Writing A Research Framework For An Evaluation Of The Effectiveness Of Sustainable Tourism Policy Implementation In Cambodia: A Case Of Angkor World Heritage Area

This article aims at writing a research framework for exploring sustainable cultural heritage tourism policy implementation at Angkor (World Heritage Area). There are six policy initiatives within Angkor's Tourism Management Plan (2012-2020) to guide sustainability of tourism development. The year 2020 was the end of implementing these policy initiatives, but there were not any documents reporting the effectiveness and success of their implementations; therefore, this study will show the framework for investigating the implementation of policy initiatives within this timeframe. There are three main objectives in this framework. First, it is necessary to identify the outcomes of policy implementation judged by stakeholders. Second, it is important to outline and understand the barriers that hinder the successful implementation of the policy. Third, there is a need to create a framework for how to successfully implement sustainable tourism policies in the development of more sustainable tourism in the future.

Challenges faced by frontline health managers during the implementation of COVID-19 related policies in India: A qualitative analysis

Background & objectives: The COVID-19 pandemic exposed the strengths and weaknesses of the healthcare systems across the world. Many directives, guidelines and policies for pandemic control were laid down centrally for its implementation; however, its translation at the periphery needs to be analyzed for future planning and implementation of public health activities. Hence, the objectives of this study were to identify the challenges faced by frontline health managers in selected States in India during the pandemic with regard to implementation of the COVID-19-related policies at the district level and also to assess the challenges faced by the them in adapting the centrally laid down COVID-19 guidelines as per the local needs of the district. Methods: A qualitative study using the grounded theory approach was conducted among frontline district-level managers from eight different States belonging to the north, south, east and west zones of India. The districts across the country were selected based on their vulnerability index, and in-depth interviews were conducted among the frontline managers to assess the challenges faced by them in carrying out COVID-19 related activities. Recorded data were transcribed verbatim, manually coded and thematically analyzed. Results: Challenges faced in implementing quarantine rules were numerous, and it was also compounded by stigma attached with the disease. The need for adapting the guidelines as per local considerations, inclusion of components of financial management at local level, management of tribal and vulnerable populations and migrants in COVID context were strongly suggested. The need to increase human resource in general and specifically data managers and operators was quoted as definite requirement. Interpretation & conclusions: The COVID-19 guidelines provided by the Centre were found to be useful at district levels. However, there was a need to make some operational and administrative modifications in order to implement these guidelines locally and to ensure their acceptability.

An assessment on the implementation of same day antiretroviral therapy initiation in eThekwini clinics, KwaZulu­Natal, South Africa

The World Health Organization (WHO) recom mends same day initiation (SDI) of antiretroviral therapy (ART) for all individuals diagnosed with HIV irrespective of CD4+ count or clinical stage. Implementation of program is still far from reaching its goals. This study assessed the level of implementation of same day ART initiation. A longitudinal study was conducted at four primary healthcare clinics in eThekwini municipality KwaZulu Natal. Data was collected between June 2020 to October 2020 using a data extraction form. Data on individuals tested HIV positive, number of SDI of ART; and clinicians working on UTT program were compiled from clinic registers, and Three Interlinked Electronic Registers.Net (TIER.Net). Non governmental organisations (NGO) supporting the facility and services information was collected. Among the 403 individuals who tested HIV positive, 279 (69.2%) were initiated on ART on the same day of HIV diagnosis from the four facilities. There was a significant association between health facility and number of HIV positive individuals initiated on SDI (chi square=10.59; P value=0.008). There was a significant association between facilities with support from all NGOs and ART SDI (chi square=10.18; P value=0.015. There was a significant association between staff provision in a facility and SDI (chi square=7.51; P value=0.006). Urban areas clinics were more likely to have high uptake of SDI compared to rural clinics (chi square=11,29; P value=0.003). Implementation of the Universal Test and Treat program varies by facility indi cating the need for the government to monitor and standardize implementation of the policy if the program is to yield success.

