ORCID Profile
0000-0001-7832-3318
Current Organisations
Helmut-Schmidt-Universität / Universität der Bundeswehr Hamburg
,
The University of Auckland
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Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JHEALECO.2015.06.004
Abstract: This study uses a discrete choice experiment (DCE) to measure patients' preferences for public and private hospital care in New Zealand. A labeled DCE was administered to 583 members of the general public, with the choice between a public and private hospital for a non-urgent surgery. The results suggest that cost of surgery, waiting times for surgery, option to select a surgeon, convenience, and conditions of the hospital ward are important considerations for patients. The most important determinant of hospital choice was whether it was a public or private hospital, with respondents far more likely to choose a public hospital than a private hospital. The results have implications for government policy toward using private hospitals to clear waiting lists in public hospitals, with these results suggesting the public might not be indifferent to policies that treat private hospitals as substitutes for public hospitals.
Publisher: Ubiquity Press, Ltd.
Date: 27-06-2017
DOI: 10.5334/IJIC.2514
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.HEALTHPOL.2012.04.011
Abstract: Does the way in which health systems are financed influence whether health policymakers are more or less interested in accessible and equitable health services? Are social democratic governments more interested in primary health care reform than conservative governments? Have particular domains of health policy really become more important over the past decade across a range of countries? In this exploratory article, we investigate the similarities and differences in patterns of attention in health policy in eleven high income countries using data from the Health Policy Monitor database from 2003 to 2010. Our study suggests significant 'islands of difference' in an overall 'sea of similarity' between the health policy agendas of the selected countries. The key findings are: (i) that improving population health outcomes is more likely to be on the agenda under tax-based systems and when centre-left parties are dominant in government (ii) health systems funded through social insurance are more preoccupied with efficiency and cost-containment than tax-funded systems (iii) the political complexion of governments is not a major factor shaping health policy agendas and (iv) since 2003 there has been an increasing interest in initiatives that address public health concerns, access and equity, and population health outcomes.
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.HEALTHPOL.2009.06.004
Abstract: Health governance internationally has become more complex, with both hierarchical and network modes of governance explicitly represented within single public systems. To understand the implementation of new modes and mechanisms of governance under New Zealand health reforms and to assess these in the context of international trends. Research methods sought data from key groups participating in governance policy and implementation. Methods included surveys of board members (N=144, 66% response rate), interviews with chairs (N=14) and chief executives (N=20), and interviews with national policy makers/officials (N=19) and non-government providers and local stakeholders (N=10). Data were collected over two time periods (2001/2002 2003/2004). Analysis integrated the findings of both qualitative and quantitative methods under themes related to modes and mechanisms of governance. Results indicate that a hierarchical mode of governance was implemented quickly, with mechanisms to ensure political accountability to the government. Over the implementation period the scope of decision-making at different levels required clarification and mechanisms for accountability required adjustment. Non-government provider networks emerged only slowly whereas a network of statutory health organisations established itself quickly. The successful implementation of a mix of governance modes in New Zealand 2001-2004 was characterised by clear government policy, flexibility of approach and the appearance of an unintended network. In New Zealand there is less tendency than in some other some other small countries/jurisdictions towards centralisation, with local elections and community engagement policies providing an element of local participation, and accountability to the centre enhanced through political rather than bureaucratic mechanisms.
Publisher: Informa UK Limited
Date: 12-2002
Publisher: Informa UK Limited
Date: 22-07-2018
Publisher: Emerald
Date: 19-09-2016
DOI: 10.1108/JHOM-08-2015-0126
Abstract: Over the last decade there has been considerable debate about the merits of targets as a policy instrument. The purpose of this paper is to examine the implementation of two health targets that were cornerstones of New Zealand health policy between 2009 and 2012: immunisation rates for two-year-olds, and time to treatment, discharge or admission in hospital emergency departments. For each policy target, the authors selected four case-study districts and conducted two waves of key-informant interviews (113 in total) with clinical and management staff involved in target implementation. Despite almost identical levels of target achievement, the research reveals quite different mixes of positive and negative implementation consequences. The authors argue that the differences in implementation consequences are due to the characteristics of the performance measure and the dynamics of the intra-organisational and inter-organisational implementation context. The research is based on interviews with clinical and management staff involved in target implementation, and this approach does not address the issue of effort substitution. While literature on health targets pays attention to the attributes of target measures, the paper suggests that policymakers considering the use of targets pay more attention to broader implementation contexts, including the possible impact of, and effects on related services, organisations and staff. The research focuses specifically on implementation consequences, as distinct from target success and/or changes in clinical and health outcomes. The paper also adopts a comparative approach to the study of target implementation.
