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Understanding the political economy of reforming global health initiatives – insights from global and country levels
Get PDFSophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Giulia Loffreda - ORCID: 0000-0003-4895-1051
https://orcid.org/0000-0003-4895-1051Maria Paola Bertone - ORCID: 0000-0001-8890-583X https://orcid.org/0000-0001-8890-583XIntroduction
Since 2000, the number and role of global health initiatives (GHIs) has been growing, with these platforms playing an increasingly important role in pooling and disbursing funds dedicated to specific global health priorities. While recognising their important contribution, there has also been a growth in concerns about distortions and inefficiencies linked to the GHIs and attempts to improve their alignment with country health systems. There is a growing momentum to adjust GHIs to the current broader range of global health threats, such as non-communicable diseases, humanitarian crises and climate change, and against the backdrop of the recent aid cuts. However, reform attempts are challenged by the political economy of the current structures.
Methods
In this article, we draw on research conducted as part of the Future of Global Health Initiatives process. The study adopted a cross-sectional, mixed-methods approach, drawing from a range of data sources and data collection methods, including a global and regional level analysis as well as three embedded country case studies in Pakistan, South Africa and Senegal. All data was collected from February to July 2023. 271 documents were analysed in the course of the study, along with data from 335 key informants and meeting participants in 66 countries and across a range of constituencies. For this paper, data were analysed using a political economy framework which focused on actors, context (especially governance and financing) and framing.
Findings
In relation to actors, the GHIs themselves have become increasingly complex (both internally and in their interrelations with other global health actors and one another). They have a large range of clients (including at national level and amongst multilateral agencies) which function as collaborators as well as competitors. Historically there have been few incentives for any of the actors to maximise collaboration given the competitive funding landscape. Power to exert pressure for reforms sits ultimately with bilateral and private funders, though single-issue northern non-governmental organisations (NGOs) are also cited as important influencers. Funders have not collaborated to enable reforms, despite concerns amongst a number of them, because of the helpful functional role of GHIs, which serves funder interests. Some key global boards are reported to be engineered for stasis, and there are widespread concerns about lack of transparency and over-claiming (by some GHIs) of their results. Framing of narratives about achievements and challenges is important to enable or block reforms and are vigorously contested, with stakeholders often selecting different outcomes to emphasise in justifying positions.
Conclusion
GHIs have played an important role in the global health ecosystem but despite formal accountability structures to include recipient governments, substantive accountability has been focused upwards to funders, with risk management strategies which prioritise tracking resources more than improved national health system performance. Achieving consensus on reforms will be challenging but current funding pressures and new threats are creating a sense of urgency, which may shift positions. Political economy analysis can model and influence these debates.The original study was funded by the Government of Norway through the Wellcome Trust. The funders were not however involved in this article and the opinions expressed here are the responsibility of the authors alone. We thank the ReBUILD for Resilience research consortium for supporting publication of this article.https://doi.org/10.1186/s12992-025-01129-021pubpub
Understanding unresolved higher education complaints: A mixed methods study on the Office of the Independent Adjudicator (OIA)
Get PDFHigher education (HE) is increasingly shaped by the pressures of marketisation, which positions students as consumers within a competitive educational marketplace. Amidst this shifting landscape, the resolution of student complaints has become a critical issue, raising fundamental questions about fairness, accessibility, and the efficacy of independent adjudication systems. This research addresses these concerns by examining the Office of the Independent Adjudicator for Higher Education (OIA), which serves as the principal complaint-handling body for unresolved disputes in HE across England and Wales. By blending theoretical and practical perspectives, this research seeks to illuminate the systemic factors shaping complaint outcomes and procedural fairness in a marketised HE context. Adopting an explanatory sequential mixed-methods approach, the research comprises two complementary studies. The first is a quantitative analysis of cross-sectional secondary data from 5,111 OIA complaints, revealing key patterns in complainant demographics and their relationship to complaint outcomes. Notably, the findings underscore significant disparities, with males, ethnic minorities, and international (non-EU) students being less likely to secure remedies. The second study delves deeper into these patterns through a qualitative exploration of stakeholder perspectives. Thematic analysis of focus groups involving complainants, university staff, and OIA staff uncovers diverse experiences shaped by structural and procedural factors. Participants describe mixed perceptions of procedural justice, encompassing concerns over impartiality, communication barriers, and varying levels of support. The qualitative findings propose three typologies of complainants, Persistent Pursuers, Reluctant Escalators, and Resolution Seekers, highlighting the motivations and expectations influencing student engagement with the OIA. This thesis makes significant contributions to both academic discourse and practical policy. It explores the application of procedural justice theory to the unique context of a HE ombudsman and challenges existing paradigms of student complaining behaviour. By providing actionable insights into the disparities and barriers within the OIA’s processes, the research offers recommendations to enhance fairness, transparency, and equity in student complaint resolution. Ultimately, this work advocates for a more thorough and transparent adjudication system that reflects the diverse needs of HE students