Primary Health Care Implementation in Asia: A systematic review

Background@#Primary health care (PHC) is a central feature of the UHC. Across Asia, health system planners seeking to strengthen PHC systems may be hindered by several factors, including lack of knowledge of what works in the setting. Pressures placed on health care systems of Asian nations caused by epidemiological changes, including COVID-19 pandemic, and other health issues, are amplified by the demands of population seeking for high-quality care.@*Objective@#To determine the implementation of primary health care across the Asian region @*Methods@#This review utilized 9 online databases, based on the Preferred Reporting Items for Systematic Review Guidelines. Inclusion criteria were studies evaluating the policy implementation of PHC in Asia, published from 2002-2022, accessible online in full-text, English or translation, published in peer-reviewed journals. Three reviewers independently evaluated the abstracts, extracted the data, and assessed the quality of the included studies based on the Critical Appraisal Skills Programme checklist. Descriptive synthesis was undertaken to summarize and report the study findings. @*Results@#Sixteen studies met the inclusion criteria out of 815 search results. Four indicators were included: governance, financing, health workforce, and medicines and other health products showed both positive and negative results. However, recurring challenges are still prevalent in the implementation of PHC, especially in health service delivery. Enabling factors for effective implementation of PHC were community behavioral change, committed political will, increased health coverage and free access, health workforce performance and evaluation among others. Barriers included were economic shocks, corruption, preventive health inequalities and inequities, resource misallocation, and health insurance status among others. @*Conclusion@#Much has already been done in PHC implementation within Asia. However, greater efforts are still needed to implement PHC efficiently in the areas of governance, financing, health workforce, and medicines and other health products. Enablers should be modeled, while barriers should be overcome.

Efeito de mudanças no contexto de implementação de uma política multinível: análise do caso da Reforma do Ensino Médio no Brasil / Efecto de los cambios en el contexto de implementación de una política multinivel: Análisis del caso de la Reforma de la Educación Media en Brasil / Effects of changes in a multi-level implementation context: analysis of the Brazilian High School Reform

Resumo O artigo busca compreender como mudanças exógenas são afetadas pelos contextos de implementação que encontram em cada local. A partir da análise da Lei 13.415/2017, que reforma o Ensino Médio no Brasil, verifica como as mudanças federais trazidas por esta política provocaram alterações nos estados e qual a variação que os contextos locais geraram na própria reforma. O artigo se baseia em uma pesquisa qualitativa que acompanhou os efeitos da publicação da Lei e o início do processo de implementação da reforma nos 26 estados e Distrito Federal ao longo de dois anos. O caso empírico foi analisado a partir das variáveis de conflito e ambiguidade que caracterizam os contextos de implementação. Estes achados contribuem para a literatura de implementação de políticas públicas, de reformas e mudanças na administração pública e de políticas de educação.

Resumen El artículo busca comprender cómo cambios exógenos son impactados por contextos de implementación establecidos en cada lugar. A partir del análisis de la Ley 13.415/2017, que reforma la Educación Media en Brasil, verifica cómo los cambios federales de esta política provocaron alteraciones en los estados y cómo los contextos locales generaron cambios también a la propia reforma. El artículo se basa en una investigación cualitativa que hizo seguimiento a los efectos de la publicación de la Ley y al inicio del proceso de implementación de la reforma en los 26 estados y el Distrito Federal a lo largo de dos años. El caso empírico fue analizado a partir de las variables de conflicto y ambigüedad que caracterizan los contextos de implementación. El artículo contribuye con la literatura de implementación de políticas públicas, de reformas a la administración pública y de políticas de educación.

Abstract The article seeks to understand how exogenous changes are impacted by implementation contexts established in each place. Based on the analysis of Law 13.415/2017, which reforms High School in Brazil, it verifies how the federal changes proposed by this policy caused alterations in the states and how the local contexts also generated changes in the reform itself. The article is based on a qualitative investigation that monitored the effects of the publication of the Law and the beginning of the process of implementing the reform in the 26 states and the Federal District over two years. The empirical case was analyzed based on the variables of conflict and ambiguity that characterize the contexts of implementation. The article contributes to the literature on the implementation of public policies, reforms in public administration, and education policies.