Publisher: Elsevier BV
Date: 11-2010
Publisher: American Society of Clinical Oncology (ASCO)
Date: 06-2028
DOI: 10.1200/GO.22.00361
Abstract: Up to one third of patients with cancer are thought to experience adverse cardiovascular events after their cancer diagnosis and treatment. High-quality information about cancer treatment-related cardiovascular disease can prepare patients and reduce anxiety. The aim of this project was to systematically identify Australian online information resources about cardiovascular health after cancer and assess the readability, understandability, actionability, and cultural relevance for Aboriginal and Torres Strait Islander patients. We conducted systematic Google and website searches to identify potentially relevant resources. Eligibility was assessed using predefined criteria. For each eligible resource, we summarized the content and assessed readability, understandability, actionability, and cultural relevance for Aboriginal and Torres Strait Islander people. Seventeen online resources addressing cardiovascular health after cancer were identified: three focused solely on cardiovascular health and the remaining 14 dedicated between % and 48% of the word count to this topic. On average, three of 12 predefined content areas were covered by the resources. Only one resource was considered comprehensive, covering eight of 12 content areas. Overall, 18% of the resources were deemed readable for the average Australian adult, 41% deemed understandable, and only 24% had moderate actionability. None of the resources were considered culturally relevant for Aboriginal and Torres Strait Islander people, with 41% addressing only one of the seven possible criteria and the remainder addressing none of the criteria. This audit confirms a gap in online information resources about cardiovascular health after cancer. New resources, especially for Aboriginal and Torres Strait Islander people, are needed. The development of such resources must be done through involvement and collaboration with Aboriginal and Torres Strait Islander patients, families, and carers, through a codesign process.
Publisher: SAGE Publications
Date: 04-2008
DOI: 10.1258/JHSRP.2008.007133
Abstract: In New Zealand in 2001, a system of purchasing health services by a centralized purchasing agency was replaced by 21 district health boards (DHBs) which are responsible for both providing health services directly and for purchasing services from non-government providers. This paper describes the processes associated with the allocation of health resources in the decentralized system and considers the extent to which four of the government's stated objectives are likely to be achieved. Two rounds of interviews with national stakeholders and senior DHB personnel plus case studies in five districts which included key informant interviews, observation at board meetings and document analysis. The re-structuring of the health sector in New Zealand appears to have simultaneously enhanced and inhibited the achievement of government objectives. Local decisionmaking has encouraged greater local responsiveness and new funding arrangements have allayed concerns about inter-regional equity. The system is less commercially oriented than it was during the 1990s and collaboration between DHBs is improving. However, the combination of increased integration of purchasing and provision within DHBs and the focus on financial deficits in the early years appears to have inhibited the development of partnership relationships between DHBs and non-government providers, and of longer-term funding arrangements for high quality providers. Non-government providers perceive that DHBs have a tendency to favour their own providers when allocating contracts. Decentralized decisionmaking is starting to make some inroads towards achieving some of the government's objectives with respect to resource allocation and purchasing.
