries do not have reliable baseline information or a clear ‘denominator’. Subsequently, numbers rather than percentages are used frequently when reporting on coverage, which gives little indication of the scope or efficacy of interventions. Many countries also reported challenges in defining and monitoring the quality of care provided, therefore the consistency and quality of the support being provided is largely unknown. Another major gap is the fact that OVC indicators are rarely included across key sectors' data collection systems (e.g. health, education). To help overcome these challenges, recommendations include the following. While for national monitoring and evaluation purposes, measurable, discrete, evidence-informed criteria should be employed – for project or programming purposes, targeting criteria should be sufficiently flexible and responsive based on community realities and the child's immediate needs. Every opportunity to use and disaggregate existing data should be exploited, while the establishment of parallel data collection mechanisms should be avoided. While quality assurance mechanisms should be established to monitor service coverage, no pilot should be undertaken without the design and implementation of an evaluation to accompany it. These should include a baseline and the establishment of comparison control groups, isolating and assessing the outcomes that the intervention is having on children.

Sub-national response in HIV/AIDS: a case study in AIDS prevention and control from Sindh province, Pakistan.

HIV/AIDS in Pakistan is slowly gaining recognition as a public health issue of great importance. However, the responses to the disease have been marred by lack of coordination and commitment. We examine, in this paper, the situation in the Sindh province of Pakistan, which is recognized as having the sole fully functioning AIDS prevention and control programme in the country. In discussing the results of the Sindh programme's activities we highlight progress made as well as gaps in data and surveillance. We also recommend strategies for implementation at the provincial and national levels. In addition this example of a sub-national government programme provides a case study for similar programmes in the region.

Sub-national response in HIV/AIDS: a case study in AIDS prevention and control from Sindh province, Pakistan

HIV/AIDS in Pakistan is slowly gaining recognition as a public health issue of great importance. However, the responses to the disease have been marred by lack of coordination and commitment. We examine, in this paper, the situation in the Sindh province of Pakistan, which is recognized as having the sole fully functioning AIDS prevention and control programme in the country. In discussing the results of the Sindh programme's activities we highlight progress made as well as gaps in data and surveillance. We also recommend strategies for implementation at the provincial and national levels. In addition this example of a sub-national government programme provides a case study for similar programmes in the region.