Desafios do multiprofissionalismo para a redução de danos em Centros de Atenção Psicossocial Álcool e outras Drogas / Multi-professionalism related challenges in the implementation of harm reduction strategies at the Center for Psychosocial Attention to Users of Alcohol and Other Drugs

Resumo O artigo aborda a implementação da estratégia de Redução de Danos (RD) por equipes multiprofissionais nos Centros de Atenção Psicossocial Álcool e outras Drogas (Caps AD) do Distrito Federal. A partir dos aportes teóricos dos estudos sobre implementação de políticas públicas e da sociologia das profissões, buscou-se refletir sobre as implicações do multiprofissionalismo para a tradução da RD em ações práticas junto aos usuários dos serviços. Realizou-se pesquisa de campo nas sete unidades de Caps AD do Distrito Federal, onde as atividades cotidianas foram observadas e profissionais foram entrevistados. A análise revelou que: (1) há variação substantiva na forma como os profissionais atuantes nos Caps AD interpretam e praticam a RD; (2) suas diferentes formas de entendimento e ação associam-se à formação profissional em distintos campos de conhecimento (psicossocial versus biomédico); e (3) estas divergências podem resultar em conflitos entre profissionais e implicar consequências negativas para os usuários dos serviços. Discute-se, também, os meios encontrados pelas gerências para a gestão e mitigação destas implicações. Os achados contribuem para reflexões mais amplas sobre os desafios que se impõem à sustentabilidade do modelo de atenção proposto para os Caps AD.

Abstract The article focuses on the implementation of the Harm Reduction strategy by multiprofessional teams in the Centers for Psychosocial Attention to Users of Alcohol and other Drugs (CAPS AD) at the Brazilian Federal District. Based on theoretical propositions from the fields of policy implementation and sociology of professions, it sought to reflect upon the implications of different professional perspectives about the concept of Harm Reduction, and its translation into practice, for the aims of the Ministry of Health Care Policy for Alcohol and Other Drugs Users and its beneficiaries. Our study is supported by empirical research involving qualitative fieldwork on the seven units of CAPS AD in the Federal District. Our findings suggest that: (1) there is substantive variation in the way CAPS AD professionals interpret and practice harm reduction principles; (2) this variation is associated with professional education in distinct fields of knowledge (psychosocial versus biomedical); and (3) divergences among professionals may result in conflicts and produce negative consequences for service users. We also discuss the means by which service managers seek to mitigate those negative implications. These findings contribute to broader reflections on the challenges for sustainability of the Caps AD model.

Analysis of key issues and implementation strategies for grid management policy of the medical alliances / 中华医院管理杂志

Objective:To analyze the grid management strategy of medical alliances in Rizhao city, Shandong province, and to provide references for improvement of this policy.Methods:In August 2020, semi-structured interviews were conducted with 31 managers of three medical alliances in Rizhao city, regarding the objectives, specific measures, problems and influencing factors of the grid layout of the medical alliances. The grounded theory was used to sort out the interview data, along with the Mazmanian-Sabatier model for further analysis.Results:The analysis resulted in 8 main categories and 19 sub-categories, including theoretical and technical support, target group characteristics, policy causality theory, current status of policy directives, inter-agency relations, socioeconomic conditions and technology, public attitudes, and media campaigns. On this basis, a theoretical framework for the implementation of the grid layout of medical alliance was formed based on the Mazmanian-Sabatier model.Conclusions:The socio-economic conditions and technologies for implementing the grid-based management of medical alliances in Rizhao city were relatively mature, enjoying strong public support and good social response. But on the other hand, there were still such problems as unclear policies, imperfect mechanisms for synergy of interests among different subjects, and incomplete supporting policies. In the future, it is expected to form a policy implementation synergy, introduce supporting policies and strengthen primary teams building, in order to ensure the orderly promotion and long-term implementation of the policy.

Study on the problems in implementing the appointment registration system at public hospitals based on the Smith-Model / 中华医院管理杂志

Objective:To analyze problems found in the implementation of the appointment registration system at public hospitals in China under the new situation, and provide a reference for the improvement and development of the system.Methods:Documents on appointment registration system published before December 31, 2020 were collected through the databases of CNKI, Wanfang, VIP and other official websites such as the National Health Commission. The Smith-Model was used as the main analysis framework in a systematical sorting and analysis of the implementation of the appointment registration system of public hospitals, in such means as qualitative interviews with relevant managers, doctors and residents and PEST analysis method.Results:The appointment registration system of public hospitals was highly idealized in its design, but there existed policy deficiencies in system standards, implementation effectiveness and supporting systems; and there were various problems in policy cognition, acceptance and implementation with its implementation agencies and target groups. Environmental factors such as politics, laws, economy, social culture and technology also posed negative effects on the implementation of policies.Conclusions:There were still some problems in the implementation of the appointment registration system in public hospitals, such as imperfect system standards, different implementation efforts in different regions, imperfect incentive and economic compensation mechanisms, and it was difficult to change residents' traditional ideas.Targeted strategies and measures should be taken regarding the policy makers, health administrative departments, business institutions, patients and environmental factors to ensure the continuous and effective implementation of the system in the future.

