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Concept: Governance


BACKGROUND: Research on practical and effective governance of the health workforce is limited. This paper examines health system strengthening as it occurs in the intersection between the health workforce and governance by presenting a framework to examine health workforce issues related to eight governance principles: strategic vision, accountability, transparency, information, efficiency, equity/fairness, responsiveness and citizen voice and participation. METHODS: This study builds off of a literature review that informed the development of a framework that describes linkages and assigns indicators between governance and the health workforce. A qualitative analysis of Health System Assessment (HSA) data, a rapid indicator-based methodology that determines the key strengths and weaknesses of a health system using a set of internationally recognized indicators, was completed to determine how 20 low- and middle-income countries are operationalizing health governance to improve health workforce performance.Results/discussion: The 20 countries assessed showed mixed progress in implementing the eight governance principles. Strengths highlighted include increasing the transparency of financial flows from sources to providers by implementing and institutionalizing the National Health Accounts methodology; increasing responsiveness to population health needs by training new cadres of health workers to address shortages and deliver care to remote and rural populations; having structures in place to register and provide licensure to medical professionals upon entry into the public sector; and implementing pilot programs that apply financial and non-financial incentives as a means to increase efficiency. Common weaknesses emerging in the HSAs include difficulties with developing, implementing and evaluating health workforce policies that outline a strategic vision for the health workforce; implementing continuous licensure and regulation systems to hold health workers accountable after they enter the workforce; and making use of health information systems to acquire data from providers and deliver it to policymakers. CONCLUSIONS: The breadth of challenges facing the health workforce requires strengthening health governance as well as human resource systems in order to effect change in the health system. Further research into the effectiveness of specific interventions that enhance the link between the health workforce and governance are warranted to determine approaches to strengthening the health system.

Concepts: Health care, Health care provider, Health economics, Medicine, Healthcare, Health informatics, Governance, Accountability


It is unclear how to engage a wide range of knowledge users in research. We aimed to map the evidence on engaging knowledge users with an emphasis on policy-makers, health system managers, and policy analysts in the knowledge synthesis process through a scoping review.

Concepts: Health, Evaluation, Policy, C, Policy analysis, Governance


Poor governance impedes the provision of equitable and cost-effective health care in many low- and middle-income countries (LMICs). Although systemic problems such as corruption and inefficiency have been characterized as intractable, “good governance” interventions that promote transparency, accountability and public participation have yielded encouraging results. Mobile phones and other Information and Communication Technologies (ICTs) are beginning to play a role in these interventions, but little is known about their use and effects in the context of LMIC health care.

Concepts: Health care, Mobile phone, Middle class, Information technology, Governance, Political corruption, Good governance, Worldwide Governance Indicators


Global markets for agricultural products, timber, and minerals are critically important drivers of deforestation. The supply chains driving land use change may also provide opportunities to halt deforestation. Market campaigns, moratoria, and certification schemes have been promoted as powerful tools to achieve conservation goals. Despite their promise, there have been few opportunities to rigorously quantify the ability of these nonstate, market-driven (NSMD) governance regimes to deliver conservation outcomes. This study analyzes the impacts of three NSMD governance systems that sought to end the conversion of natural forests to plantations in Chile at the start of the 21st century. Using a multilevel, panel dataset of land use changes in Chile, we identify the impact of participation within each of the governance regimes by implementing a series of matched difference-in-differences analyses. Taking advantage of the mosaic of different NSMD regimes adopted in Chile, we explore the relative effectiveness of different policies. NSMD governance regimes reduced deforestation on participating properties by 2-23%. The NSMD governance regimes we studied included collaborative and confrontational strategies between environmental and industry stakeholders. We find that the more collaborative governance systems studied achieved better environmental performance than more confrontational approaches. Whereas many government conservation programs have targeted regions with little likelihood of conversion, we demonstrate that NSMD governance has the potential to alter behavior on high-deforestation properties.

