Identifying and costing common gaps in Central and West Africa pharmaceutical regulation.

Background: Regulatory systems strengthening is crucial for catalyzing access to safe and effective medical products and health technologies (MPHT) for all. Identifying and addressing common regulatory gaps through regional approaches could be instrumental for the newly incepted African Medicine Agency. Aims: This original study sheds light on common gaps among 10 national regulatory authorities (NRAs) and ways to address them regionally. Objectives: The study used NRA self-assessment outcomes to identify common gaps in four critical regulatory pillars and estimate the cost of addressing them from regional perspectives that aimed at raising the maturity level of regulatory institutions. Methods: A cross-sectional study, using the WHO Global Benchmarking Tool (GBT), was conducted between 2020 and 2021 with five NRAs from ECCAS and ECOWAS member states that use French and Spanish as lingua franca. Results: The 10 NRAs operated in a non-formal-to-reactive approach (ML1-2), which hinders their ability to ensure the quality of MPHT and respond appropriately to public health emergencies. Common gaps were identified in four critical regulatory pillars-good regulatory practices, preparedness for public health emergencies, quality management systems, and substandard and falsified medical products-with overall cost to address gaps estimated at US$3.3 million. Contribution: We elaborated a reproducible method to strengthen regulatory systems at a regional level to improve equitable access to assured-quality MPHT. Our bottom-up approach could be utilized by RECs to address common gaps through common efforts.

"We talk teeth": Exploring faculty EDIA (equity, diversity, inclusivity, and access) capacity in dental education.

PURPOSE: There are increasing concerns regarding inequitable educational access and experiences for underrepresented populations in health education, prompting dental faculties to recognize EDIA (equity, diversity, inclusivity, and access) capacity as a strategic priority. Faculty members contribute to the establishment and reinforcement of institutionally engrained norms within learning settings with significant influence on the experience of students. Currently, there is limited literature on faculty EDIA capacity within dental education and minimal evidence to inform barriers to development. This study sought to explore how dental faculty members perceive their personal and institutional EDIA capacity and to identify current strengths and weaknesses of EDIA development within the institution of study and dental education. METHODS: Using a hermeneutic study design, semi-structured interviews were conducted on a convenience sampling of dental faculty members (n = 10) and a thematic, interpretative analysis was applied. RESULTS: Findings revealed six dominant themes impacting EDIA capacity. Knowledge of EDIA language, interfaculty communication, and institutional messaging are identified as weaknesses, whereas informal, community building events for EDIA development are identified as novel strengths meriting prioritization. Motivation to engage in EDIA by faculty members overall is illuminated in relation to emotionally provocative experiences. CONCLUSION: Current institutional communication of EDIA is unconsciously restricting capacity building based on hierarchical and prescribed parameters. Developing capacity in dental education requires a redirection of resources to initiatives valuing social bonding over prescribed box-checking. This study reveals a new narrative of EDIA capacity within dental education and sustainable pathways for development with high transferability to other health programs.

Impact of multiple performance feedback and regional institutional development on enterprises' exploratory innovation.

With the increasing uncertainty in the external environment, exploratory innovation has gradually become the key path for enterprises to obtain core competitiveness and achieve sustainable growth. According to the behavioral theory of the firm, performance feedback is an essential driving factor affecting corporate innovation decisions. However, previous studies have ignored the consistency or inconsistency between historical and industry performance feedback, and its impact on exploratory innovation. Based on the data of Chinese companies listed from 2008 to 2019, this paper explores the impact of consistency and inconsistency between historical and industry performance feedback on enterprises' exploratory innovation. In the cases of consistency, this study finds that the scenario of historical performance shortfall-industry performance shortfall is more likely to promote enterprises' exploratory innovation than the industry performance surplus-historical performance surplus; in the cases of inconsistency, compared with historical performance surplus-industry performance shortfall, the scenario of historical performance shortfall-industry performance surplus is more likely to promote enterprises' exploratory innovation. Further research shows that regional institutional development enhances these relationships. This study enriches the driving factors of enterprises' exploratory innovation from the perspective of multiple performance feedback, which can provide decision-making references for enterprises' exploratory innovation strategies.