A implementação do Auxílio Emergencial como medida excepcional de proteção social / La implementación de la Ayuda de Emergencia como medida excepcional de protección social / The Implementation of Emergency Aid as an exceptional measure of social protection

Resumo O Auxílio Emergencial, instituído pela Lei nº 13.982, de 2020, é uma das maiores iniciativas do Governo Federal para minimizar os efeitos econômicos da pandemia do coronavírus (COVID-19) para a parte mais vulnerável da população, entres eles os beneficiários do Programa Bolsa Família (PBF) e os inscritos no Cadastro Único para Programas Sociais do Governo Federal (CadÚnico), cidadãos que já tinham algum tipo de relacionamento com políticas de assistência social. Além desses, o benefício abrange também trabalhadores informais, autônomos e microempreendedores individuais (MEI). Com base na análise documental e por meio de observação direta, este estudo buscou delinear o processo de implementação do Auxílio Emergencial, no âmbito do arranjo estabelecido pelo Ministério da Cidadania (MC), através da abordagem da burocracia de nível de sistema.

Resumen La Ayuda de Emergencia, instituida por la Ley n. 13.982, de 2020, es una de las mayores iniciativas del Gobierno Federal Brasileño para minimizar los efectos económicos de la pandemia de coronavirus (COVID-19) para la parte más vulnerables de la población, entre ellas, los beneficiarios del "Programa Bolsa Família" (PBF) y aquellos inscritos en el Registro Único para Programas Sociales del Gobierno Federal" (CadÚnico), ciudadanos que ya tenían algún tipo de relación con las políticas de asistencia social. Además de estos, el beneficio también abarca a trabajadores informales, autónomos e microempresarios individuales (MEI). Basado en el análisis documental y a través de la observación directa, este estudio buscó esbozar el proceso de implementación de la Ayuda de Emergencia, en el marco establecido por el Ministerio de Ciudadanía (MC), a través del enfoque de burocracia a nivel de sistema.

Abstract Emergency Aid, instituted by Law 13982, of 2020, is one of the biggest initiatives of the Brazilin Federal Government to minimize the economic effects of the COVID-19 pandemic. This aid is directed at the most vulnerable population, among them, the beneficiaries of the conditional cash transfer program "Bolsa Família" (PBF) and those enrolled in the single registry for social protection "Cadastro Único para Programas Sociais do Governo Federal" (CadÚnico). The benefit also covers informal employees, self-employed and individual microentrepreneurs (MEI). Based on documentary analysis and through direct observation, this study sought to outline the process of implementing emergency aid measures, within the framework established by the Ministry of Citizenship (MC), through the system-level bureaucracy approach.

O burocrata de médio escalão na implementação de políticas públicas / El burócrata de nivel medio en la implementación de políticas públicas / Mid-level bureaucrats perception on the implementation of public policies

Resumo Este artigo busca contribuir com os estudos sobre as percepções de Burocratas de Médio Escalão (BMEs) na implementação de uma política pública. Para tanto, analisam-se empiricamente as percepções dos BMEs na implementação do Programa de Apoio a Planos de Reestruturação e Expansão das Universidades Federais (Reuni) no âmbito da Universidade Federal de Goiás (UFG). Realizou-se um estudo de caso, mediante pesquisa documental e entrevistas com esses burocratas. Os resultados demonstram a importância de que o BME tenha apoio institucional e preparação técnica e emocional para realizar um bom trabalho. Em termos empíricos, demonstra-se que a UFG não conseguiu atender às metas globais do Reuni, porém, cumpriu a maioria das diretrizes estipuladas pelo Ministério da Educação (MEC) em decreto, com destaque para a ampliação de políticas de inclusão e assistência estudantil, transformando uma universidade "elitizada" em uma universidade "igualitária". De modo unânime, os BMEs reconhecem a grande importância do Reuni na UFG, em termos estruturais e de ensino, e que sua atuação poderia ter sido mais bem desempenhada com suporte e preparação adequados.

