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This chapter highlights the relevance of studying healthcare reform in Latin America’s new democracies. It identifies the empirical puzzle of this study and the gaps in the literature that it seeks to fill. It examines why healthcare reform outcomes vary so significantly across Latin American democracies. While many countries in the region have pursued policies to expand access and address healthcare inequality, the quality and sustainability of these reforms vary. The chapter then introduces the novel argument about political parties’ programmatic commitment and policymaking. It provides key findings from a comparative analysis of reforms in Chile, Mexico, and Peru, explaining that reforms are most successful when parties’ core values align directly with the policy, leading to greater engagement during policymaking and implementation. In settings where parties lack programmatic commitment, technocrats or external actors often dominate the process, resulting in reforms that may expand formal coverage but lack sustainable funding, infrastructure development, and effective access. The chapter thus emphasizes that it is not simply the presence of strong or programmatic parties, but their programmatic commitment to the policy area, that predicts the quality and feasibility of social policy reform, with broader implications for democratizing societies and policymakers globally.
Across global and Pacific contexts, inclusive education policies often struggle to move from adoption to practice, leaving a persistent gap between commitments and classroom realities. In Vanuatu, inclusive education is both a constitutional and a statutory obligation: the Constitution of the Republic of Vanuatu guarantees equal rights without discrimination, the Education Act No. 9 of 2014 mandates culturally relevant schooling, and Vanuatu 2030: The People’s Plan: National Sustainable Development Plan 2016–2030 positions inclusion as central to national progress. Building on this foundation, the Ministry of Education and Training has launched the Inclusive Education and Training (IET) Policy 2025–2030, which sets ambitious goals for equitable access, teacher development, and systemic transformation. This article applies the Kokonas Research Methodology (KRM), a Vanuatu-born Indigenous implementation framework grounded in kastom (customary knowledge) and storian (dialogue), to the IET Policy. KRM structures implementation through five stages — initiation, validation, intervention, monitoring and support, and replication — which are mapped to policy priorities to demonstrate how culturally grounded processes can guide enactment in practice. Findings highlight the national significance of KRM in strengthening legitimacy and ownership of reforms in Vanuatu, while also offering transferable lessons for other Pacific countries and contributing to wider Asia-Pacific debates on inclusive education.
Rising levels of household food insecurity in England, and associated health and well-being impacts for children, have led to calls to expand access to free school meals (FSM). Policymakers have been hesitant to extend provision of FSM due to concerns surrounding acceptability, affordability and implementation challenges. The most effective strategies for expanding FSM are not yet fully understood. This work aims to fill this gap by examining school meal policy from the perspective of multiple stakeholders, to provide actionable recommendations for policies that could expand school meal provision.
Design:
A qualitative interview study design was used. The data were analysed using the Framework Method, underpinned by the Context and Implementation of Complex Interventions (CICI) framework. Themes were categorised into context-related and implementation-related factors. Detailed recommendations were discussed at the macro, meso and micro levels of the school food system.
Setting:
The study was conducted in England, UK.
Participants:
Seventeen stakeholders represented the views of local, regional and national government, policy, academia and schools.
Results:
Stakeholders indicated that policies should prioritise stigma reduction and integrate expansion of school meals with existing school policies where possible, including the monitoring of school food standards and ensuring maintenance of school food quality. Stakeholders also suggested improvement to the administrative process and communication with families and recommended a joined-up approach linking interventions with common goals across the whole food system.
Conclusions:
Crucially, sufficient financial support is essential for successful implementation.
This chapter examines Indigenous nation-building as a critical strategy for bridging gaps between policy intent and meaningful connection to Country, focusing on the Western Australian Aboriginal Empowerment Strategy. It highlights persistent disparities stemming from settler-colonial governance, where institutions often fail to address Indigenous cultural, social, economic, and ecological priorities. The analysis shows how empowerment efforts encounter resistance when they challenge entrenched power dynamics, reflecting systemic reluctance toward transformative change. In contrast, Indigenous nation-building provides a self-determined framework for governance, development, and community empowerment rooted in Aboriginal worldviews. The chapter assesses Western Australia’s Closing the Gap Implementation Plan 2023–2025 through this lens, underscoring the importance of cultural integrity, truth-telling, genuine partnerships, and shared decision-making. It concludes with recommendations for institutional reform, arguing that only deep systemic change can deliver equity and improved outcomes for Aboriginal communities.
This chapter develops a conceptual framework for understanding the Right to Repair (R2R) and its intersection with upcycling within contemporary intellectual property and sustainability discourse. It argues that the right to repair encompasses both negative and positive rights: the former protecting individual freedom from interference in repairing owned goods (‘freedom to repair’), and the latter requiring institutional and manufacturer support to ensure ‘repairability’. These differing conceptions manifest in contrasting policy models. Decentralized, market-oriented approaches in the US emphasizing ownership and autonomy, and centralized, circular economy frameworks in the EU prioritizing product design, durability, and extended producer responsibility.