Concepts: Biodiversity, Agriculture, Forest, TheStart, 21st century, The Conversion, Relative effectiveness factor, Governance


Synthetic biology (SB) applies engineering principles to biology for the construction of novel biological systems designed for useful purposes. From an oversight perspective, SB products come with significant uncertainty. Yet there is a need to anticipate and prepare for SB applications before deployment. This study develops a Societal Risk Evaluation Scheme (SRES) in order to advance methods for anticipatory governance of emerging technologies such as SB. The SRES is based upon societal risk factors that were identified as important through a policy Delphi study. These factors range from those associated with traditional risk assessment, such as health and environmental consequences, to broader features of risk such as those associated with reversibility, manageability, anticipated levels of public concern, and uncertainty. A multi-disciplinary panel with diverse perspectives and affiliations assessed four case studies of SB using the SRES. Rankings of the SRES components are compared within and across the case studies. From these comparisons, we found levels of controllability and familiarity associated with the cases to be important for overall SRES rankings. From a theoretical standpoint, this study illustrates the applicability of the psychometric paradigm to evaluating SB cases. In addition, our paper describes how the SRES can be incorporated into anticipatory governance models as a screening tool to prioritize research, information collection, and dialogue in the face of the limited capacity of governance systems. To our knowledge, this is the first study to elicit data on specific cases of SB with the goal of developing theory and tools for risk governance.

Concepts: Scientific method, Evaluation, Risk, Evaluation methods, Assessment, Risk management, Policy, Governance


Issues of balancing data accessibility with ethical considerations and governance of a genomics research biobank, Generation Scotland, are explored within the evolving policy landscape of the past ten years. During this time data sharing and open data access have become increasingly important topics in biomedical research. Decisions around data access are influenced by local arrangements for governance and practices such as linkage to health records, and the global through policies for biobanking and the sharing of data with large-scale biomedical research data resources and consortia.

Concepts: Time, Gene, Medical research, Policy, Public policy, Biobank, Governance, The Universal


Concepts underpinning the planetary boundaries framework are being incorporated into multilateral discussions on sustainability, influencing international environmental policy development. Research underlying the boundaries has primarily focused on terrestrial systems, despite the fundamental role of marine biomes for Earth system function and societal wellbeing, seriously hindering the efficacy of the boundary approach. We explore boundaries from a marine perspective. For each boundary, we show how improved integration of marine systems influences our understanding of the risk of crossing these limits. Better integration of marine systems is essential if planetary boundaries are to inform Earth system governance.

Concepts: Earth, Planet, Dwarf planet, Policy, Venus, Terrestrial planet, Governance, Planetary habitability


Despite China’s regulatory initiatives to promote its research accountability, it still needs to prove itself as a trusted player in life science research. In addition, in contrast to its huge investment, China is losing the race in delivering quality application of stem cells. The trial implementation of the 2015¬†ministerial regulations seemed to offer hope in ending this dual ‘lost-in-translation’. Yet skepticism remains. By examining China’s regulatory trajectory in the last 15¬†years, this paper illustrates that it is a post hoc pragmatic policy rationale and a soft centralization regulatory approach that have hampered China’s governance. To improve China’s governance of accountability, policy-makers need to get beyond an ‘act-in-response’ regulatory ethos and to engage with diverse stakeholders.

Concepts: Cell, Cell division, Stem cell, Cell biology, Policy, Governance, Hwang Woo-Suk


The potential menstrual hygiene management barriers faced by adolescent girls and women in workplace environments in low- and middle-income countries has been under addressed in research, programming and policy. Despite global efforts to reduce poverty among women in such contexts, there has been insufficient attention to the water and sanitation related barriers, specifically in relation to managing monthly menstruation, that may hinder girls' and women’s contributions to the workplace, and their health and wellbeing. There is an urgent need to document the specific social and environmental barriers they may be facing in relation to menstrual management, to conduct a costing of the implications of inadequate supportive workplace environments for menstrual hygiene management, and to understand the implications for girls' and women’s health and wellbeing. This will provide essential evidence for guiding national policy makers, the private sector, donors and activists focused on advancing girls' and women’s rights.

Concepts: Environment, Management, Woman, Hygiene, Governance


Integrating health and social care has long been a goal of policy-makers and practitioners. Yet, this aim has remained elusive, partly due to conflicting definitions and a weak evidence base. As part of a special edition exploring the use of the TAPIC (transparency, accountability, participation, integrity and capability) framework in different national contexts and inter-agency settings, this article examines the governance of integrated care in England since 2010, focusing on the extent to which thesefive governance attributes are applicable to integrated care in England. The plethora of English policy initiatives on integrated care (such as the ‘Better Care Fund’, personal health budgets, and ‘Sustainability and Transformation Plans’) mostly shows signs of continuity over time although the barriers to integrated care often persist. The article concludes that the contribution of integrated care to improved outcomes remains unclear and yet it remains a popular policy goal. Whilst some elements of the TAPIC framework fit less well than others to the case of integrated care, the case of integrated care can be better understood and explained through this lens.

Concepts: Evaluation, Evidence-based medicine, Policy, Explanation, Alternative medicine, Policy analysis, Governance, Accountability