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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…

1304

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

Open Access
Article
Publication date: 26 July 2021

James Brackley, Penelope Tuck and Mark Exworthy

This paper examines the contested value of healthy life and wellbeing in a context of severe austerity, exploring how the value of “Public Health” is constructed through and with…

1572

Abstract

Purpose

This paper examines the contested value of healthy life and wellbeing in a context of severe austerity, exploring how the value of “Public Health” is constructed through and with material-discursive practices and accounting representations. It seeks to explore the political and ethical implications of constructing the valuable through a shared consensus over the “facts” when addressing complex, multi-agency problems with long time horizons and outcomes that are not always easily quantifiable.

Design/methodology/approach

The theorisation, drawing on science and technology studies (STS) scholars and Karen Barad's (2007) agential realism, opens up the analysis to the performativity of both material and discursive practices in the period following a major re-organisation of activity. The study investigates two case authorities in England and the national regulator through interviews, observations and documentary analysis.

Findings

The paper demonstrates the deeply ethical and political entanglements of accounting representations as objectivity, consensus and collective action are constructed and resisted in practice. It goes on to demonstrate the practical challenges of constructing “alternative accounts” and “intelligent accountabilities” through times of austerity towards a shared sense of public value and suggests austerity measures make such aims both more challenging and all the more essential.

Originality/value

Few studies in the accounting literature have explored the full complexity of valuation practices in non-market settings, particularly in a public sector context; this paper, therefore, extends familiar conceptual vocabulary of STS inspired research to further explore how value(s), ethics and identity all play a crucial role in making things valuable.

Details

Accounting, Auditing & Accountability Journal, vol. 34 no. 7
Type: Research Article
ISSN: 0951-3574

Keywords

Open Access
Article
Publication date: 24 August 2021

Maureen Alice Flynn and Niamh M. Brennan

The paper examines interviewee insights into accountability for clinical governance in high-consequence, life-and-death hospital settings. The analysis draws on the distinction…

1711

Abstract

Purpose

The paper examines interviewee insights into accountability for clinical governance in high-consequence, life-and-death hospital settings. The analysis draws on the distinction between formal “imposed accountability” and front-line “felt accountability”. From these insights, the paper introduces an emergent concept, “grounded accountability”.

Design/methodology/approach

Interviews are conducted with 41 clinicians, managers and governors in two large academic hospitals. The authors ask interviewees to recall a critical clinical incident as a focus for elucidating their experiences of and observation on the practice of accountability.

Findings

Accountability emerges from the front-line, on-the-ground. Together, clinicians, managers and governors co-construct accountability. Less attention is paid to cost, blame, legal processes or personal reputation. Money and other accountability assumptions in business do not always apply in a hospital setting.

Originality/value

The authors propose the concept of co-constructed “grounded accountability” comprising interrelationships between the concept’s three constituent themes of front-line staff’s felt accountability, along with grounded engagement by managers/governors, supported by a culture of openness.

Details

Journal of Health Organization and Management, vol. 35 no. 9
Type: Research Article
ISSN: 1477-7266

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

Open Access
Article
Publication date: 15 July 2022

Sulistyowati, Raditya Sukmana, Ririn Tri Ratnasari, Ascarya and Tika Widiastuti

This paper attempts to rejuvenate waqf in the health sector by identifying and elaborating on its issues and challenges. The government budget for this sector is significant;…

4318

Abstract

Purpose

This paper attempts to rejuvenate waqf in the health sector by identifying and elaborating on its issues and challenges. The government budget for this sector is significant; thus, the present paper aims to provide a nongovernment budget to lessen the government's burden

Design/methodology/approach

This qualitative study uses structured in-depth interviews with 12 respondents to generate valuable insights and thoughts in order to frame recommendations.

