Cultural Governance and Resistance in Pacific Asia

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In this chapter, the capability of local governments will be analyzed, by using survey data on Thai local government conducted in Our findings suggest that people's access to local governments plays a significant part in the capability of local governments. To respond to slow economic development, urbanization and other challenges many South East Asian countries have undertaken wide ranging public administration reforms, ranging from the big bang decentralization in Indonesia which started in to the more gradual approach taken by the government of Vietnam.

The objectives have usually been to enhance the effectiveness and efficiency of service provision in order to reduce transaction costs and enhance opportunities for economic growth and respond to the citizens' demand for greater participation in decision making processes.

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This chapter describes specific innovation in the field of governance looking at the role that research-based evidence has played in informing or influencing the policy reforms. The assumption is that while governance reforms are extremely complex, the adoption of an evidence-based approach to pilot and design the reforms can enhance the possibility to design policies and define practices more in line with specific institutional needs and local demands.

Three case studies illustrate these developments: One Stop Services in Indonesia, development planning through participatory rural appraisal in the Philippines, and the case of simplification of administrative procedures in Vietnam. Metropolitan governments in South Asia are facing difficult challenges in meeting citizens' demands for better services. Innovations are being attempted to effectively counter the challenges faced and to prepare to move forward into an uncertain future.

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Innovations have been more successfully implemented and institutionalized in some Indian cities, but slow to come in two Pakistani cities. The experience of Colombo in Sri Lanka has been encouraging from the perspective of innovation initiation and institutionalization. Dhaka's experience in Bangladesh provides a mixed picture as small innovations are initiated from time to time but these have not been institutionalized. The variables critical for the successful introduction and sustenance of innovations in metropolitan governance are: active citizen involvement, dissemination of relevant information to citizens, regular monitoring of the progress of innovations through client participation, transparency in the decision-making process and accountability of the officials concerned to the consumers of service.

The system of public governance through progressive strategic planning lays down the mechanism to deliver services to the people. Though an innovative approach is the prerequisite for evolving an effective dynamic system, it is equally important to follow the fundamental normative patterns inherited in societal conventions. The Indian system of governance is one such example where traditionalism is amalgamated with modernism.

Thus there are certain legacies which form the basic fabric of governance, but at the same time the government has also introduced highly-advanced practices to keep pace with changing circumstances. This chapter presents an analysis of the main developments in order to understand how the Indian system has evolved. Market-State interactions are quite interesting these days in dual preference economies like India, in which both the public and private sectors are equally active.

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The Market expects minimal interference from the State but the question is: does the market require assistance from the State or should the State leave the market alone? In this connection India is an interesting economy to observe new trends in the interrelationship between Market and State, where both are uncomfortable in decisionmaking, especially in the field of privatization. Another equally important question is: in which capacity does the State have its role? Does the responsibility of the State end or start after privatization?

These questions are essential to answer because the Constitution of India places a very high degree of welfare responsibility on the State. This paper traces the unique and innovative responsibility of the state and the market to govern privatization properly. Due to the tremendous growth of information technology, economic globalization and development and the increasing role of the third sector and civil society organizations, the innovation of public governance in developing countries can be considered an important policy issue in meeting the challenges of the 21st century.

This chapter attempts to explain the major innovations in local governance during the various successive regimes in Bangladesh since Two major aspects of democratic local governance and good governance, such as decentralization and people's participation, have been examined in a descriptive and analytical manner.

It has been found that despite many past reforms, decentralization of local governance and people's participation in local development have not taken place due to lack of political and bureaucratic will, the patron-client relationship, massive corruption, institutional incapability and conflicting political culture of the country.

As a result, local governance institutions became a meeting place of the elites rather than of the local people and corruption remained endemic. Guest Access. Register Log in. As a guest user you are not logged in or recognized by your IP address. Series Innovation and the Public Sector.

Mapping REDD in the Asia-Pacific: Governance, marketisation and contention

Description Public governance is one of the most important topics in public administration and political science worldwide. Order hardcopy. Front Matter. Preface Public governance is one of the most important topics in public administration worldwide. Bailey, Pekka Valkama. This article outlines actions for how public hospitals can be reshaped from a health system perspective. First, hospitals should be integrated into the fabric of the local health system; they can lead in this through working in alliances with other healthcare facilities, including primary care and private hospitals.

Policymakers have a role in facilitating this as it contributes to health improvement of the population. Second, investments in system innovation, management improvement and information systems are required and their impact assessed. Such investments can contribute to cost control and efficiency. Public hospital sector investments should be strategic, efficient and should not bias investment in broader determinants of health.

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Third, reorienting health workforce competencies and appropriate skills should be central to hospital sector reforms, from policy to frontline services delivery. Pivotal to achievement of each of these three areas of reform is good governance and leadership. In many Asian and Pacific jurisdictions, the public hospital sector is underdeveloped and not able to meet changing community needs due to insufficient financial and policy support, poor or perverse incentives and workforce challenges.

Forging an agenda for public hospital sector reform is a critical development issue, particularly given rapidly changing demographics towards societal ageing and increasing non-communicable disease with multiple morbidities. In the absence of reform, there is considerable risk that public hospitals and broader health systems within which they are located will fail to meet future healthcare needs of the population. What should be the future role of the public hospital sector in the health systems of Asia and the Pacific and how might policymakers and health professionals work to shape this?

This is because: hospital funding has developed along a trajectory that provides periodic treatment of individual patients with limited links with broader health systems and inadequate responses to community and population health needs; funding incentives are often oriented towards inpatient treatment and concepts of competition rather than collaboration have tended to be central to activities of public hospitals, driving behaviour that is counter to the whole system approaches that future healthcare needs will demand.

