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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.

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.

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.

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.

The aim of this paper is to contribute to a greater understanding of non-profit organization (NPO) management control systems (MCS) and accountability in organizations providing support service for capacity constrained service users. Specifically, the paper examines the role of MCS and accountability in supporting mission realization in NPOs providing services to people with intellectual disabilities and reflects on this in the context of the COVID-19 pandemic.

The research comprised a case study of four NPOs providing services to people with intellectual disabilities in Ireland conducted prior to the global COVID-19 pandemic. The study probed management's perceptions of stakeholders and examined the manner in which the design and use of MCS and accountability processes supported mission realization.

Service users were regarded as the least powerful stakeholder and consequently the least attended to in terms of MCS and accountability processes. The absence of relational and dialogical accountability with service users is not only central to maintaining this power asymmetry but also poses a threat to mission realization. These deficits can be addressed through the integration and monitoring of internal advocacy activities into MCS and accountability processes, which, on reflection, may also mitigate some of the negative consequences for service users of isolation from external support networks in times of crisis.

This research has opened up an area for enquiry – internal advocacy – heretofore not addressed in the management accounting literature, opening up a novel vein for future research. Such research could further examine the role of internal advocacy, drawing from and adding to the research in other support service domains. A number of objectives and questions might be considered: (1) probing the level of management recognition of the role of direct engagement in advocacy activities in supporting service user agency; (2) identifying with service users and management the nature and attributes of effective advocacy activities and practices; (3) questioning how such advocacy activities and practices might be reflected in MCS; (4) identifying what service user stakeholders regard as effective accountability to them in relation to their needs and objectives; and (5) assessing the impact on service user experience and on NPO mission realization of internal advocacy activities and the monitoring and review thereof through MCS. These suggestions for future research draw attention to aspects of support service delivery that have the potential to be profoundly influential on service outcomes.

A performance management model reflecting the identified need to incorporate internal advocacy mechanisms into organizational management control systems is proposed in an effort to increase accountability of NPOs to their core mission stakeholder – service users. This model may be of value to NPO management as they move from a medical-model of care to a rights-based model for service delivery in care settings.

The paper reflects the importance of listening to the voice of vulnerable service users in NPO care settings and proposes a mechanism for embedding internal advocacy in formal management control systems and accountability processes.

In proposing an “agency” supportive relational and dialogical accountability logic for such organizations, underpinned by “internal advocacy”, this research provides theoretical and practical insights for accountability processes and the design of MCS. The findings contribute empirically, not just to the NPO management and MCS literature but also to understanding the relational interaction of service users with service organizations, and what this means in supporting service user objectives and realization of organizational mission.

This study aims to describe the COVID-19 risk mitigation strategies implemented in California prisons and the impact of these policies on the mental health of incarcerated women.

The authors conducted semi-structured qualitative interviews with ten women who were over the age of 50 and/or had a chronic illness and had been incarcerated in California prisons during the COVID-19 pandemic. The authors also interviewed ten health-care providers working in California jails or prisons during the pandemic. Interviews were analyzed using a grounded theory coding framework and triangulated with fieldnotes from ethnographic observations of medical and legal advocacy efforts during the pandemic.

Participants described being locked in their cells for 23 hours per day or more, often for days, weeks or even months at a time in an effort to reduce the spread of COVID-19. For many participants, these lockdowns and the resulting isolation from loved ones both inside and outside of the prison were detrimental to both their physical and mental health. Participants reported that access to mental health care for those in the general population was limited prior to the pandemic, and that COVID-19 risk mitigation strategies, including the cessation of group programs and shift to cell-front mental health services, created further barriers.

There has been little qualitative research on the mental health effects of the COVID-19 pandemic on incarcerated populations. This paper provides insight into the mental health effects of both the COVID-19 pandemic and COVID-19 risk mitigation strategies for the structurally vulnerable older women incarcerated in California prisons.

Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans.

This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes.

Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships.

Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles.

The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study’s findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care.