Music therapy in adult hospices: a national multicentre survey
Get PDFFrom BMJ via Jisc Publications RouterHistory: received 2025-02-04, accepted 2025-03-24, ppub 2025-05-07, epub 2025-05-07Peer reviewed: TrueArticle version: VoRPublication status: PublishedGiorgos Tsiris - ORCID: 0000-0001-9421-412X https://orcid.org/0000-0001-9421-412XBackground: In recent years, there has been an increased demand for non-pharmacological, complementary therapies and psychosocial provisions in hospices, aimed at creating spaces for communication and personalised expression in response to the bio-psycho-socio-existential needs of patients and their caregivers. As a contemporary evidence-based professional practice, music therapy is an integral part of multidisciplinary teams in many palliative care settings internationally. In Italy, however, music therapy is a developing area of practice facing certain challenges around professionalisation, funding and service development. This study seeks to explore the current state of music therapy in Italian hospices. Methods: From January 2024 to March 2024, an online survey was disseminated to 213 hospices across Italy. The survey consisted of 10 closed-ended questions. Data was analysed using descriptive statistics. Results: A 73.7% completion rate was achieved. Music-based interventions are provided in 49.6% of hospices (n=62), and 43.5% of these offer a music therapy service led by a qualified music therapist. Most hospices (n=17) offer music therapy sessions for 3 hours per week. Across all hospices, sessions are primarily individual and take place in patients' rooms. The presence of caregivers varies, and patients are referred to music therapy by different professionals in the team. Information was gathered regarding the use of music therapy during sedation and for bereavement support of caregivers, along with details on assessment tools used. Conclusion: This study offers an initial overview of music therapy in hospices across Italy and highlights critical questions regarding team integration, training standards, evaluation and funding.aheadofprintaheadofprin
The Impact of Minority Status on the Cross-Race Effect: A Critical Review
Get PDFDilhan Töredi - ORCID: 0000-0001-8420-1245
https://orcid.org/0000-0001-8420-1245Jamal K. Mansour - ORCID: 0000-0001-7162-8493
https://orcid.org/0000-0001-7162-8493Sian Jones - ORCID: 0000-0002-2399-1017
https://orcid.org/0000-0002-2399-1017Users who receive access to an article through a repository are reminded that the article is protected by copyright and reuse is restricted to non-commercial and no derivative uses. Users may also download and save a local copy of an article accessed in an institutional repository for the user's personal reference. For permission to reuse an article, please follow our Process for Requesting Permission.Meta-analyses have consistently demonstrated the robustness of the cross-race effect (CRE; i.e., better recognition of same-race faces compared to different-race faces). These analyses have unveiled variations in the dependent variables associated with the CRE across combinations of participant and target races (Lee & Penrod, 2022; Meissner & Brigham, 2001). However, the underlying factors driving these variations remain poorly understood. We posit that although the CRE is robust, its generalizability may be contingent on the specific racial groups compared, particularly when contrasting majority and minority racial groups. In this comprehensive review, we delve into the dynamics of the CRE across distinct racial groups and explore how minority status may influence research outcomes. We considered the manuscripts included in the latest meta-analyses of the CRE with a spotlight on minority status. We suggest that minority-race status may explain why many studies considering non-White participants do not show a CRE. The CRE might not be as robust as it appears to be because much of the research on the effect has focused on majority-race participants and minority-race faces. Going forward, researchers should consider incorporating measures relevant to the minority effect, fully crossing participant and target races, and studying a greater variety of races.pubpu
A need to begin: Unravelling psychological knowledge to find a suitable starting point
Get PDFThis is a pre-publication version of the following article: Jones, S.E. (2025) ‘A need to begin: Unravelling psychological knowledge to find a suitable starting point’, Psychology of Education Review.49pubpub
Included or excluded: The Lived Experiences of Scottish Undergraduate Students with a Physical Disability [Dataset]
No full textDataset for dissertation: Included or excluded: The Lived Experiences of Scottish Undergraduate Students with a Physical Disabilit
Book review of ‘Developing Inclusive Schools: Pathways to Success’ (Ainscow 2024)
No full textSian Jones - ORCID: 0000-0002-2399-1017
https://orcid.org/0000-0002-2399-1017Item is restricted in this repository.in pressin pres