Resumen Este artículo se propone contribuir a los estudios sobre las percepciones de los burócratas de nivel medio (BME) en la implementación de políticas públicas. Para ello, se analizan empíricamente las percepciones de los BME en la implementación del Programa de Apoyo a Planes de Reestructuración y Expansión de las Universidades Federales (REUNI) en el ámbito de la Universidad Federal de Goiás (UFG). Se realizó un estudio de caso, con investigación documental y entrevistas con estos burócratas. Los resultados demuestran la importancia de que los BME tengan apoyo institucional, preparación técnica y emocional para hacer un buen trabajo. En términos empíricos, se demuestra que la UFG no logró cumplir los objetivos globales del REUNI, no obstante, cumplió con la mayoría de las directrices estipuladas por el Ministerio de Educación, con énfasis en expandir las políticas de inclusión y asistencia estudiantil, transformando una universidad de "elite" en una universidad "igualitaria". Por unanimidad, los BME reconocen la gran importancia del REUNI en la UFG en términos estructurales y educativos y que su desempeño podría haber sido mejor con el apoyo y la preparación adecuados.

Abstract This article contributes to studies about the perceptions of mid-level bureaucrats on the implementation of public policies. The article empirically analyzes the perceptions of mid-level bureaucrats (MLB) on the implementation of REUNI within the Federal University of Goiás (UFG). A case study was conducted, with documentary research and interviews with MLB. The results demonstrate the importance of institutional support and technical and emotional preparation for MLB to perform appropriately. In empirical terms, the study demonstrates that UFG failed to meet the program's global goals, but has met most of the guidelines set forth by the Ministry of Education, with emphasis on expanding student inclusion and assistance policies, transforming a university that served the elite into an inclusive institution. Unanimously, all MLBs recognize the great importance of REUNI for the UFG in structural and educational terms and that their activities could have been better performed with adequate support and preparation.

Serviços Farmacêuticos na Atenção Primária em Saúde à luz do modelo ambiguidade-conflito / Pharmaceutical Services in Primary Health Care in light on the ambiguity-conflict model

Resumo Este artigo tem por objetivo analisar os níveis de ambiguidade e conflito em relação aos objetivos e meios necessários à implementação dos Serviços Farmacêuticos (SeFar) no âmbito da Atenção Primária à Saúde no município do Rio de Janeiro. Os dados foram coletados por meio de entrevistas-semiestruturadas com 14 atores-chave, realizadas em 2018. Os resultados foram interpretados com base na análise temática de conteúdo e à luz do modelo ambiguidade-conflito de análise de implementação. Quanto aos objetivos dos SeFar, houve alto consenso intracategorias, porém baixo intercategorias. Quanto aos meios, foram identificadas divergências importantes intercategorias e consenso quanto a aspectos relevantes como a insuficiência de recursos financeiros e humanos. Os conflitos identificados resultam especialmente da falta de clareza de outros atores mais afastados do nível local ou de outras categorias profissionais, sobre o papel dos SeFar. Assim, considera-se que houve predomínio de características de "implementação experimental", apresentando alta ambiguidade quanto aos objetivos e meios dos SeFar num ambiente de médio conflito e fortemente dependente dos recursos disponíveis no nível local. Também apresentou alguns atributos de "implementação política", uma vez que em determinadas circunstâncias os resultados sofreram influência do contexto político, condicionados por conflitos em relação aos meios para a consecução dos SeFar.

Abstract This article aims to analyze the levels of ambiguity and conflict regarding the objectives and means required for the Pharmaceutical Services (PharmSer) implementation within the Primary Health Care in the city of Rio de Janeiro. Data were collected through semi-structured interviews applied in 2018 with 14 key actors. The results were interpreted based on thematic content analysis and in the light of the ambiguity-conflict model of implementation analysis. Related to the PharmSer aims, we found high consensus intra key actors categories and low inter categories. Related to the means, we found important inter-categories divergences and consensus regarding relevant aspects as insufficient financial and human resources. The conflicts identified result mainly from low clarity of other actors more distant from the local level or other professionals, about role of PharmSer. We conclude for the predominance of "experimental implementation" characteristics, with high ambiguity regarding the objectives and means of the PharmSer, in a medium conflict environment and being strongly dependent on the resources available at the local level. It also presented some attributes of "political implementation", since in certain circumstances the results were influenced by the political context, conditioned by conflicts over the means for achieving the PharmSer.