Findings

The findings highlight the key themes: human resources, finance, collaboration and coordination, legal issues, basic healthcare insufficiency, data and digitalization, accountability and sustainability and infrastructure. The following are the proposed solutions: capacity building program (CBP), hybrid waqf scheme, big data connectivity, specific legal framework, refocusing and reallocating of resources for the health sector during and after the pandemic

Research limitations/implications

This study focuses on Indonesia and Malaysia as the authors believe that these two countries have a lot of practice in the field. Further studies may focus on other countries, such as Pakistan.

Practical implications

This paper proposes potential ways to embrace government policy consideration, optimize the elaboration among productive waqf with other kinds, improve governance of and coordination among waqf institutions and increase the awareness to improve significant development.

Social implications

By considering this paper's recommendations, waqf stakeholders in the healthcare system can improve the social benefits for poor and needy patients.

Originality/value

This study presents the latest strategic analysis of waqf, which is important for the government policy in developing waqf.

Details

Islamic Economic Studies, vol. 30 no. 1
Type: Research Article
ISSN: 1319-1616

Keywords

Open Access
Article
Publication date: 26 August 2022

Giuseppe Grossi and Daniela Argento

The purpose of this paper is to explain how public sector accounting has changed and is changing due to public governance development.

6788

Abstract

Purpose

The purpose of this paper is to explain how public sector accounting has changed and is changing due to public governance development.

Design/methodology/approach

This paper conducts a traditional literature review based on selected studies in the fields of accounting, public administration and management. The aim of the review is to explain how diverse forms of public governance influence the fate of public sector accounting, including accountability, performance measurement, budgeting and reporting practices.

Findings

Public governance is developing into more inclusive but also complex forms, resulting in network, collaborative and digital governance. Consequently, the focus and practices of public sector accounting have changed, as reflected in new types of accountability, performance measurement, budgeting and reporting practices.

Research limitations/implications

Drawing upon literature from different fields enables a deeper understanding of the changes in public sector accounting. Nevertheless, the intention is not to execute a systematic literature review but to provide an overview and resolve the scattered body of knowledge generated by previous contributions. The areas of risk management and auditing were not included and deserve further attention.

Originality/value

This paper discusses the need to continually redefine and reassess public sector accounting practices, by recognising the interdependencies between different actors, citizens and digital technologies.

Details

Accounting, Auditing & Accountability Journal, vol. 35 no. 9
Type: Research Article
ISSN: 0951-3574

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

Open Access
Article
Publication date: 5 July 2019

Rod Sheaff, Joyce Halliday, Mark Exworthy, Alex Gibson, Pauline W. Allen, Jonathan Clark, Sheena Asthana and Russell Mannion

Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and…

2589

Abstract

Purpose

Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. The purpose of this paper is to examine the connections between ownership, organisational structure and managerial regime within an elaboration of Donabedian’s reasoning about organisational structures. Using new data from England, it considers: how do the internal managerial regimes of differently owned healthcare providers differ, or not? In what respects did any such differences arise from differences in ownership or for other reasons?

Design/methodology/approach

An observational systematic qualitative comparison of differently owned providers was the strongest feasible research design. The authors systematically compared a maximum variety (by ownership) sample of community health services; out-of-hours primary care; and hospital planned orthopaedics and ophthalmology providers (n=12 cases). The framework of comparison was the ownership theory mentioned above.

Findings

The connection between ownership (on the one hand) and organisation structures and managerial regimes (on the other) differed at different organisational levels. Top-level governance structures diverged by organisational ownership and objectives among the case-study organisations. All the case-study organisations irrespective of ownership had hierarchical, bureaucratic structures and managerial regimes for coordinating everyday service production, but to differing extents. In doctor-owned organisations, the doctors’, but not other occupations’, work was controlled and coordinated in a more-or-less democratic, self-governing ways.

Research limitations/implications

This study was empirically limited to just one sector in one country, although within that sector the case-study organisations were typical of their kinds. It focussed on formal structures, omitting to varying extents other technologies of power and the differences in care processes and patient experiences within differently owned organisations.