Political economy analysis of health financing reforms in times of crisis: findings from three case studies in south-east Asia
Get PDFFrom Springer Nature via Jisc Publications RouterHistory: received 2024-10-15, registration 2025-01-23, accepted 2025-01-23, epub 2025-02-03, online 2025-02-03, collection 2025-12-01Acknowledgements: We would like to thank all key informants whose insights made the case studies rich. In addition, we would like to acknowledge the support of the Indonesian Ministry of Health for their valuable contribution during the study design phase and to those who reviewed our drafts, including Dr Piya Hanvoravongchai and Dr Viroj Tangcharoensathien for the Thailand case study.Publication status: PublishedFunder: World Health Organization; doi: http://dx.doi.org/10.13039/100004423Sophie Witter - ORCID: 0000-0002-7656-6188
https://orcid.org/0000-0002-7656-6188Maria Paola Bertone - ORCID: 0000-0001-8890-583X
https://orcid.org/0000-0001-8890-583XBackground: Over the last decades, universal health coverage (UHC) has been promoted in south-east Asia (SEA), where many countries still need to ensure adequate financial protection to their populations. However, successful health financing reforms involve complex interactions among a range of stakeholders, as well as with context factors, including shocks and crises of different nature. In this article, we examine recent health financing reforms in Nepal, Thailand and Indonesia, using a political economy lens. The objective is to understand whether and how crises can be utilised to progress UHC and to analyse the strategies used by reformers to benefit from potential windows of opportunity. Methods: The study adopted a retrospective, comparative case study design, using a shared framework and tools. The case studies mapped the contexts, including economic, political, social trends and any shocks which had recently occurred. A focal health financing reform was chosen in each setting to examine, probing the role of crisis in relation to it, through the key elements of the reform process, content and actors. Data sources were largely qualitative and included literature and document review (144 documents included across the three cases) and key informant interviews (26 in total). Results: The findings, which bring out similarities and differences in the roles played by change teams across the settings, highlight the importance of working closely with political leaders and using a wide range of strategies to build coalitions and engage or block opponents. Changing decision rules to block veto points was significant in one case, and all three cases used participation and dialogue strategically to further reforms. More broadly, the links with context emerged as important, with prior conflicts and economic crises creating a sense of urgency about addressing health inequities, while in all countries appeal was made to underlying values to enhance the legitimacy of the reforms. Conclusion: The lessons from these case studies include that technical teams can and should engage in Political Economy Analysis (PEA) thinking and strategizing, including being aware of and adaptable to the changing PEA landscape and prepared to take advantage of windows of opportunity, including, but not limited to, those emerging from crisis. There is a need for more empirical studies in this area and sharing of lessons to support future reforms to increase health coverage and financial protection, including in the face of likely shocks.pubpu
Effects of hybrid custom foot orthoses on running economy, running mechanics and comfort: a double-blinded randomized crossover study
No full textKen van Alsenoy - ORCID: 0000-0002-0430-965X
https://orcid.org/0000-0002-0430-965XMarietta van der Linden - ORCID: 0000-0003-2256-6673 https://orcid.org/0000-0003-2256-6673Derek Santos - ORCID: 0000-0001-9936-715X https://orcid.org/0000-0001-9936-715XItem is restricted in this repository.Objective: This study examined the effects of orthotic materials on running economy, running mechanics, and footwear comfort. Design: A double-blinded randomized crossover study design was used. Method: Eighteen athletes ran on an instrumented treadmill for six minutes at speeds corresponding to 10% below their first ventilatory threshold (average: 9.9 ± 1.3 km/h) in four footwear conditions [control (CON), Ethyl vinyl acetate (EVA), Thermoplastic Polyurethane (TPU), and a combination of EVA and TPU (HYB)]. Results: No differences were found in running economy between conditions (p=0.099). All custom foot orthoses materials reduced peak heel impact force vs CON (p<0.001). TPU reduced hysteresis at heel impact vs CON (-47.8%, p=0.016). Shorter flight time (-3.8%, p=0.016; -3.1%, p=0.021) and lower mean vertical loading rate (-4.0%, p=0.003; -7.1%, p<0.001) occurred for HYB vs TPU and CON, respectively. Higher peak vertical loading rates (+7.4%, p=0.002) and earlier impact peaks (-5.7%, p<0.001) were found for HYB vs TPU. HYB exhibited longer propulsive phase duration (+2.0%, p=0.003) but lower peak propulsive force (-3.3%, p=0.009) vs CON. Reduced ‘overall comfort’ (-26.4%, p=0.004), ‘comfort of heel cushioning’ (-43.3%, p<0.001), and ‘comfort of forefoot cushioning’ (-18.3%, p=0.048) was found for HYB vs TPU, but ‘comfort of forefoot cushioning’ (+48.0%, p=0.032) showed an increase vs EVA. Conclusions: Combining materials could enhance comfort during running causing subtle changes in running mechanics. Overall, neither EVA, TPU nor their combination significantly improved running economy compared to CON.118aheadofprintaheadofprin
Destigmatising Sex: The Role of ‘Sexfluencers’ in Deconstructing Sex Positivity through Digital Advocacy on Social Media
No full textItem is not available in this repository.inpressinpres
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