Institutional development and the government response to COVID-19 in China.

As COVID-19 is pervasive across the globe, governments in different countries face the dilemma of restricting the transmission risk of the virus by social distancing while yet maintaining economic activity. Inadequate social distancing policies lead to more infection cases and deaths, while over stringent social distancing policies have significant economic cost implications. This study investigates the role of local government institutions in striking the balance between saving lives and economic recovery. We based our study on a sample of 28 provincial governments in China during the early outbreak of 2020 when the emergency responses of local governments were synchronous. The findings show that local governments in those provinces with lower degrees of marketization, which were accustomed to directly intervene in the social system, mandatorily quarantined many more close contacts for each confirmed case than those in the more market-oriented provinces whose social distancing policies took economic considerations into account. The 'overdone' (over stringent) social distancing policies in the more state-oriented provinces led to lower human mobility and economic growth. This study highlights the importance of taking economic considerations into account when adopting policies and strategies to combat the spread of COVID-19 and how different institution management cultures lead to different outcomes.

Features of the Medium Term Outlook for the Production of Structural Materials in Russia.

The article deals with the problems of decision-making on the development of a complex of structural materials. The features of meeting the needs of the economy in materials in the 2000s are shown. Particular attention is paid to changes in the global market and the specifics of processes in the Russian economy. It is noted that the transition to assessing the prospects of companies engaged in the production of structural materials, based on the dynamics of invested funds, business assets, makes it possible to resolve conflicts of market participants regarding income, eliminate differences in the attractiveness of the domestic and foreign economic environment. Directions for improving the tools of state regulation of the processes of sectoral development are proposed.

Advance-CTR: Statewide Infrastructure to Improve Health in Rhode Island through Clinical and Translational Research.

The universities, hospitals, government agencies, and community organizations in Rhode Island (RI) are well-positioned to bridge gaps between basic and clinical science. RI's manageable size, population demographics, and organizational structure present opportunities to test and implement impactful, transformative clinical and translational research. However, the state's resources had not been optimally coordinated to develop a multi-institutional, clinical and translational research infrastructure to improve clinical practice effectiveness and impact health care in RI. The objective of Advance Clinical and Translational Research (Advance-CTR) is to bridge these gaps by creating a statewide hub to coordinate and leverage existing research resources and provide new career development support and funding for academic researchers, particularly junior investigators. Research support offerings are responsive to a wide variety of needs and readily available via a service request form on AdvanceCTR.org, the first of its kind on a statewide level.

Os nós críticos do processo de trabalho na Atenção Primária à Saúde: uma pesquisa-ação / The critical nodes of the work process in Primary Health Care: an action research

Resumo Pesquisa qualitativa com abordagem da pesquisa-ação cujo objetivo foi identificar os nós críticos inscritos no processo de trabalho da Atenção Primária à Saúde (APS). Participaram 44 profissionais/gestores da APS de um município do interior de Minas Gerais. A coleta de dados ocorreu de junho a dezembro de 2019, por meio da técnica de observação participante e, posteriormente, de oficinas. Os dados foram analisados a partir da técnica de Análise de Conteúdo de Bardin e sob a perspectiva dos referenciais teóricos de Rudimar Baldissera e Paulo Freire. Na análise, emergiram cinco categorias, que expressaram os nós críticos identificados na observação participante e validados pelos profissionais nas oficinas: ambiência, comunicação, educação permanente, planejamento e identidade profissional. Esta pesquisa sinaliza a importância do diálogo e da reflexão crítica das práticas de saúde como instrumentos de transformação do processo de trabalho em saúde.