We here give a narrative account of Signs of Safety implementation in M, a poorly rated children’s social care department, overseen by a new director. This director worked hard to gain support from parties including department staff, partner agencies and local politicians for the reforms. Staff participated in many meetings about the reform plans and provided feedback, eliciting generally positive comments especially about the value base, but also concerns about Signs of Safety’s emphasis on relying on family networks. Implementation was undertaken using the Signs of Safety’s organisational Theory of Change, involving interconnecting strands of learning, leadership and organisational alignment of policies and procedures, working with partner agencies and oversight mechanisms to monitor use. We detail work undertaken as part of each of these strands, noting that, for illustration, we will apply our detailed evaluation method to some of these causal pathways in later chapters.
Approximately 20% of Nigerians experience a mental health condition, yet fewer than 10% receive minimally adequate care. This scoping review synthesises the development, implementation and outcomes of mental health policies in Nigeria from 1916 to 2025. Using Arksey and O’Malley’s framework, systematic searches were conducted across PubMed, Web of Science, PsycINFO, AJOL and Google Scholar (inception–December 2024), supplemented by grey literature from governmental and non-governmental sources. The Walt and Gilson Policy Triangle guided the analysis of policy context, content, processes and actors. Nigeria’s policy trajectory demonstrates normative progress, transitioning from custodial approaches under the Lunacy Ordinance (1916) to a rights-based orientation in the Mental Health Act (2023). However, implementation outcomes remain constrained. Workforce expansion has been modest (psychiatrists increased from 250 in 2018 to approximately 350 in 2024), treatment coverage remains low (10–15%) and budget allocation is insufficient (3.3% of the health budget). Barriers include inadequate financing, weak coordination across federal and state levels, limited stakeholder engagement and insufficient integration of community, traditional and faith-based providers. Comparative analysis highlights that Ghana’s autonomous Mental Health Authority, South Africa’s provincial directorates and Kenya’s community health volunteer model provide governance and implementation structures absent in Nigeria. Findings indicate that Nigerian mental health policies, while necessary, are insufficient alone for system strengthening. Effective policy translation requires increased and protected financing (target: 5% of health budget by 2027), task-shifting strategies, establishment of a National Mental Health Information System, federal incentives for state-level adoption, integration into primary healthcare (5,000 PHCs by 2028) and inclusive governance that incorporates service users and traditional healers.
Democratic governments continually expand their policy portfolios to address various challenges, a process known as policy accumulation. While doing so can ensure more comprehensive governance, it also puts the administrative agencies tasked with implementing new and existing policies at risk of overload. Without matching resources or capacities, these agencies may be forced to engage in policy triage, whereby they must prioritize certain tasks and delay or neglect others. Policy triage lowers overall implementation effectiveness, as attention devoted to one area can draw resources away from another. Yet, existing research on policy growth has largely focused on the causes and patterns of expanding policy stocks, while implementation studies traditionally analyze individual policies rather than the organizational challenges arising from larger policy bundles. By shifting the analytical lens to how organizations handle their entire policy portfolios, this chapter zooms in on organizational trade-off decisions that shape the success or failure of public policies.
What happens to the proposals generated by participatory processes? One of the key aspects of participatory processes that has been the subject of rare systematic analysis and comparison is the fate of their outputs: their policy proposals. Which specific factors explain whether these proposals are accepted, rejected or transformed by public authorities? In this article contextual and proposal‐related factors are identified that are likely to affect the prospect of proposals being implemented. The explanatory power of these factors are tested through multilevel analysis on a diverse set of 571 policy proposals. The findings offer evidence that both contextual and proposal‐related variables are important. The design of participatory processes affects the degree of implementation, with participatory budgeting and higher quality processes being particularly effective. Most significant for explaining outcomes are proposal‐level, economic and political factors: a proposal's cost, the extent to which it challenges existing policy and the degree of support it has within the municipality all strongly affect the chance of implementation.
Do more rules improve overall policy performance? To answer this question, we look at rule growth in the area of environmental policy from an aggregate perspective. We argue that impactful growth in rules crucially depends on implementation capacities. If such capacities are limited, countries are at risk of ‘empty’ rule growth where they lack the ability to implement their ever‐growing stock of policies. Hence, rules are a necessary, yet not sufficient condition for achieving sectoral policy objectives. We underpin our argument with an analysis of the impact of a new, encompassing measure of environmental rule growth covering 13 countries from 1980 to 2010. These findings call for ‘sustainable statehood’ where the growth in rules should not outpace the expansion in administrative capacities.
