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Book part
Publication date: 7 February 2024

Anne M. Hewitt

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public…

Abstract

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.

Open Access
Article
Publication date: 24 June 2022

Jean Grugel, Sarah C. Masefield and Alan Msosa

Health in low-income countries has become associated with the provision of minimum guaranteed public health services though Essential Health Packages (EHPs). How far do EHPs…

1251

Abstract

Purpose

Health in low-income countries has become associated with the provision of minimum guaranteed public health services though Essential Health Packages (EHPs). How far do EHPs deliver the human right to health for all? This study addresses this question through qualitative research into access to health care for vulnerable communities, using Malawi as a case study. This study shows that there are significant accountability gaps and perceptions of weak service provision in Malawi’s EHP in relation to some particularly marginalised (and stigmatised) groups that limit the right to health and the promise of “health for all”.

Design/methodology/approach

This study extends the body of qualitative work on EHPs in general and on Malawi in particular by exploring the perceptions of key stakeholders in relation to inclusivity and the delivery of health policies to particularly vulnerable groups. To do so, this study adopted an approach based on interpretive epistemologies (Scott, 2014). This study conducted largely unstructured interviews with a range of health stakeholders, speaking to stakeholders individually, rather than through focus groups due to the potentially sensitive nature of the topic.

Findings

The findings of this study are as follows: limited inclusion of civil society actors and local communities; local communities and local policymakers feel frustration with the gap between the promises of consultation in the EHP and the reality, and the difficulties of not having effective channels of communication; and exclusionary health practices for particularly vulnerable groups.

Research limitations/implications

There are limitations based on the qualitative methodology, and in terms of the particularly vulnerable groups – the authors studied two such groups (people with disabilities and those who identify as LBTQ) but a wider survey of vulnerable groups is needed to extend and confirm the findings.

Practical implications

Greater attention to the health rights of vulnerable groups would improve access and services, even in the context of resource restrictions. This study suggests that a deeper engagement with human rights-based approaches would pay dividends in terms of increasing access to health in Malawi, even within the constraints of the EHP process. Furthermore, without this, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised.

Social implications

Without addressing these issues, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised.

Originality/value

This paper makes an important contribution to the growing literatures on EHP in sub-Saharan Africa and Malawi in particular and to the importance of listening to stakeholder perceptions. It provides original data on stakeholder perspectives of the challenges associated with universalising health care in resource-constrained countries. To the best of the authors’ knowledge, it is one of the first papers to focus on the rights of disabled and LBTQ people in relation to EHPs.

Details

International Journal of Human Rights in Healthcare, vol. 17 no. 1
Type: Research Article
ISSN: 2056-4902

Keywords

Article
Publication date: 4 September 2023

Ahmed Diab

This study analyses the socioeconomic impact of COVID-19 on government accountability regarding the employment of both national and migrant workforces by bringing evidence from an…

Abstract

Purpose

This study analyses the socioeconomic impact of COVID-19 on government accountability regarding the employment of both national and migrant workforces by bringing evidence from an emerging market. In doing so, this study addresses if/how the government discharged its accountability to the public during this recent global health crisis, which started in late 2019, with its effects still being felt today.

Design/methodology/approach

This study is based on a close reading of the relevant news media (local and international), published research and official reports, as well as ten conversations with business managers to analyse the socioeconomic impact of COVID-19 on government accountability in the Kingdom of Saudi Arabia (KSA). This study draws on insights from public choice theory in trying to understand why some governments take an economic perspective while exercising accountability to their population during the pandemic.

Findings

It was found that COVID-19 led the government to pursue plans for the localization of the professions and increase employment rates among nationals vs. foreigners or migrant workers. The crisis was exploited by the government to achieve macro socio-political and economic goals, demonstrating its accountability to citizens, rather than foreign workers. This shift shows that difficult and exceptional circumstances can present opportunities for policymakers in emerging markets to achieve national policy and political aims.

Originality/value

This study enhances the author’s understanding of accountability during crises (i.e. crises-induced accountability) in emerging markets. The analyses presented enrich the crisis management literature by highlighting the implicit actions of national leaders that affect the lives and well-being of their constituents, especially vulnerable groups.

Details

Journal of Accounting in Emerging Economies, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2042-1168

Keywords

Article
Publication date: 14 August 2023

Olusola Joshua Olujobi and Tunde Ebenezer Yebisi

The purpose of this study is to examine the corruption prevalent in the distribution of COVID-19 palliatives during the lockdown and movement restrictions in the country. This…

Abstract

Purpose

The purpose of this study is to examine the corruption prevalent in the distribution of COVID-19 palliatives during the lockdown and movement restrictions in the country. This study seeks to analyse the current state of corruption in the distribution of COVID-19 palliatives and public health facilities in Nigeria while also providing a legal insight and strategic blueprint to combat corruption. To this end, this study will address the current legal framework for combating corruption and build upon this to formulate a working strategy for tackling corruption in the future.