Models of Child Health Appraised (MOCHA) was a wide-ranging, multi-disciplinary and multi-method study that aimed to identify the best models of provision of primary care for the children of the European Union. The research has identified two main conclusions: (1) The depth of interdependency of health, economy and society. Primary care needs to be an active partner in public debate about current child health concerns. It should orientate more effectively in addressing wider societal influences on child health through advocacy and collaborative intersectoral public health approaches with those agencies responsible for public and community health if it is to address effectively issues such as childhood obesity, mental health and vaccine hesitancy. As part of this, it needs to address its workforce composition and skills, not least in two-way communication. (2) The European Community has many visions and commitments to children and child health policies, but their effectiveness is largely unfulfilled. The Commission can strengthen its impact on children’s health and healthcare services within current remits and resources by focusing on a number of key fields: planned and structured research, providing insight into optimal human resources and skills in child primary care, developing and using ethical means of listening to children’s views, remedying the invisibility of children in data, measuring the quality of primary care from a child-centric perspective, understanding the economics of investing in children’s health, developing e-health standards and evaluation, collaborative and harmonised use of downloaded research databases, understanding and respecting children’s rights and equity, and appreciating and allowing for children’s evolving autonomy as they grow up. An optimal model of primary care for children is proactive, inclusive, corporately linked, based on and providing robust evidence, and respects the wider determinants of health and children’s involvement in their health trajectory.

This study explored Croatian nursing students' knowledge and attitudes regarding brominated flame retardants (BFRs) as indicators of their predisposition to educate future patients. The purpose of the study was to identify knowledge gaps and barriers and to propose possible remedies.

The cross-sectional survey was conducted on a convenience sample of 114 nursing students at undergraduate and graduate levels from three Croatian universities during the winter semester in the academic year 2018–2019. Descriptive and inferential statistical  analyses were performed using STATISTICA 13 software.

Slightly over half of the students (58.49%) were knowledgeable of BFR health effects and 45.28% showed knowledge about its presence in the environment. Only 33.02% of students identified prenatal exposure effects and 24.53% answered correctly about legislative actions. Participants expressed modest interest in the topic (M = 3.15, SD = 1.35). Although informing the public on the health consequences of BFRs was important to them (M = 4.18, SD = 1.03), they did not perceive health-care providers as primarily responsible for communicating that information.

There is a need to enhance related content in the curriculum to improve students' knowledge. Raising students' awareness regarding the role of nurses in clinical and policy arenas is proposed to facilitate active participation in improving environmental health.

The menstrual health and menstrual hygiene management (MHM) of incarcerated women remains relatively low on the agenda of public health interventions globally, widening the inequitable access of incarcerated women to safe and readily available menstrual health products (MHP). The COVID-19 pandemic has adversely impacted on the MHM gains made in various development sectors in the global North and South, through its amplification of vulnerability for already at-risk populations. This is especially significant to developing countries such as South Africa where the incarcerated female population are an often-forgotten minority.

This viewpoint highlights the ignominious silence of research and policy attention within the South African carceral context in addressing MHM. The ethical and political implications of such silences are unpacked by reviewing international and local literature that confront issues of inequality and equitable access to MHP and MHM resources within incarcerated contexts.

Structural inequalities in various contexts around the world have exacerbated COVID-19 and MHM. Within the prison context in South Africa, women face multiple layers of discrimination and punishment that draw attention to the historical discourses of correctional facilities as a site of surveillance and discipline.

This study acknowledges that while this viewpoint is essential in rising awareness about gaps in literature, it is not empirical in nature.

The authors believe that this viewpoint is essential in raising critical awareness on MHM in carceral facilities in South Africa. The authors hope to use this publication as the theoretical argument to pursue empirical research on MHM within carceral facilities in South Africa. The authors hope that this publication would provide the context for international and local funders, to assist in the empirical research, which aims to roll out sustainable MHP to incarcerated women in South Africa.

The authors believe that this viewpoint is the starting point in accelerating the roll out of sustainable MHP to incarcerated females in South Africa. These are females who are on the periphery of society that are in need of practical interventions. Publishing this viewpoint would provide the team with the credibility to apply for international and national funding to roll out sustainable solutions.

It is hoped that the gaps in literature and nodes for social and human rights activism highlighted within this viewpoint establish the need for further participatory research, human rights advocacy and informed civic engagement to ensure the voices of these women and their basic human rights are upheld.

This case study aims to explore the efforts of a small start-up company, whose unique solutions are being deployed in the fight against COVID-19, with encouraging results. Using innovative technology and local volunteer networks, they have set out to identify the medical needs of local care providers, while reducing the effects of fraud, corruption and mis-management.

This case study involved the interrogation of data made available by the company and an interview with the chief executive officer.

The research suggests that small enterprises can have a positive impact, far beyond what either the state or the market might assume. By properly equipping and empowering people at the grassroots level, they can identify and solve local resourcing issues and root-out fraud, corruption and mismanagement before they happen.

This is a unique approach to the problem of resource management in the non-profit sector, with implications for grant projects beyond the COVID-19 pandemic.

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”.

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.

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.

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.

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.

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

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.