Abstract Qualitative research with an action research approach whose objective was to identify the critical nodes enrolled in the Primary Health Care (PHC) work process. Forty-four PHC professionals / managers from a municipality in the interior of Minas Gerais participated. Data collection took place from June to December 2019, using the participant observation technique and later through workshops with the participants. The data were analyzed using Bardin's Content Analysis technique and from the perspective of the theoretical frameworks of Rudimar Baldissera and Paulo Freire. The analysis allowed the emergence of five categories, which expressed the critical nodes identified in the participant observation and validated by the professionals in the workshops: ambience, communication, continuing education, planning and professional identity. This research signals the importance of dialogue as an instrument of transformation within the health work process.

The Effect of Cyberpower on Institutional Development in Norway.

Through analysis of empirical interview data this research undertakes to investigate the ways in which the growing phenomenon of cyberpower - defined as using cyberspace for advantage and influence - is impacting on institutional development in Norway. Exploring this governance challenge through the conceptual framework of complexity, difference and emergence opens space - political or otherwise - for discussion regarding why rapid developments arising from digitalization are transforming the way individuals, organizations, institutions and states behave, relate and make decisions. Cyberpower is creating an uncertain institutional landscape as a dependency vs. vulnerability paradox shapes values, rules and norms. Findings from this thematic analysis of qualitative data reflect this paradox, and suggest that organizations in Norway are in a survival-mode that is blocking collaboration. This occurs as national governance systems, human capacity and cyberpower effects lack synergy making for an uneasy arena where complexity, contestation and emerging challenges frame institutional development. To improve long-term prospects of governing cyberpower effects requires a cross-sectorial conflation of time and human resources. This means consciously taking steps to merge organizational and institutional boundaries through expressive innovative collaborations that foster a shared and holistic agenda. The emerging challenges cyberpower is presenting across multiple domains means further research is recommended to build a richer understanding of the term cyberpower from different perspectives. The investigation recommends investment in building the skills and capacities necessary for the co-creation of new models and strategies for managing the effects of cyberpower.

Elementos regulatorios sobre la marihuana, a consideración para la efectiva protección a la salud de la población / Regulatory elements on marijuana, for the effective population health protection

Resumen: Al hablar del abordaje de salud pública al uso de la marihuana se soslaya la complejidad de la protección a la población a través de intervenciones regulatorias rigurosas. Considerando la experiencia de gobiernos donde ya existen estas prácticas, se introduce la regulación como una función esencial de la salud pública, haciendo explícitos siete propósitos para el control de la marihuana. Se detallan luego los elementos técnicos, de capacidad institucional (incluyendo la capacidad técnica y financiera) y de gobernanza que deben cumplirse para cualquier regulación rigurosa de su uso. Se señala la dificultad de regular sustancias psicoactivas considerando que la capacidad de control de otras actualmente legales se ha traducido en su creciente consumo. Se expone también que no debe minimizarse la necesidad del fortalecimiento institucional y gobernanza de la autoridad regulatoria para la regulación efectiva de la marihuana.

Abstract: When discussing the public health approach to the use of marijuana, the complexity of rigorous regulatory interventions for population protection is omitted. Using the experience of governments where these practices already exist, regulation is introduced as an essential public health function, spelling out seven purposes for controlling marijuana. The technical elements of institutional capacity -including the technical and financial capacity- and of governance that must be covered by any rigorous regulation of its use are detailed below. The difficulty of regulating psychoactive substances is addressed when considering the capacity to control other legal substances manifested with their increased consumption. It is concluded that for an effective regulation of marijuana, the need for strengthening the institutional and governance aspects of the regulatory authority should not be minimized.

Research capacity strengthening for sexual and reproductive health: a case study from Latin America.