Design/methodology/approach

Using a doctrinal legal research methodology, this study draws upon existing literature, tertiary data sources and information from the Nigeria Centre for Disease Control. The collected data is analysed and compared with current literature to identify key findings. Rent-seeking and utilitarian theories of the law were examined to guide this study. This study offers useful insights into combating corruption. The use of this method is justified, as it enhances the credibility of the findings on the importance of strategies for future emergencies. This legal research approach is consistent with the law and can be easily verified. The empirical aspect of this study involved a survey of multidimensional health-care and economic data set of 36 states in Nigeria plus the Federal Capital Territory on COVID-19 in Nigeria. A survey linearised regression model was estimated to determine the influence of government revenue and public health-care facilities in the control of the virus spread in Nigeria.

Findings

This study reveals the need for emphasis on the imperative of combating corruption in the distribution of COVID-19 palliatives and establishing economic resilience through transparent and accountable practices, supported by legal frameworks.

Research limitations/implications

Rent-seeking and utilitarian theories of law are evaluated because of their impacts on combating corruption. The limitation of this study is the intricacy of gathering data on COVID-19 palliatives corruption in Nigeria because of secrecy and the absence of reliable data on the subject.

Practical implications

Estimating the exact number of stolen palliatives and their fiscal impact on Nigeria's economy proves to be a formidable task because of the covert nature of corruption. This study equips policymakers in Nigeria with a better understanding of the legal challenges posed by corruption in the health care sector and provides an effective strategy to combat it.

Social implications

The lack of reliable data on the extent of palliative theft hinders the ability of lawmakers to enact effective legislation and strategies for combating corruption in the distribution of COVID-19 palliatives and addressing future emergencies in Nigeria. The policy implications of this study can assist policymakers in Nigeria and other countries in formulating measures to combat corruption in the distribution of COVID-19 palliatives and other future emergencies. Furthermore, it recommends the overhaul of anti-corruption laws and mechanisms in Nigeria to ensure effective measures against corruption.

Originality/value

In conclusion, this study contributes to knowledge by proposing a legal model centred on people's participation to enhance transparency and accountability in future palliative distribution processes. This study recommends legal strategies that can effectively address corruption in future emergencies or shocks. This study proposes a strategic blueprint to tackle corruption in the future. This blueprint includes an analysis of existing laws and regulations, as well as potential policy changes and legislative reform. This study also includes recommendations for improved enforcement and oversight mechanisms and for improved public awareness and education. As part of this, this study considers the potential for public–private partnerships to increase transparency and accountability in public health and health-care services.

Details

Journal of Financial Crime, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1359-0790

Keywords

Article
Publication date: 29 July 2022

Elisavet Athanasia Alexiadou

Health sector corruption constitutes a pervasive challenge and a major obstacle to the equitable enjoyment of the right to health by exacerbating health inequalities within…

Abstract

Purpose

Health sector corruption constitutes a pervasive challenge and a major obstacle to the equitable enjoyment of the right to health by exacerbating health inequalities within societies, while often eroding public trust primarily amid public health crises that threaten human security. The purpose of this paper is to examine the value of advancing right to health considerations in national legislative and regulatory responses against health sector corruption.

Design/methodology/approach

This paper builds on existing evidence, with focusing attention on international standards that are relevant to the topic under discussion. The literature research included publicly available reports, peer-reviewed studies and other documents primarily of human rights bodies at the United Nations level.

Findings

Advancing right to health considerations in national responses against health sector corruption offers comprehensive guidance for the deployment of a strong regulatory anti-corruption framework for action by the governments as part of their health rights obligations. Essentially, the implementation of such a national framework for action, encompassing accountability, participatory decision-making and transparency, constitutes a necessary and an important step towards maintaining well-functioning health systems and a robust social pressure for continued political commitment with the ultimate goal the provision of equitable access to quality health services at all times.

Originality/value

By using a rights-based approach, the paper identifies a national framework for state action consisting of legal obligations and tools towards guiding governments, while at the same time empowering civil society groups to demand the implementation of core human rights principles of transparency, participation and accountability within health system governance. It provides insights for the future development, reinforcement and/or reform of national law, policies and practices towards minimizing and eradicating vulnerabilities to health sector corruption.