A burgeoning line of research examines nonprofit advocacy, yet few have examined how nonprofits advocate against policy objectives. We explore how groups serve client needs by examining immigrant-serving organizations shaping local enforcement of federal immigration removal policies. We demonstrate how groups have helped to reshape national immigration enforcement through the litigation process. These organizations play a vital role in providing legal aid to individuals facing removal. With information on 1079 nonprofits, we predict regional removal numbers from US Immigration and Customs Enforcement. We find that the availability of nonprofit pro bono legal aid does predict local removal rates. Regions with greater numbers of pro bono attorney groups produce fewer immigration removals, controlling for other factors. The number of non-attorney advocates in a region predicts fewer non-criminal immigrant removals. This finding is important for both scholars and immigrant advocates at a time of heightened national enforcement.
In political research, scholars have increasingly paid attention to the political challenges of integrating new public policies into existing policy subsystems, which bears important implications for the study of eco-social policy and politics. By drawing on policy integration research, we identify and discuss insights and lessons deriving from policy integration scholarship, which appear to be relevant for understanding policy linkages between the social and environmental domains especially regarding the European Green Deal (EGD). More specifically, we focus on the following two aspects: (1) the elements of policy design and implementation practices that are deemed to be helpful for ensuring equilibrium between social and environmental goals and (2) political factors that are likely to affect policy integration dynamics along the social and environmental aspects (eco-social nexus). This article contributes to the literature by tracing novel research trajectories for the eco-social debate to explore in the policy integration perspective.
In a global landscape increasingly shaped by technology, artificial intelligence (AI) is emerging as a disruptive force, redefining not only our daily lives but also the very essence of governance. This Element delves deeply into the intricate relationship between AI and the policy process, unraveling how this technology is reshaping the formulation, implementation, and advice of public policies, as well as influencing the structures and actors involved. Policy science was based on practice knowledge that guided the actions of policymakers. However, the rise of AI introduces an unprecedented sociotechnical reengineering, changing the way knowledge is produced and used in government. Artificial intelligence in public policy is not about transferring policy to machines but about a fundamental change in the construction of knowledge, driven by a hybrid intelligence that arises from the interaction between humans and machines.
Despite growing front-of-pack labelling (FOPL) policy implementation in low-and middle-income countries (LMIC), research approaches for evaluating these policies remain poorly characterized, hindering evidence-based policy development and methodological gaps. This study explored research approaches, frameworks, and methods used in assessing FOPL policy implementation and response in LMIC.
Design:
Systematic search of five databases, including Medline, Web of Science, Scopus, Global Health, and CINAHL, for peer-reviewed articles published between 2014–2025. Studies on FOPL policy implementation or response in LMIC were included. Data on study characteristics, methods, and findings were extracted and synthesized.
Setting:
LMIC.
Participants:
All populations.
Results:
Thirty-one studies revealed significant research imbalances. Implementation studies (n 3) used qualitative approaches with policy theories, while response studies (n 28) predominantly employed quantitative methods including surveys, experiments, and modeling. Pronounced geographical bias emerged, with 24 studies conducted in Latin America while other LMIC regions remained underrepresented. Common limitations included non-representative sampling, self-reported data, and short timeframes. Mandatory FOPL policies achieved higher compliance than voluntary schemes, though implementation faced challenges including inadequate monitoring, limited resources, and industry resistance. Consumer awareness was generally high but varied significantly across population groups, revealing substantial equity gaps.
Conclusions:
This review reveals critical gaps in FOPL implementation research in LMIC, with evidence heavily skewed toward consumer responses and geographically concentrated in Latin America. Future research should prioritize implementation science approaches, geographical diversity, and understanding policy processes in resource-constrained settings to develop effective, context-appropriate FOPL policies.
Implementation arrangements are increasingly recognized as a decisive factor in the success of contemporary welfare policies, particularly those that combine income support with activation requirements. This paper examines the Italian case of minimum income schemes - the Reddito di Inclusione and the Reddito di Cittadinanza - to explore how local implementation arrangements shape one of their core objectives: reintegrating beneficiaries into the labour market. Drawing on an original dataset that integrates administrative data with a unique INAPP survey of local institutions, we operationalize “implementation arrangements” along three dimensions: institutional capacity, alignment between organizational missions and policy goals, and the quality of institutional cooperation within a multilevel governance framework. Using regression models at the municipal level, we find that implementation strength matters, but horizontal cooperation and effective communication between Public Employment Services (PES) and Local Social Planning Institutions (LSPIs) emerge as the strongest predictors of successful outcomes. While PES performance is central due to their policy mandate, LSPIs’ ability to foster integrated networks also contributes positively when well-coordinated. These findings highlight that policy success depends less on formal design than on the quality of local governance and institutional complementarities. The results provide new evidence for the literature on implementation, underscoring the importance of horizontal multilevel governance in active social policies.