An essential, but often overlooked part of health promotion and development support to achieve self-sufficiency in developing countries is the concomitant need to build and strengthen research capacity. This is even more challenging and critical in the area of sexual and reproductive health because of diverse interplay of socio cultural, religious, economic factors in relation to reproductive health.This paper presents the case study of HRP's efforts to build research capacity in Latin America by studying and analyzing the 5-year history of institutional development support to an institution in Paraguay. In reviewing the efforts, we identify the strengths in the approaches used by HRP, the challenges and outcomes of the process and we present recommendations for future efforts to strengthen research capacity to improve sexual and reproductive health. The authors call for greater support from and collaborative efforts of developmental partners and governments to strengthen research capacity in low and middle-income countries to improve sexual and reproductive health.

Exploring Institutional Research Ethics Systems: A Case Study From Uganda.

BACKGROUND: The increasing globalization of research drives a need for greater research ethics capacity in low resource countries. Several programs have attempted to expand research ethics capacity by training individuals, but few have focused on broader research ethics systems and institutions. This study describes and applies an institutional research ethics model to assess the institutional research ethics capacity of Makerere University College of Heath Sciences (MakCHS) in 2011. METHODS: Internal and external stakeholders conducted the assessment of MakCHS using the multidimensional Octagon framework. Five methods were used to collect data on current ethical processes and institutional relationships. RESULTS: MakCHS scored in the mid range on all Octagon domains, with some variation between external and internal assessments. The external Octagon scores suggest that MakCHS's areas of strengths are in identity, structure, relevance, target groups, and working environment; needs are greater in the areas of production, competence, and systems of finance and administration. Discrepancies in external and internal assessment can serve as a useful platform to shape ongoing discussions and strategic efforts. CONCLUSIONS: The assessment identified strengths, opportunities, and challenges for institutional research ethics capacity at MakCHS. We believe this systematic approach was helpful in evaluating research ethics needs and provides a benchmark for institutions to measure progress over time.

Foreign direct investment, institutional development, and environmental externalities: evidence from China.

The question of how foreign direct investment (FDI) affects a host country's natural environment has generated much debate but little consensus. Building on an institution-based theory, this article examines how the institutional development of a host setting affects the degree of FDI-related environmental externalities in China (specifically, industrial sulfur dioxide emissions). With a panel data set of 287 Chinese cities, over the period 2002-2009, this study reveals that FDI in general induces negative environmental externalities. Investments from OECD countries increase sulfur dioxide emissions, whereas FDI from Hong Kong, Macau, and Taiwan shows no significant effect. Institutional development reduces the impacts of FDI across the board. By focusing on the moderating role of institutions, this study sheds new light on the long-debated relationships among FDI, institutions, and the environments of the host countries.

ESTIMATING THE AFFECTS OF ACCREDITATION PROCESS ON HIGHER / Шинэ санаа Шинэ нээлт

BACKGROUND Advantages of Accreditation process are assessing the institution as well as its staffs and teachers, involving them into the organization plan, determining a current level of organization, experiencing all the staffs and developing organization. This thesis was chosen to study how the voluntary audits effect development, quality and efficiency of high educational organization and the individual development. OBJECTIVE Accreditation processes to study that how influence on the institution and individual development METHOD Survey has been conducted by cross- sectional study of analytical study and collected materials through quantitative method. Totally 446 participants were provided by questionnaire sheets and 21 sheets of those were excluded due to incomplete, 407 participants involved. Data processing was implemented by interval evaluation and SWOT. RESULTS There are high prevalence of diabetes, cardiovascular diseases, cancer and mental health problem among the general populations. Majority of these conditions appear with other disability types. 66.5% of the persons with disabilities, who are living under poverty line, have chronic conditions. Number of vehicles increased in urban and rural area, high migration from rural area to urban area, high density in central area. Weak city planning, low light in the street, high number of unemployed people, and alcoholism is increased in the country. But the current collected statistics do not satisfy the basic needs of the country. CONCLUSION Comparison of interval evaluation shows that index of the influences for the institution and individual is 3.5:3.6 and it approved the accreditation influences more for the institutional development. SWOT analyzes show that there are possibilities to achieve more opportunities by using institutional and individual advantages and also strategy should be strengthening advantages by using opportunities. Accreditation process affects more for institutional development.