Study on the implementation difficulties and countermeasures of the hierarchical medical system based on the Meter-horn model / 中华医院管理杂志

Objective To analyze the dilemmas of our hierarchical medical system, in order to seek a viable path for effective implementation.Methods Based on the Meter-horn model, six related factors were used, including policy standards and goals, policy resources, implementation methods, characteristics of the actuator, value orientation of the executive and the system environment, to analyze the dilemmas of the implementation of hierarchical medical system.Results This policy had not achieved the expected effect in the implementation process, which deviated from the original intention of policy designers to some extent. There exist the following setbacks for the roadblocks. For example, policy standard was ambiguous, the policy resources were insufficient, the execution method was not proper, the implementation mechanism was"criticized" , the implementation personnel value orientation was biased and the complex system environment.Conclusions All the factors involved in the implementation of the hierarchical medical policy affect each other.In this consideration, medical institutions at all levels and the relevant departments should coordinate and deal with the relationship between these six related factors, and timely take effective measures to amend and improve the policy, so as to ensure the orderly progress and long-term implementation of the hierarchical medical system.

A implementação do programa de saúde específico para a população em situação de rua - Consultório na rua: barreiras e facilitadores / The implementation of the Brazilian health program for the homeless population - Consultório na Rua: obstacles and advantages

Resumo O objetivo deste trabalho é investigar as razões da baixa adesão à implementação do programa de saúde específico para a população em situação de rua - Consultório na Rua - pela maioria dos municípios elegíveis. A partir da literatura contemporânea de determinantes da implementação de políticas públicas, a pesquisa, de caráter exploratório-descritivo, utiliza análise de conteúdo em documentos oficiais e, sobretudo, entrevistas com gestores federais e a aplicação de questionários aos gestores de municípios em ambas as situações, aderentes e não aderentes ao programa. Sob a ótica do governo federal, os resultados da investigação sugerem que a implementação do programa foi influenciada positivamente pelo alinhamento com uma política pública maior, com mais recursos e priorização governamental, embora as restrições fiscais, a partir de 2015, e as fragilidades do pacto federativo se apresentem como principais barreiras. Do ponto de vista dos gestores locais, as evidências empíricas demonstram percepções diferentes entre os municípios aderentes ao programa e os que não aderiram, porém há convergências quanto a relevância de um contexto favorável, do legado de políticas prévias e de fatores relacionados às competências e capacidades das prefeituras como determinantes à participação no programa Consultório na Rua.

Abstract The paper's main goal is to investigate the determinants of the adherence to a federal health program focused on homeless population - named Consultório na Rua - by eligible municipalities. Grounded on the contemporary literature of determinants of policy implementation, the exploratory and descriptive research employs official documents analysis, interviews with federal managers and a survey with local government managers, from the cities that joined the program and from the cities that didn't. Through the perspective of the federal government, the research results suggest that the implementation of the program was positively influenced by the alignment with a larger public policy, which has more funds and priority from the government, in spite of the fiscal restrictions, since 2015, and the weaknesses of the federative pact. On the other hand, the empirical evidences of the local managers' views demonstrate differences between these two groups of municipalities, however there are convergences towards the fact that favorable context, legacy of prior policies and aspects of competences and capacities of the local governments are determinants to the program adherence.

Implementation of the hierarchical medical system :an analysis based on the Smith policy implementation process model / 中华医院管理杂志

Objective To analyze the problems existing in the implementation of the hierarchical medical system in China under the new situation .Methods The Smith policy implementation process model was used as an analytic framework.By means of literature analysis ,stakeholder analysis and PEST analysis ,the analysis was conducted in terms of such elements as the Smith policy implementation process model ,namely ,the idealized policy ,the implementing organization ,the target group and the environmental factors ,as well as its mechanism of action .Results The literature review found that the main obstacle that hinders the smooth implementation of the hierarchical medical system was the lagging of relevant supporting measures ,which accounted for 16.6％ (161)of the problems.In addition ,defects in policy design(the lack of division and cooperation mechanism etc .)and constraints in existing institutional mechanism (separation of revenue and expenditure ,unclear orientation ,etc .) were suggested to accelerate the introduction of supporting policies ,respectively accounting for 6.0％(58) and 9.3％ (90 ) of the results .Conclusions In the process of policy implementation ,the relationship between the four elements of the ideal policy outcomes ,the implementing organization ,the target group and the environmental factors needs to be coordinated to ensure the effective implementation of the hierarchical medical system .