Publisher: Informa UK Limited
Date: 12-2005
Publisher: Informa UK Limited
Date: 22-08-2017
Publisher: Informa UK Limited
Date: 03-1996
Publisher: Informa UK Limited
Date: 21-10-2023
Publisher: Springer Science and Business Media LLC
Date: 21-02-2012
Publisher: Springer Science and Business Media LLC
Date: 04-07-2023
DOI: 10.1007/S10643-023-01531-6
Abstract: Internationally, professionalization has become a key policy strategy targeting quality improvement in early childhood education and care (ECEC), utilizing top-down managerial strategies including implementation of quality standards and increased workforce qualifications. Set against this backdrop, this study explored educators’ accounts of their professional status and professionalism in their work. Data were collected from a representative s le of Australian educators ( n = 98) participating in a national ECEC workforce study. Educator accounts were inductively and deductively coded, while statistical analysis examined association of codes with educator personal and professional characteristics. Educators overwhelmingly named their work as a profession, with three categories of explanation: purpose (educating children), qualification, and public opinions. However, analysis of educator accounts of their work practices, drawing on Moss’s (2006) understandings of the ECEC workforce, found that less than half of the educators presented their roles as other than technical or nurturing/laboring. Degree qualified teachers were more likely than less qualified educators to define professionalization in terms of purpose and professionalism in terms of autonomous decisions based on expert knowledge . Policy or practice: The study provides grassroots perspectives on professionalization and professionalism in ECEC and draws attention to three areas of misalignment between current policy and educators’ views and practices that require attention.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.SOCSCIMED.2017.12.029
Abstract: Complex adaptive systems (CAS) theory views healthcare as numerous sub-systems characterized by erse agents that interact, self-organize, and continuously adapt. We apply this complexity science perspective to examine the extent to which CAS theory is a useful lens for designing and implementing health policies. We present the case of Health Links, a "low rules" policy intervention in Ontario, Canada aimed at stimulating the development of voluntary networks of health and social organizations to improve care coordination for the most frequent users of the healthcare system. Our s le consisted of stakeholders from regional governance bodies and organizations partnering in Health Links. Qualitative interview data were coded using the key complexity concepts of sensemaking, self-organization, interconnections, coevolution, and emergence. We found that the complexity-compatible policy design successfully stimulated local dynamics of flexibility, experimentation, and learning and that important mediating factors include leadership, readiness, relationship-building, role clarity, communication, and resources. However, we saw tensions between preferences for flexibility and standardization. Desirable developments occurred only in some settings and failed to flow upward to higher levels, resulting in a piecemeal and patchy landscape. Attention needs to be paid not only to local dynamics and processes, but also to regional and provincial levels to ensure that learning flows to the top and informs decision-making. We conclude that implementation of complexity-compatible policies needs a balance between flexibility and consistency and the right leadership to coordinate the two. Complexity-compatible policy for integrated healthcare is more than simply 'letting a thousand flowers bloom'.
Publisher: Informa UK Limited
Date: 12-2009
Publisher: CSIRO Publishing
Date: 06-09-2022
DOI: 10.1071/HC22096
Publisher: Informa UK Limited
Date: 09-2004
Publisher: Ubiquity Press, Ltd.
Date: 2021
DOI: 10.5334/IJIC.5679
Publisher: Elsevier BV
Date: 12-2013
Publisher: SAGE Publications
Date: 23-07-2023
DOI: 10.1177/09520767231183506
Abstract: Research on governance often assumes that governance requires combinations of hierarchical, market and network co-ordination. However, governance versatility – understood as the existence of a repertoire of different modes of coordination – is not a characteristic of all instances of governance. The aim of this paper is to offer a more thorough analysis by exploring existing levels of governance versatility and how these are influenced by institutional profiles. Our comparative study of primary care performance across six jurisdictions suggests that higher levels of governance versatility can be shaped by very different institutional profiles. Our analysis raises important questions for future studies of governance versatility.