La gestión del desarrollo, las entidades de ciencia y los sistemas locales de innovación / Development Management, Science Institutions and Local Systems of Innovation

Se presenta un análisis sobre la relación necesaria a lograr entre los elementos: gestión del desarrollo-entidades de ciencia- sistemas locales de innovación, que se realiza en la provincia de Cienfuegos, Cuba (estudio de caso), con el objetivo de elaborar un programa de acción que asegure la articulación entre la gestión del desarrollo, las entidades de ciencia y los sistemas locales de innovación como un proceso de mejora continua, acompañado de un sistema de indicadores que permita evaluar el desempeño de la entidades de ciencia y elevar la efectividad, eficiencia y eficacia del mismo en función del desarrollo local. Se utilizó como método de investigación la consulta a expertos, a partir de cuyos resultados se definen los aspectos a tomar en consideración para dicho programa, en correspondencia con la aptitud que requieren expresar las entidades de ciencia para poder integrar las dimensiones ciencia, tecnología, innovación y medioambiente de forma equilibrada a través de las interfases. La evaluación del programa se realizó a nivel teórico y práctico. Como conclusión fundamental se derivó que la integración de la gestión de la ciencia, la tecnología, la innovación y el medioambiente a través de las entidades de ciencia, en función del desarrollo, articuladas por los sistemas locales de innovación, requiere de una adecuación de sus acciones para asegurar efectividad, eficiencia y eficacia en su desempeño.

An analysis on the necessary relationship among development management, science institutions and local innovation systems was conducted in the province of Cienfuegos, Cuba (Case study), in order to develop an action plan to ensure the coordination of development management, science institutions and local systems of innovation as a continuous improvement process, which is accompanied by a system of indicators to assess the performance of science institutions and to enhance its effectiveness and efficiency in terms of local development. Expert consultation was used as research method. Its results defined the aspects to consider for the plan, in line with the role that science institutions need to play to integrate science, technology, innovation and environment through interfaces in a balanced way. The major conclusion of the study is that the integration of science, technology, innovation and environment management through science institutions, which are interrelated by local innovation systems, requires an adaptation of their actions to ensure effectiveness and efficiency in performance conducive to development. Plan assessment was conducted at theoretical and practical level.

Saúde nas empresas: um modelo gráfico para identificar oportunidades de gestão / Health in enterprises: a graphical model to identify management opportunities

A gestão de saúde nas empresas encontra fatores de resistência às propostas de melhoria e se caracteriza como um problema com vícios. Novas formas de abordar estes vícios podem ser úteis como ferramentas de reflexão estratégica. O presente trabalho parte do pressuposto dedutivo em que “a causa precede a consequência” e desenvolve estrutura gráfica simples em que desenha o fluxo de formação / concentração e dissolução / desconcentração de doentes em uma empresa. Essa abordagem gráfica permite novos olhares sobre essa dinâmica e facilita a identificação de alguns dos vícios existentes. A estrutura gráfica identifica 7 pontos de inflexão, que são apresentados como oportunidades de intervenção para reverter os vícios identificados na análise estratégica.

Health management in companies is facing resistance factors to proposed improvements and is characterized as a problem, as something having defects. New ways of approaching these defects may be useful as tools for strategic thinking.This paper is based on the deductive assumption that “cause precedes consequence” developing a simple graphical structure that draws the flow of formation / concentration and dissolution / deconcentration of sick people in a company. This graphical approach allows new perspectives on this dynamic and facilitates the identification of some existing defects.The graphical structure identifies seven turning points, which are presented as opportunities for intervention to reverse the defects identified in the strategic analysis.

Strengthening institutional and organizational capacity for social health protection of the informal sector in lesser-developed countries: a study of policy barriers and opportunities in Cambodia.