Investigation and Evaluation on the Implementation Situation of Financial Information Disclosure Policy for Public Hospitals in Pilot Cities / 中国卫生经济

Objective:To investigate and evaluate the status of financial information disclosure in public hospitals.Methods:Taking the method of policy analysis,descriptive statistics,consult the relevant policy and the hospital website of 200 countries for public hospital reform pilot cities,sum up the change trend and implementation status of public hospital financial information disclosure regulation policy from 2006 to 2017.Results:There were obvious differences in public financial information in public hospitals from various regions,only 130 hospitals(65％) disclosed financial information in the website,the goal of "hospitals in comprehensive reform of all urban public hospitals should disclose financial information to the public by the end of 2016" was not fully achieved,the standardization and comparison of financial information was not high.Conclusion:In order to achieve the goal of "opening the financial information disclosure system to all public hospitals and all regions in China by the end of 2018",it suggested to integrate the existing documents,combined with the beneficial practices in pilot cities,unified public hospital financial disclosure guidelines and perfect supporting measures for policy implementation.

Implementação de políticas como processo social: agentes, estruturas, discurso e arenas de poder / Policy implemention as a social process: agents, structures, discourse and arenas of power

Esse artigo de revisão tem como objetivo central identificar osconceitos essenciais para gestores de política pública relacionadosà implementação de políticas. Para o cumprimento do objetivo, ométodo utilizado é o de revisão conceitual de literatura, sendo que aescolha das obras para revisão tem como origem os esforços de sínteseapresentados por Hall e Taylor (1996), Hill e Hupe (2002), Barrett(2004), Saraiva e Ferrarezi (2006) e Bertelli (2012). A questão centralque une todas as obras identificadas é a debatida por Pressman eWildavsky (1973), sobre porque os resultados frequentemente diferemdos objetivos da política pública. Para organizar a revisão das diversasabordagens propostas pelos autores identificados, o artigo se inspira nodebate proposto por Giddens (1979, 1984) sobre Agente (burocracia)e Estrutura (instituições), além de dois elementos ligados ao processode estruturação, Discurso (argumentação) e Arenas de Poder (tipo depolítica). Como resultados, a revisão proposta pelo artigo identifica vintee três conceitos essenciais para os gestores de políticas. A conclusãodo artigo discute a importância do ensino e debate dos conceitos eteorias sobre implementação de políticas para o processo democráticono Brasil, bem como o desafio de construir conhecimento a partir daprática e experiência.

The main objective of the review article is to identify the key conceptsin policy implementation for public policy managers. To reach theobjective, the chosen method is the conceptual literature review. Thesampling process of the academic pieces to be reviewed is limited bythe references presented in Hall and Taylor (1996), Hill and Hupe(2002), Barrett (2004), Saraiva and Ferrarezi (2006), and Bertelli(2012). The main research question that unifies all the academic piecesunder review comes from the seminal study presented by Pressman eWildavsky (1973), about why the policy results frequently differ fromthe objectives. As a guide to organize and filter the various theoretical approaches contained in the texts under review, the article drawsfrom the methodological debate proposed by Giddens (1979, 1984)about Agent (bureaucracy) and Structure (institutions), as well as fromtwo elements closely related to the structuration process, discourse(argumentation) and arenas of power (policy type). As results, thearticle identifies twenty-three core concepts for public policy managers.The final remarks recall the importance of teaching and debating theconcepts and theories of policy implementation to the democraticprocess in Brazil, as well as the challenge of learning from the experienceand practice.

Organizational Analysis on Inefficient Contract-Community Health Service Policy Implementation / 中国卫生经济

Objective:To analyze the causes and countermeasures for the inefficiency of implementing the contract community health service policy.Methods:Based on the authority and regulation of organization,it innovatively used the French organization theory,build an analysis framework of organizational actors adapting to the general organization.On the above basis combined with the characteristics of contract health service,it constructed a new organizational structure of contract health service and analyzed the low efficiency of policy implementation from the three relations among the actors,the power and the rule.Results and Conclusion:It needed to focus on authority and rule to rationally division the authorities of actors,optimize the organizational structure,adjust the benefit relationship of actors;play the regulation role,implement the incentive and constraint mechanism to improve the execution efficiency of contract health service policy.