This chapter examines the circular economy as a pathway to building more resilient and sustainable cities. As urban areas expand, they face growing environmental pressures, such as increased waste, rising emissions, and resource depletion. The circular economy responds to these issues by replacing the traditional linear model of ‘take–make–dispose’ with approaches that prioritise resource efficiency, waste reduction, and regeneration. The chapter emphasises the link between circular practices and urban resilience – defined as a city’s capacity to recover from shocks like climate change, disasters, and economic disruptions. Through strategies such as recycling, reuse, and the integration of nature-based solutions, cities can strengthen infrastructure and sustainability. Key urban sectors including waste, water, and the built environment are explored to show how circular strategies are being applied globally. Despite the promise, the chapter acknowledges several challenges, including regulatory and financial barriers, as well as the need for cultural transformation. However, it also highlights opportunities in policy innovation, public–private collaboration, policy innovation, and technology. The chapter concludes that the circular economy is vital for enabling cities to adapt, endure, and prosper in a world of accelerating change.
This chapter examines the ways that language-in-education policies respond to the multilingualism of student populations and outlines some key issue that have contributed to children’s first languages being relatively marginalised in language policy and implementation. It considers contexts in which multilingual educational programmes have been normalised in policy. It then examines some of the ideological positions about education that conflict with the aims of multilingual education. It examines how different understandings of the nature and purpose of education shape the wider context in which language-in-education policies are developed and implemented to identify some key constraints that operate in such contexts.
Understanding the process of seeking long-term care (LTC) in old age helps identify what contributes to delays and inequalities in accessing it. Current research highlights the roles of individual and policy factors, but pays little attention to how these factors interact. This qualitative study aims to fill this gap by identifying facilitating factors and mechanisms in the initial approaches to LTC policies. It examines care-seeking in two towns in northern Italy, where a demand-based approach, high fragmentation and poor coordination pose significant challenges. In a bottom-up approach to policy implementation, the experiences and perspectives of both care-seekers and professionals are integrated. Indeed, the data collection (April 2023–May 2024) triangulates 100+ hours of participant observation and semi-structured or vignette-based interviews. The study finds that care-seeking entails three interrelated steps: recognising care needs, being willing to receive LTC, and reaching an entry point. At each stage, three mechanisms operate at intrapersonal and interpersonal levels and can be promoted by LTC policies to facilitate care-seeking, especially for those experiencing barriers. The mechanisms are (1) taking the initiative to raise awareness of care needs and share information about available solutions; (2) fostering trust between professionals and care-seekers, who often rely on confidential relationships to discuss care arrangements; and (3) combining primary information with tailored guidance on the local offer, enabling care-seekers to make informed decisions. The findings provide actionable insights into policies and practices that facilitate care-seeking, and offer a conceptual framework that explains the driving factors behind this process and its mechanisms.
Evidence-based concussion practices have been codified into legislation, yet implementation has been narrowly evaluated. We examined implementation of concussion practices in Massachusetts high schools and adopted a disproportionality lens to assess the relationship between school sociodemographic and policy implementation and examine whether differences in policy implementation represent systematic disparities consistent with the disproportionality literature.
Methods
A cross-sectional survey was sent to Massachusetts high school nurses (N=304). Responses (n=201; 68.1% response rate) were tallied so that higher scores indicated greater policy implementation. School demographic data were collected using publicly available datasets and were linked to survey responses. Descriptive statistics, correlations, k-means clustering, and groupwise comparisons were conducted.
Results
Policy implementation is varied across schools and is associated with school sociodemographic variables. As percentages of marginalized identities in student population increased, implementation rates decreased. K-means cluster analysis revealed two discrete groups based on policy implementation scores, with significant differences in sociodemographic variables between groups. Schools with low implementation scores had a greater percentage of students who identified as African American/Black and nurses with less experience.
Conclusions
Findings highlight current disparities in the implementation of concussion management policies and support adoption of a disproportionality lens in this sphere.
This article posits that the multi-level governance literature can benefit from administrative burden theory if scholars are interested in understanding under which conditions policy implementation fails. To support this argument, we build on these two bodies of research to examine how implicit welfare rescaling – where the central government expands its role in a previously devolved policy – may increase administrative burdens for claimants, and to what extent local welfare systems can help to mitigate these burdens despite lacking coordination. To address these research aims, we assess the implementation of the “Ingreso Mínimo Vital,” a national minimum income scheme introduced in Spain within a fragmented regional system. Qualitative fieldwork with frontline professionals and policy experts shows that welfare rescaling heightened claimants’ administrative burdens due to inter-institutional misfit among governance levels. This imposed substantial learning, compliance, and psychological costs on claimants, making frontline professionals essential for guiding them through these challenges.