Reaching out to the poor and the informal sector is a major challenge for achieving universal coverage in lesser-developed countries. In Cambodia, extensive coverage by health equity funds for the poor has created the opportunity to consolidate various non-government health financing schemes under the government's proposed social health protection structure. This paper identifies the main policy and operational challenges to strengthening existing arrangements for the poor and the informal sector, and considers policy options to address these barriers. Conducted in conjunction with the Cambodian Ministry of Health in 2011-12, the study reviewed policy documents and collected qualitative data through 18 semi-structured key informant interviews with government, non-government and donor officials. Data were analysed using the Organizational Assessment for Improving and Strengthening Health Financing conceptual framework. We found that a significant shortfall related to institutional, organisational and health financing issues resulted in fragmentation and constrained the implementation of social health protection schemes, including health equity funds, community-based health insurance, vouchers and others. Key documents proposed the establishment of a national structure for the unification of the informal-sector schemes but left unresolved issues related to structure, institutional capacity and the third-party status of the national agency. This study adds to the evidence base on appropriate and effective institutional and organizational arrangements for social health protection in the informal sector in developing countries. Among the key lessons are: the need to expand the fiscal space for health care; a commitment to equity; specific measures to protect the poor; building national capacity for administration of universal coverage; and working within the specific national context.

Institutional design and organizational practice for universal coverage in lesser-developed countries: challenges facing the Lao PDR.

There is now widespread acceptance of the universal coverage approach, presented in the 2010 World Health Report. There are more and more voices for the benefit of creating a single national risk pool. Now, a body of literature is emerging on institutional design and organizational practice for universal coverage, related to management of the three health-financing functions: collection, pooling and purchasing. While all countries can move towards universal coverage, lower-income countries face particular challenges, including scarce resources and limited capacity. Recently, the Lao PDR has been preparing options for moving to a single national health insurance scheme. The aim is to combine four different social health protection schemes into a national health insurance authority (NHIA) with a single national fund- and risk-pool. This paper investigates the main institutional and organizational challenges related to the creation of the NHIA. The paper uses a qualitative approach, drawing on the World Health Organization's institutional and Organizational Assessment for Improving and Strengthening health financing (OASIS) conceptual framework for data analysis. Data were collected from a review of key health financing policy documents and from 17 semi-structured key informant interviews. Policy makers and advisors are confronting issues related to institutional arrangements, funding sources for the authority and government support for subsidies to the demand-side health financing schemes. Compulsory membership is proposed, but the means for covering the informal sector have not been resolved. While unification of existing schemes may be the basis for creating a single risk pool, challenges related to administrative capacity and cross-subsidies remain. The example of Lao PDR illustrates the need to include consideration of national context, the sequencing of reforms and the time-scale appropriate for achieving universal coverage.

Building institutions for health and health systems in contexts of rapid change.

Many Asian countries are in the midst of multiple interconnected social, economic, demographic, technological, institutional and environmental transitions. These changes are having important impacts on health and well-being and on the capacity of health systems to respond to health-related problems. This paper focuses on the creation of institutions to overcome information asymmetry and encourage the provision of safe, effective and affordable health services in this context of complexity and rapid change. It presents a review of literature on different approaches to the analysis of the management of system development and institution-building. There is a general agreement that the outcome of an intervention depends a great deal on the way that a large number of agents respond. Their response is influenced by the institutional arrangements that mediate relationships between health sector actors and also by their understandings and expectations of how other actors will respond. The impact of a policy or specific intervention is difficult to predict and there is a substantial risk of unintended outcomes. This creates the need for an iterative learning approach in which widespread experimentation is encouraged, good and bad experiences are evaluated and policies are formulated on the basis of the lessons learned. This enables actors to learn their roles and responsibilities and the appropriate responses to new incentive structures. The paper concludes with an outline of the information needs of managers of health system change in societies in the midst of rapid development.