Publisher: University of Queensland Library
Date: 2022
DOI: 10.14264/EF2D045
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.HEALTHPOL.2017.05.013
Abstract: In high-income countries, the arena of primary health care is becoming increasingly subject to 'performance governance' - the harnessing of performance information to the broader task of governance. Primary care presents many governance challenges because it is predominantly provided by sole practitioners or small organisations. In this article we compare Denmark and New Zealand, two small countries with tax-funded health systems which have adopted quite different instruments for performance governance in primary care. Denmark has adopted a 'soft hierarchy' approach to primary care performance based on accreditation processes but few strong sanctions, whilst New Zealand has relied on a combination of explicit hierarchical targets and financial incentives. These differences are attributable to: primary care institutional arrangements, - specifically, the presence or absence of 'intermediate organisations'- the degree to which policy processes are corporatist or pluralist and the mix of objectives of primary care policies. We conclude that New Zealand's approach has relied heavily on 'extrinsic' incentives, whereas Denmark exhibits the opposite problem of overreliance on intrinsic motivation to improve quality, without 'extrinsic' instruments to address other important goals such as population health and equity. Our comparative framework has the potential to be applied across a wider range of countries.
Publisher: Routledge
Date: 25-11-2020
Publisher: Informa UK Limited
Date: 12-2008
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.HEALTHPOL.2017.05.012
Abstract: In July 2016, New Zealand introduced a new approach to measuring and monitoring health system performance. This 'Systems Level Measure Framework' (SLMF) has evolved from the Integrated Performance and Incentive Framework (IPIF) previously reported in this journal. The SLMF is designed to stimulate a 'whole of system' approach that requires inter-organisational collaboration. Local 'Alliances' between government and non-government health sector organisations are responsible for planning and achieving improved health system outcomes such as reducing ambulatory sensitive hospitalisation for young children, and reducing acute hospital bed days. It marks a shift from the previous regime of output and process targets, and from a pay-for-performance approach to primary care. Some elements of the earlier IPIF proposal, such as general practice quality measures, and tiered levels of performance, were not included in the SLM framework. The focus on health system outcomes demonstrates policy commitment to effective integration of health services. However, there remain considerable challenges to successful implementation. An outcomes framework makes it challenging to attribute changes in outcomes to organisational and collaborative strategies. At the local level, the strength and functioning of collaborative relationships between organisations vary considerably. The extent and pace of change may also be constrained by existing funding arrangements in the health system.
Publisher: Springer Science and Business Media LLC
Date: 29-05-2020
Publisher: Routledge
Date: 25-11-2020
Publisher: SAGE Publications
Date: 06-2020
Abstract: Theoretical perspectives, and a large body of empirical research examining sex-segregated occupations, identify the attitudinal barriers of the majority as pivotal for both workplace well-being and the retention of minorities. Globally, where more than 90% of the early childhood education and care workforce is female, understanding the attitudes of the majority is critical in informing actions to sustain men’s participation. So too are female educators’ understanding, acceptance and responses to the attitudes of other key stakeholders. The extent to which decisions in the workplace reflect personal, organisational or parent perspectives is not well understood. In this study, the authors analyse interview data from the female majority to distinguish personal voice and attributed beliefs regarding the inclusion of men in the early childhood education and care workplace. They analyse interview data from 96 women working as educators in a representative s le of long-day-care and kindergarten services in Queensland, Australia. The analyses suggest that the view of male educators as assets was claimed, while concerns about risk or competency were typically attributed to others. Attributed views were not often contested, but instead accepted or excused. The findings suggest that while the inclusion of men in the early childhood education and care workforce is explicitly accepted by female colleagues, actions within the workforce may be influenced by the attitudes of those outside or by latent personal attitudes distanced by positioning as the voice of others.