Details

International Journal of Human Rights in Healthcare, vol. 16 no. 5
Type: Research Article
ISSN: 2056-4902

Keywords

Open Access
Article
Publication date: 3 January 2024

Leticia Mahuwi and Baraka Israel

Understanding the interplay between transparency, accountability and e-procurement and their collective contribution to anti-corruption efforts in public procurement is crucial…

Abstract

Purpose

Understanding the interplay between transparency, accountability and e-procurement and their collective contribution to anti-corruption efforts in public procurement is crucial for developing effective strategies and policies. This research seeks to investigate whether e-procurement plays a significant role in enhancing transparency and accountability and subsequently reducing corruption risks in the public pharmaceutical procurement system.

Design/methodology/approach

The study employed a cross-sectional questionnaire survey to gather data from 274 procurement personnel and pharmacists working in 28 government-owned hospitals in the Southern Highlands of Tanzania. The collected data were then analysed using confirmatory factor analysis (CFA) and the Hayes PROCESS macro to test the study hypotheses.

Findings

The study findings revealed a negative and significant relationship between transparency and procurement corruption (ß = −0.117, p < 0.008). Moreover, accountability negatively and significantly affects procurement corruption (ß = −0.162, p = 0.006). Furthermore, the findings indicate that, at a high degree of e-procurement system implementation, transparency and accountability have a stronger impact on procurement anti-corruption measures.

Practical implications

Policymakers and decision-makers should implement robust mechanisms that enhance transparency, accountability and anti-corruption efforts. These may include providing clear and accessible information on procurement processes, efficient mechanisms for monitoring and reporting procurement irregularities and continuous improvement of e-procurement systems. By incorporating these measures and nurturing collaboration amongst procurement stakeholders, it becomes possible to foster a procurement environment characterised by integrity, fairness, accountability and reduced corruption.

Originality/value

Whilst previous studies delved into exploring the effect of transparency and accountability on procurement anti-corruption, the novelty of this study is the inclusion of e-procurement as a moderating variable in the relationship between transparency, accountability and anti-corruption. By so doing, this study adds to the existing body of knowledge regarding anti-corruption measures and offers valuable practical insights for policymakers and professionals aiming to enhance transparency, accountability and ethical conduct within the public pharmaceutical procurement system.

Details

Management Matters, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2279-0187

Keywords

Article
Publication date: 14 September 2023

Sina Furnes Øyri, David W. Bates and Siri Wiig

The authors compare perspectives on external evaluation of health service provision between Norway and the USA. External inspection and accreditation are examples of…

Abstract

Purpose

The authors compare perspectives on external evaluation of health service provision between Norway and the USA. External inspection and accreditation are examples of internationally wide-spread external evaluation methods used to assess the quality of care given to patients. Different countries have different national policy strategies and arrangements set up to do these evaluations. Although there is growing attention to the impact and effects on quality and safety from external evaluation, there is still a gap in knowledge to how structures and processes influence these outcomes. Accordingly, the purpose of this article is to describe the structures and processes in external evaluation designed to promote quality improvement in Norway and the USA with attention to comparison of enablers and barriers in external evaluation systems.

Design/methodology/approach

Data collection consisted of documentary evidence retrieved from governmental policies, and reviews of the Joint Commission (the US), international guidelines, recommendations and reports from the International Society for Quality in Health Care, and the World Health Organization, and policies and regulations related to Norwegian governmental bodies such as the Ministry of Health and Care Services, the Norwegian Directorate of Health, and the Norwegian Board of Health Supervision . Data were analyzed inspired by a deductive, direct content analytical framework.

Findings

The authors found that both accreditation and inspection are strategies put in place to ensure that healthcare providers have adequate quality systems as well as contributing to the wider risk and safety enhancing management and implementation processes in the organizations subjected to evaluation. The US and the Norwegian external regulatory landscapes are complex and include several policymaking and governing institutions. The Norwegian regulatory framework for inspection has replaced an individual blame logic with a model which “blames” the system for inadequate quality and patient harm. This contrasts with the US accreditation system, which focuses on accreditation visits. Although findings indicate an ongoing turning point in accreditation, findings also demonstrate that involving patients and next of kin directly in adverse event inspections is a bigger part of a change in external inspection culture and methods than in processes of accreditation.

Research limitations/implications

The message of this paper is important for policymakers, and bodies of inspection and accreditation because knowledge retrieved from the comparative document study may contribute to better understanding of the implications from the different system designs and in turn contribute to improving external evaluations.

Originality/value

Although there is a growing attention to the impact and effects on quality and safety from external evaluation, the implications of different regulatory strategies and arrangements for evaluation on quality and safety remain unclear.

Details

International Journal of Health Governance, vol. 28 no. 4
Type: Research Article
ISSN: 2059-4631

Keywords

Open Access
Article
Publication date: 22 March 2024

Anell Anders

A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional…

Abstract

Purpose

A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional consequences. The purpose of this article is to discuss new approaches to performance management in health care services when the purpose is to support innovative changes in the delivery of services.