With the rapidly changing population and disease profiles of Asia and the Pacific, policymakers, managers and health professionals have an obligation to reshape public hospitals and their role in the health system. As part of the system, public hospitals should work closely with other providers to ensure treatment in the right place, at the right time and by the right provider. Policymakers need to develop and promote effective systems for referral between hospital and primary healthcare to improve patient outcomes and efficiency. This article outlines an agenda for reshaping the public hospital sector, based on three key components: hospitals should be integrated into the fabric of local health systems through an alliance governance model with strong community linkages; they should be leaders on, and strategic investors in, innovation and they have an opportunity to develop and implement new health workforce configurations and influence debates around training and regulation of health professionals.

The article details this agenda, including why the three components are critical, why public hospitals are best placed to provide leadership on them and how committing to implementing the three components can contribute to achieving the triple aim. Introduced in by the Institute for Healthcare Improvement, the triple aim brings together the fundamental issues that many health system leaders around the globe are concerned about.

The essential argument is that, if all three aims are kept in focus, then overall system performance will naturally improve. The focus will tilt towards identifying health determinants that contribute to disease in the population and initiatives for alleviating these. This will, in turn, shift care providers increasingly to work with others in the community able to influence these factors, many of which may sit outside of the direct influence of healthcare. The second aim is that providers—especially of hospital care—make quality improvement a priority to ensure patient safety and favourable clinical outcomes, with recognised approaches to quality improvement applied to care design and delivery.

Aim number three, cost containment, is an outcome of the first two aims. A growing body of literature demonstrates the successes that can result from pursuit of the triple aim. Yet, it has had impact in that country and in others with predominantly public hospitals and public funding. The framework is, arguably, applicable to hospitals and health systems in Asia and the Pacific; indeed, it has been deployed in Singapore and New Zealand as well as parts of Australia and Japan.

This present pattern is one of public hospitals often a step behind their private counterparts in terms of agenda setting, patient perceptions and quality of care; of hospitals operating in isolation from one another and the rest of the health system, including primary care, with development ad hoc and passive responses to growth in healthcare demand and of governance mostly oriented towards hospital-specific and, especially, financial performance.

The next sections elaborate on the fundamentals of a reform and investment strategy that includes developing alliance governance, investing in innovation and reorienting the health workforce. There is an emerging global consensus that system integration is critical for meeting the challenges of ageing patients, non-communicable diseases and multimorbidity—the patients who, into the future, will potentially overwhelm the health systems of Asia and the Pacific.

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This includes shifting the locations of service delivery from hospitals to community settings where appropriate as well as shifting responsibility for care provision away from hospital specialists to appropriately qualified and supported generalists and primary care providers. Alliance governance offers the best method for facilitating the discussions required for such shifts in the provision landscape.

An effective alliance consists of leaders from across the care spectrum, including both health professionals and managers. It therefore brings together the managers from different services along with clinical leaders, emphasising the latter as robust clinical leadership is necessary for care redesign and system integration. An alliance governance group may feature, according to health system context, doctors, nurses and allied professionals from primary care and hospitals along with others in the health system such as ambulance and aged care residential services.

The private sector should also participate. Patient representatives, of course, should also be involved for the reason that health systems of the future should be designed around the needs of patients rather than providers of services. With such membership, it is possible to have conversations around who, in the local system, should be responsible for which components of patient care and what resources are required from resulting collaborations and agreements for service shifts. Which other primary care providers will be able to assist with this? And what does the perspective and preferences of patients and their experiences with the system, which is often revealing, bring to the care design process?

In terms of structure, an alliance governance group may delegate activities to a series of clinical networks, each charged with responsibility for integration and care redesign in their area of responsibility. Composition should be similar to that of an alliance governance group, including professionals, managers and patient representatives.

Ideally, a clinical network should be given a mandate for members to work together to change the system on behalf of patients. Research shows that effective alliance governance requires alternative or innovative funding models, which provide incentives for the different partners to share resources and support one another and achieve health improvement and efficiency. As key players, often at the centre of healthcare delivery in a locality, public hospitals in the respective countries of Asia and the Pacific have potential to lead alliance development. They have an opportunity to transform governance arrangements, with members entering into an alliance on the understanding that they are there to share resources and work collaboratively with one another to build integrated systems on behalf of their communities.

Alliances have been shown to be effective, improving efficiency as well as patient experiences and clinical leadership. They have also produced service delivery innovations that can only come when different providers in the spectrum of care agree to work collaboratively, putting the patient at the centre of discussions. Globally, there has been considerable attention in recent years to innovation in health systems. Yet, this cannot happen without leadership, commitment to change and investment. Indeed, innovation investment may either need to be a budgetary supplement or redirected from within existing budgets on the understanding that resulting innovations will produce long-term financial benefits and quality improvements.

This, of course, is in keeping with the triple aim as well as the findings of various innovation and improvement studies.

Cultural Governance and Resistance in Pacific Asia Cultural Governance and Resistance in Pacific Asia
Cultural Governance and Resistance in Pacific Asia Cultural Governance and Resistance in Pacific Asia
Cultural Governance and Resistance in Pacific Asia Cultural Governance and Resistance in Pacific Asia
Cultural Governance and Resistance in Pacific Asia Cultural Governance and Resistance in Pacific Asia
Cultural Governance and Resistance in Pacific Asia Cultural Governance and Resistance in Pacific Asia
Cultural Governance and Resistance in Pacific Asia Cultural Governance and Resistance in Pacific Asia
Cultural Governance and Resistance in Pacific Asia Cultural Governance and Resistance in Pacific Asia
Cultural Governance and Resistance in Pacific Asia Cultural Governance and Resistance in Pacific Asia

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