Publisher: Bristol University Press
Date: 04-2011
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.SOCSCIMED.2008.06.008
Abstract: Since 2000, the substantive focus of health policy in New Zealand has been closely aligned to the agendas of improving population health and reducing health inequalities. Health system restructuring, through the introduction of locally based and partially elected District Health Boards (DHBs), was the structural mechanism chosen for reorienting the health sector towards population health. Strategic planning at the DHB level was the key mechanism by which central government population health objectives would be translated into local action. This analysis of the early years of elected DHBs (2001-2005) sets out to answer the following broad questions: (i) did strategic planning by District Health Boards reflect an orientation to population health? (ii) to what extent was strategic planning towards population health shaped by community participation and input? (iii) to what extent did strategic planning lead to a re-prioritisation of resources? These questions were explored as part of a larger research project investigating the introduction and implementation of the DHB system. Data were collected from over 350 interviews of local and national stakeholders, and two surveys of DHB Members between 2002 and 2004-2005. Overall, DHBs demonstrated the 'will' to engage in strategic decision-making processes to enhance population health but have difficulty in finding the 'way'. The priorities and requirements of central government and the weight of institutional history were found to be the most influential factors on DHB decision-making and practice, with flexibility and innovation only exercised at the margins. This raises the key question of whether there is the governmental capacity at the local level to adequately address nationally determined population health policy priorities.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Victoria University of Wellington Library
Date: 11-05-2020
Abstract: This article explores the experience of health services decision makers using Mäori health data to inform decision making. It draws on selected findings from the second phase of a three-year Health Research Council-funded study and discusses how Mäori health data identification, data analysis and data interpretation processes are being used by decision makers to help to identify the most promising strategies to improve Mäori health. Data is critical to monitoring inequity and has the potential to drive health service change. However, improvement is needed at all steps in the decisionmaking process to better facilitate utilising data to leverage change in Mäori health outcomes.
Publisher: Informa UK Limited
Date: 23-12-2014
Publisher: Maad Rayan Publishing Company
Date: 20-06-2020
Publisher: Springer Science and Business Media LLC
Date: 29-06-2023
Publisher: Ubiquity Press, Ltd.
Date: 23-04-2021
DOI: 10.5334/IJIC.5602
Publisher: Informa UK Limited
Date: 06-2005
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2021-052209
Abstract: To investigate interdistrict variations in childhood ambulatory sensitive hospitalisation (ASH) over the years. Observational population-based study over 2008–2018 using the Primary Health Organisation Enrolment Collection (PHO) and the National Minimum Dataset hospital events databases. New Zealand primary and secondary care. All children aged 0–4 years enrolled in the PHO Enrolment Collection from 2008 to 2018. ASH. Only 1.4% of the variability in the risk of having childhood ASH (intracluster correlation coefficient=0.014) is explained at the level of District Health Board (DHB), with the median OR of 1.23. No consistent time trend was observed for the adjusted childhood ASH at the national level, but the DHBs demonstrated different trajectories over the years. Ethnicity (being a Pacific child) followed by deprivation demonstrated stronger relationships with childhood ASH than the geography and the health system input variables. The variation in childhood ASH is explained only minimal at the DHB level. The sociodemographic variables also only partly explained the variations. Unlike the general ASH measure, the childhood ASH used in this analysis provides insights into the acute conditions sensitive to primary care services. However, further information would be required to conclude this as the DHB-level performance variations.
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Publisher: Emerald
Date: 28-06-2021
DOI: 10.1108/JHOM-10-2020-0417
Abstract: In 2016, New Zealand's Ministry of Health introduced the System Level Measures Framework which marked a departure from health targets and pay-for-performance incentives towards an approach based on local, collaborative approaches to health system improvement. This exemplifies an attempt to “overwrite” New Public Management (NPM) institutional practices with New Public Governance (NPG). We aim to trace this process of overwriting so as to understand how attempts to change institutional practices were facilitated, blocked, translated and edited. We develop a conceptual framework for understanding and tracing institutional change towards NPG which emphasises the importance of discursive strategies in policy attempts to overwrite NPM with NPG. To analyse the New Zealand case, we drew on policy documents and interviews conducted in 2017–18 with twelve national key informants and fifty interviewees closely involved in local development and/or implementation of the SLMF. Policy sponsors of collaborative approaches to health system improvement first attempted formal institutional change, arguing that adopting collaborative, quality improvement (NPG) approaches would supplement existing performance management (NPM) practices, to create a superior synthesis . When this formal approach was blocked, they adopted an approach based on informal persuasion of local organisational actors that quality improvement should supplant performance improvement. This approach was edited and translated by local actors, and the success of local implementation varied considerably. This article offers a novel conceptualisation of public management institutional change, which can help explain why it is difficult to completely erase NPM practices in health. This paper explores the rhetorical practices that are used in the introduction of a New Public Governance policy framework.