Design/methodology/approach

The article represents cross-boundary work as the theoretical and empirical material used to discuss and reconsider performance management comes from several relevant research disciplines, including systematic reviews of audit and feedback interventions in health care and extant theories of human motivation and organizational control.

Findings

An enabling approach to performance management in health care services can potentially contribute to innovative changes. Key design elements to operationalize such an approach are a formative and learning-oriented use of performance measures, an appeal to self- and social-approval mechanisms when providing feedback and support for local goals and action plans that fit specific conditions and challenges.

Originality/value

The article suggests how to operationalize an enabling approach to performance management in health care services. The framework is consistent with new governance and managerial approaches emerging in public sector organizations more generally, supporting a higher degree of professional autonomy and the use of nonfinancial incentives.

Details

Journal of Health Organization and Management, vol. 38 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 31 January 2024

Margit Malmmose and Mai Skjøtt Linneberg

The objective of this study is to examine developments in the discursive practice of non-financial reporting in the public healthcare sector. In doing so, the authors investigate…

Abstract

Purpose

The objective of this study is to examine developments in the discursive practice of non-financial reporting in the public healthcare sector. In doing so, the authors investigate how the main reform foci of productivity and quality are represented, with a specific focus on the patient.

Design/methodology/approach

Drawing on critical discourse analysis (CDA), the authors conduct a longitudinal study (2007–2018) of healthcare reporting foci across the five administrative regions responsible for public hospitals in Denmark. The study analyses sixty annual reports and draws on contemporary reform documents over this period. CDA enables a micro-textual analysis, combined with macro-insights and discussions on social practice.

Findings

The findings show complex webs of presentation strategies, but in particular two changes occur during the period. First, the patient is centred throughout but the framing changes from productivity and waiting lists to quality and dialogue. Second, in the first years, the regions present themselves as actively highlighting financial and quality concerns, which changes to a passive and indirect form of presentation steered by indicators and patient legislation enforced by central government. This enhances passivity and distance in healthcare regional non-financial reporting where the regions seek to conform to such demands. Simultaneously, however, the authors find a tendency to highlight very different local initiatives, which shows an attempt to go beyond a pure automatic mode of reporting found in earlier studies.

Originality/value

Responding to the literature on both healthcare and financial reporting, this study identifies novel links between micro-level texts and macro-level social practices, enabling insights into the potentially intertwined impacts of public-sector reporting. The authors offer insights into the complexity of the construction of non-financial reporting in the public sector, which has a wider impact and different intentions than private-sector reporting.

Details

Accounting, Auditing & Accountability Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0951-3574

Keywords

Article
Publication date: 9 May 2023

Baraka Israel

The problems that face health service delivery across different countries are compounded by financial, political, institutional and technical deficiencies. Yet, the role of…

103

Abstract

Purpose

The problems that face health service delivery across different countries are compounded by financial, political, institutional and technical deficiencies. Yet, the role of technological aspects in the procurement of health commodities and health service delivery system requires in-depth exploration. This study bridges this gap by examining the mediating effect of an integrated health commodities procurement system on the relationship between responsiveness and health service delivery.

Design/methodology/approach

Data for this study were collected from 274 respondents, comprising procurement staff and pharmacists using a cross-sectional questionnaire survey. A total of 28 government-owned hospitals from 6 regions in the Southern Highland of Tanzania were sampled for observation. Confirmatory factor analysis (CFA) and structural equation modelling (SEM) were used for data analysis.

Findings

The results of the study revealed a positive and significant relationship between responsiveness and integrated health commodities procurement system (β = 0.572, p < 0.001). Responsiveness positively and significantly affects health service delivery (β = 0.175, p = 0.004). The results also show that integrated health commodities procurement system is positive and significantly related to health service delivery (β = 0.264, p < 0.001). Lastly, the bootstrapping confidence intervals revealed that an integrated health commodities procurement system significantly mediates the relationship between responsiveness and health service delivery.

Practical implications

To strengthen the health service delivery system, the study recommends enforcing internal control mechanisms and supporting policies that will monitor and evaluate the effectiveness of the integrated health commodities procurement system and service practitioners' responsiveness. Moreover, health service managers should ensure that the planning, procurement and distribution of health commodities are fully and effectively integrated at each node of the health supply chain.

Originality/value

The study contributes to the body of knowledge which examines the efficacy of health service delivery from procurement perspective. To the best of the author's knowledge, this is the first study that offers empirical evidence for the mediating effect of integrated health commodities procurement system on the link between responsiveness and health service delivery.

Details

International Journal of Health Governance, vol. 28 no. 3
Type: Research Article
ISSN: 2059-4631

Keywords

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