Practical implications

Type of ownership does appear, overall, to make a difference to at least some important aspects of an organisation’s governance structures and managerial regime. For the broader field of health organisational research, these findings highlight the importance of the owners’ agency in explaining organisational change. The findings also call into question the practice of copying managerial techniques (and “fads”) across the public–private boundary.

Originality/value

Ownership does make important differences to healthcare providers’ top-level governance structures and accountabilities and to work coordination activity, but with different patterns at different organisational levels. These findings have implications for understanding the legitimacy, governance and accountability of healthcare organisations, the distribution and use power within them, and system-wide policy interventions, for instance to improve care coordination and for the correspondingly required foci of healthcare organisational research.

Details

Journal of Health Organization and Management, vol. 33 no. 7/8
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 27 December 2021

Gabrielle Samuel and Federica Lucivero

In April 2020, it was announced that NHSX, a unit of the UK National Health Service (NHS) responsible for digital innovation, was developing a contact tracing app that would offer…

1184

Abstract

Purpose

In April 2020, it was announced that NHSX, a unit of the UK National Health Service (NHS) responsible for digital innovation, was developing a contact tracing app that would offer a digital solution to managing the COVID-19 pandemic. Despite the urgency with which the app was developed, a clear commitment was made to designing the technology in a way that enshrined key ethical principles, and an ethics advisory board (EAB) was established to provide timely advice, guidance and recommendations on associated ethical issues. Alongside this, there were extensive criticisms of how NHSX adhered to ethical principles in the handling of the app development-criticisms that require empirical exploration. This paper explores how ethics was incorporated into decision-making during governance processes associated with the development of app.

Design/methodology/approach

Interviews were conducted with those involved in the app's development/governance, those with a consulting role associated with the app, or those who sat on the EAB.

Findings

The EAB fulfilled an important role by introducing ethical considerations to app developers. Though at times, it was difficult to accommodate key ethics principles into governance processes, which sometimes suffered from little accountability.

Originality/value

While several articles have provided overviews of ethical issues, or explored public perceptions towards contact tracing apps, to the best the authors, knowledge this is the first empirical piece analysing ethics governance issues via stakeholder interviews.

Details

International Journal of Health Governance, vol. 27 no. 2
Type: Research Article
ISSN: 2059-4631

Keywords

Open Access
Article
Publication date: 7 April 2020

Purwoko Aji Prabowo, Bambang Supriyono, Irwan Noor and M. Khairul Muluk

The purpose of this study is to evaluate the Special Autonomy policy to improve the community welfare of Papua Province.

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Abstract

Purpose

The purpose of this study is to evaluate the Special Autonomy policy to improve the community welfare of Papua Province.

Design/methodology/approach

This study was carried out using a qualitative approach assessing program activities and client satisfaction. It focused on program activity, target and implementation effectively and efficiently, involving the client’s evaluation process. Research data was obtained from the Papua Regional Development Planning Agency and separated into primary and secondary sources. Primary data was obtained through observation, interview and documentation from several informants. The informants were determined based on the role and involvement in the Papua Province Special Autonomy. Secondary data sources were obtained through field studies, scientific journals, previous research, written documents from relevant agencies, internet and electronic and print media.

Findings

This study exhibits characteristics of Papua Province Special Autonomy, which are identical to an asymmetric decentralization model, although it took 20 years of implementation because of the lack of evaluation and improvement. It disproves Katorobo’s (2004) theory that the said asymmetric decentralization model is more effective than symmetrical decentralization. Material requirement planning (MRP) empowerment or abolition should be considered important because of the lack of positive results. Otsus needs to improve the system and financial management, considering financial distribution for developed regions in the coastal areas and plains rather than mountainous regions.

Originality/value

This research was conducted because of the phenomenon of Papua Province Special Autonomy, also driven by the problems in the implementation of Special Autonomy Policy for Papua Province that had not borne optimum results. This study aimed to make recommendations for the Special Autonomy policy of the Papua Province to improve community welfare.

Details

International Journal of Excellence in Government, vol. 2 no. 1
Type: Research Article
ISSN: 2516-4384

Keywords

1 – 10 of over 1000