Publisher: Informa UK Limited
Date: 16-04-2014
Publisher: Elsevier BV
Date: 11-2002
DOI: 10.1016/S0168-8510(02)00017-9
Abstract: Discussions about public participation in health priority-setting have tended to assume that the best type of information about public values is that in which the public 'speaks for itself'. However, wherever public input has been used in priority-setting, the way in which it is used is far from transparent. Those jurisdictions that have initiated priority-setting processes have been characterised by the substantial involvement of 'mediating bodies' i.e. bodies such as the Oregon Health Services Commission or the New Zealand National Health Committee, that take on the role of interpreting information about public values. The information that they interpret is usually presented in a highly ambiguous form and most definitely does not 'speak for itself'. In the priority-setting literature, however, little attention has been paid to the role of these bodies and the way in which they interpret and digest information about public values. This article argues that these bodies are essential, but that their decision-making processes are necessarily opaque and should not be judged according to the criterion of transparency.
Publisher: WORLD SCIENTIFIC
Date: 12-2009
Publisher: Informa UK Limited
Date: 10-2012
DOI: 10.1586/ERP.12.58
Abstract: Following a period of quite radical structural reform during the 1990s, health reform in New Zealand is now more incremental and often 'under the radar' of public scrutiny and debate. However, many changes have been made to the roles and functions of key agencies and this could have a profound effect on the direction and performance of the public health system. In particular, the objective of reform at the national level has shifted away from improving population health and reducing health disparities towards improving the performance of service providers. This article describes some of the reforms that have been introduced in recent years and discusses some implications of these changes. We argue that policy settings that are concerned only with getting the right services to the right people at the right time are inherently short-sighted if they fail to tackle the long-term causes of increasing demand for future health services.
Publisher: Oxford University Press
Date: 2009
Publisher: Informa UK Limited
Date: 31-10-2017
Publisher: Elsevier BV
Date: 09-2013
Publisher: Elsevier BV
Date: 07-2021
Publisher: Maad Rayan Publishing Company
Date: 03-11-2019
Abstract: Background: Gaming is a potentially dysfunctional consequence of performance measurement and management systems in the health sector and more generally. In 2009, the New Zealand government initiated a Shorter Stays in Emergency Department (SSED) target in which 95% of patients would be admitted, discharged or transferred from an emergency department (ED) within 6 hours. The implementation of similar targets in England led to well-documented practices of gaming. Our research into ED target implementation sought to answer how and why gaming varies over time and between organisations. Methods: We developed a mixed-methods approach. Four organisation case study sites were selected. ED lengths of stay (ED LOS) were collected over a 6-year period (2007-2012) from all sites and indicators of target gaming were developed. Two rounds of surveys with managers and clinicians were conducted. Interviews (n=68) were conducted with clinicians and managers in EDs and the wider hospital in two phases across all sites. The interview data was used to develop explanations of the patterns of variation across time and across sites detected in the ED LOS data. Results: Our research established that gaming behaviour – in the form of ‘clock-stopping’ and decanting patients to short-stay units (SSUs) or observation beds to avoid target breaches – was common across all 4 case study sites. The opportunity to game was due to the absence of independent verification of ED LOS data. Gaming increased significantly over time (2009-2012) as the means to game became more available, usually through the addition or expansion of short-stay facilities attached to EDs. Gaming varied between sites, but those with the highest levels of gaming differed substantially in terms of organisational dynamics and motives. In each case, however, high levels of gaming could be attributed to the strategies of senior management more than to the in idual motivations of frontline staff. Conclusion: Gaming of New Zealand’s ED target increased after the real benefits (in terms of process improvement) of the target were achieved. Gaming of ED targets could be minimised by eliminating opportunities to game through independent verification, or by monitoring and limiting the means and motivations to game.