Why some rural health policies are difficult to be implemented in F counties: A case study of New Rural Cooperative Medical System and the Basic Public Health Policy / 中国卫生政策研究

Rural health policies are difficult to be implemented at the village level in China.From the perspective of health administrative departments and township health centers, this is due to the lack of the basic conditions of rural health policy and the basic ability of the rural health policy.But from the point of view of village doctors, this is because of the lack of personnel, funding and other embarrassing situations, especially due to crisis and risks are taken to the village clinics and village doctors by the township health centers.In fact, the main reason why the health policy is difficult to land at the village level is that the relationship between the township health centers and village clinics have not been rationalized, as can be specifically seen in weak position of village clinics compared with township health centers.The key to rationalize the relationship between the township health centers and village clinics is to strengthen the development capacity of village doctors, at the same time to get rid of the misunderstanding for village doctors in some of the thinking and policy and strengthen the accountability of primary authorities, and finally open up the relationship between the township health centers and village clinics.

Why universities terminated organized vaccination? An analysis using the Smith model of poli-cy implementation process / 中国卫生政策研究

Objective:Using the Smith Model of policy implementation, the paper analyses how an adverse e-vent,the"Si-xian County Vaccine Incident",caused the termination of organized vaccination in universities L city. Methods:Case study, in-depth interviews among 15 key insiders, and 5 focus-group interviews among college students. All interviews transcribed,coded and analyzed. Results:There are no clear policy targets nor specific im-plementation standards for college students' vaccination. The target group (college students) holds a low level of awareness of vaccination. Implementation departments are sensitive to any risks due to the prevalent stability-oriented social environment,and have limited space for action when facing emergencies. Conclusion:In the stability-oriented social environment,the Si-xian County Vaccine Incident amplified the risks and limited the space of vaccination poli-cy implementation. In the absence of policy goals for college student vaccination,it was safer to terminate organized vaccination programs,which had a negative impact on university vaccination. The government should lay out specific policy goals for vaccination,and broaden the possible implementation space,as well as establish mechanisms for at-tenuating the risks of vaccination.

The convention on the rights of persons with disabilities UN: analysis of the implementation in Andalucía (Spain) of article 33 / La convención sobre los derechos de las personas con discapacidad de la ONU: análisis de la aplicación del artículo 33 en Andalucía (España)

The United Nations Convention on the Rights of Persons with Disabilities is a major human rights instrument of the United Nations with the goal of ensuring protection of rights of persons with disabilities. In Article 33, ‘National implementation and monitoring’ establishes, among other things, that States Parties shall implement the Convention and establish or designate a coordination mechanism at government level. This article aims to show the results of implementing Article 33 in Andalucía (Spain) in the context of the European project ‘Planning Inclusive Communities’ led by the University of Siegen (Germany). The methodology used in this study was based on a comparative analysis of data obtained through a series of surveys addressed to local governments in different European regions. This article shows the results obtained in Andalucía region where the Convention is disseminated in various formats, at local levels it shows a low presence, because ratification have neither led to a legal obligation at lower state levels. Local managers showed disregard for the principles of the Convention and its practical application. This lack of information at local level influences the methods that Spanish occupational therapists (OT) use with persons with disabilities in occupational centers (OC).

La Convención de las Naciones Unidas sobre los Derechos de las Personas con discapacidad es un importante instrumento de derechos humanos que tiene como objetivo garantizar la protección de los derechos de las personas con discapacidad. En el artículo 33, ‘Aplicación y seguimiento nacional‘ se establece, entre otras cosas, que los Estados deben aplicar los artículos de la Convención y establecer o designar un mecanismo de coordinación a nivel gubernamental. Este artículo tiene como objetivo mostrar los resultados obtenidos en Andalucía (España) de la aplicación del artículo 33 dentro del proyecto europeo `Planning Inclusive Communities‘ dirigido por la Universidad de Siegen (Alemania). La metodología seguida en este estudio se basó en un análisis comparativo de los datos obtenidos a través de una serie de encuestas dirigidas a gobiernos locales de diferentes regiones europeas. Este artículo muestra los resultados obtenidos en la región de Andalucía, en la cual la Convención se difunde en una gran variedad de formas. A nivel local, la Convención se muestra con una presencia baja debido a que la ratificación no ha conllevado una obligación legal en los niveles administrativos más bajos. Los gerentes locales mostraron un cierto desconocimiento de los principios de la Convención de las Naciones Unidas y su aplicación práctica. Esta falta de información a nivel local influye en los métodos que los terapeutas ocupacionales (TO) españoles utilizan con las personas con discapacidad en los centros ocupacionales (CO).