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/HC20012
Abstract: ABSTRACT INTRODUCTIONIn 2016, the New Zealand Ministry of Health introduced the System Level Measures (SLM) framework as a new approach to health system improvement that emphasised quality improvement and integration. A funding stream that was a legacy of past primary care performance management was repurposed as ‘capacity and capability’ funding to support the implementation of the SLM framework. AIMThis study explored how the capacity and capability funding has been used and the issues and challenges that have arisen from the funding implementation. METHODSSemi-structured interviews with 50 key informants from 18 of New Zealand’s 20 health districts were conducted. Interview transcripts were coded using thematic analysis. RESULTSThe capacity and capability funding was used in three different ways. Approximately one-third of districts used it to actively support quality improvement and integration initiatives. Another one-third tweaked existing performance incentive schemes and in the remaining one-third, the funding was passed directly on to general practices without strings attached. Three key issues were identified related to implementation of the capacity and capability funding: lack of clear guidance regarding the use of the funding funding perceived as a barrier to integration and funding seen as insufficient for intended purposes. DISCUSSIONThe capacity and capability funding was intended to support collaborative integration and quality improvement between health sector organisations at the district level. However, there is a mismatch between the purpose of the capacity and capability funding and its use in practice, which is primarily a product of incremental and inconsistent policy development regarding primary care improvement.
Publisher: Bristol University Press
Date: 07-2000
Publisher: Springer Science and Business Media LLC
Date: 26-09-2017
Publisher: Wiley
Date: 17-04-2020
Publisher: Springer Science and Business Media LLC
Date: 27-11-2021
Publisher: Springer Science and Business Media LLC
Date: 08-2023
DOI: 10.1007/S11629-022-7872-X
Abstract: Climate change strongly influences the available water resources in a watershed due to direct linkage of atmospheric driving forces and changes in watershed hydrological processes. Understanding how these climatic changes affect watershed hydrology is essential for human society and environmental processes. Coupled Model Intercomparison Project phase 6 (CMIP6) dataset of three GCM’s (BCC-CSM2-MR, INM-CM5-0, and MPI-ESM1-2-HR) with resolution of 100 km has been analyzed to examine the projected changes in temperature and precipitation over the Astore catchment during 2020–2070. Bias correction method was used to reduce errors. In this study, statistical significance of trends was performed by using the Man- Kendall test. Sen’s estimator determined the magnitude of the trend on both seasonal and annual scales at Rama Rattu and Astore stations. MPI-ESM1-2-HR showed better results with coefficient of determination (COD) ranging from 0.70–0.74 for precipitation and 0.90–0.92 for maximum and minimum temperature at Astore, Rama, and Rattu followed by INM-CM5-0 and BCC-CSM2-MR. University of British Columbia Watershed model was used to attain the future hydrological series and to analyze the hydrological response of Astore River Basin to climate change. Results revealed that by the end of the 2070s, average annual precipitation is projected to increase up to 26.55% under the SSP1–2.6, 6.91% under SSP2–4.5, and decrease up to 21.62% under the SSP5–8.5. Precipitation also showed considerable variability during summer and winter. The projected temperature showed an increasing trend that may cause melting of glaciers. The projected increase in temperature ranges from - 0.66°C to 0.50°C, 0.9°C to 1.5°C and 1.18°C to 2°C under the scenarios of SSP1–2.6, SSP2–4.5 and SSP5–8.5, respectively. Simulated streamflows presented a slight increase by all scenarios. Maximum streamflow was generated under SSP5–8.5 followed by SSP2–4.5 and SSP1–2.6. The snowmelt and groundwater contributions to streamflow have decreased whereas rainfall and glacier melt components have increased on the other hand. The projected streamflows (2020–2070) compared to the control period (1990–2014) showed a reduction of 3%–11%, 2%–9%, and 1%–7% by SSP1–2.6, SSP2–4.5, and SSP5–8.5, respectively. The results revealed detailed insights into the performance of three GCMs, which can serve as a blueprint for regional policymaking and be expanded upon to establish adaption measures.
Location: Germany
No related grants have been discovered for Tim Tenbensel.