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Country-owned, as opposed to donor-driven, is a principle within the development sector that recognizes the centrality of countries\' leadership, systems, and resources in executing programs and achieving sustainable development. In alignment with this notion, the Immunization Agenda 2030 was developed with country ownership as one of four core principles of the ambitious ten-year plan. This means that the success of immunization programs, including those with eradication and elimination goals such as polio, measles, and rubella, and those with broader equity goals to \"leave no one behind\" on immunization, would be largely driven by country systems. In this paper we deconstruct country ownership into five operational principles: commitment, coordination, capacity, community participation, and accountability. Through this lens, we illustrate how two countries, Nepal and Nigeria, have exemplified country ownership in their measles and rubella elimination programs and we infer the ways in which country ownership drives system performance and sustains program efforts.

Political entrepreneurs seek to mobilise public opinion and access large audiences who are not directly interested in politics, but are exposed to the digital environment. The aim of this research was to analyse how these figures promote experimental communication uses on channels far removed from political activity. We focused on Twitch, a successful platform for promoting entertainment and learning in the video games field. To do so, we conducted a significant case study, that of Íñigo Errejón, a Spanish male Member of Parliament, in 2021 through 18 live streamings that lasted 1223 min. We specifically described the conception and use of Twitch, measured the audience\'s impact, analysed the accountability exercise through this platform and evaluated the deliberative quality of conversation with users. To conclude, we identified three novel contributions of Twitch to digital political communication: self-monitoring, insofar as the elected politician himself proactively exercises accountability to the public without a third party intervening; the activation of mediated authenticity as a key value in the political actor\'s public construction; promoting connective democracy, which would help those sectors not used to employing political information to take an interest in it by detecting attention being paid to their needs and questions.

Classical dilemmas of how to distribute limited resources have been rekindled by the rise of advanced, high-cost therapies. Building on a case study of a novel gene therapy in neuropaediatric care, this article explores the dilemmas that explicit priority setting can create for frontline professionals and develops a typology of professionals\' responses to these dilemmas. Despite political attempts to centralise priority setting and spare health professionals from having to consider treatment costs at the \'bedside\', this study shows that concern for economic efficiency and budget control nonetheless need to be handled and balanced against other accountabilities in the daily work of frontline professionals. Contributing to the sociological debate on priority setting and rationing, this study develops an analytical perspective attuned to the relational aspects of frontline work and the challenges related to the balancing of diverging ideas of good conduct. Further, focussing on an empirical field at the forefront of genomic medicine, this study brings the sociological debate on priority setting and rationing up to date with current developments in precision medicine.

This article explores the dynamic interaction of emergency policies and parliamentary constitutional review in the early policy response to the COVID-19 outbreak in Finland. A thorough analysis of the official records of Parliament\'s Constitutional Law Committee shows how the Government\'s use of delegated emergency powers raised particular concerns about inter-institutional transparency during the state of emergency. These findings prompt an enquiry into whether delegated emergency powers and the related quest for centralized transparency-led accountability produced a rupture in the theory of complex multicentric policymaking. This analysis suggests that policy process research can play an important role in exposing the more subtle and longitudinal effects of emergency policies on democratic governance.

OBJECTIVE: To delineate contemporary practice of registered nurses working in rural and remote areas of Australia.
BACKGROUND: Despite the implementation of strategies to address challenges reported by rural and remote nurses, concern remains over safety and quality of care, the well-being of nurses and retention of the nursing workforce. Twenty years on, geographically dispersed nurses still experience scarce human and material resources.
METHODS: A multiple case study design was implemented.
METHODS: Nurses were recruited from 240 sites. The study comprised three phases of data collection. First, a content analysis of 42 documents relating to the context of nursing, specifically rural and remote nursing; second, a content analysis of an online questionnaire (n = 75); and third, a thematic analysis of semi-structured interviews (n = 20). COREQ reporting guidelines were used.
RESULTS: Each phase of data collection informed subsequent data collection and analysis within the study. Following triangulation of data from each phase of the study, the major themes reported are \"a medley of preparation for rural and remote work\"; \"being held accountable\"; \"alone, with or without someone\"; and \"spiralling well-being.\"
CONCLUSIONS: Regardless of strategies, challenges of nursing in rural and remote areas persist. Issues of isolation, stress, burnout and a lack of organisational commitment to employees affect the retention of rural and remote nurses. While useful, professional development courses and graduate certificates are yet to make an impact on reducing these issues.
CONCLUSIONS: Registered nurses argue for more experience rather than more education to facilitate transition into this nursing area. The finding that experience is perceived as more valuable than education suggests the need for innovative ways to gain experience to practice in rural and remote nursing. Lack of organisational commitment requires attention to promote the well-being of nurses and patient safety.

BACKGROUND: For evidence-based decision-making, there is a need for quality, timely, relevant and accessible information at each level of the health system. Limited use of local data at each level of the health system is reported to be a main challenge for evidence-based decision-making in low- and middle-income countries. Although evidence is available on the timeliness and quality of local data, we know little about how it is used for decision-making at different levels of the health system. Therefore, this study aimed to assess the level of data use and its effect on data quality and shared accountability at different levels of the health system.
METHODS: An implementation science study was conducted using key informants and document reviews between January and September 2017. A total of 21 key informants were selected from community representatives, data producers, data users and decision-makers from the community to the regional level. Reviewed documents include facility reports, district reports, zonal reports and feedback in supervision from the district. Thematic content analysis was performed for the qualitative data.
RESULTS: Respondents reported that routine data use for routine decision-making was low. All health facilities and health offices have a performance monitoring team, but these were not always functional. Awareness gaps, lack of motivating incentives, irregularity of supportive supervision, lack of community engagement in health report verification as well as poor technical capacity of health professionals were found to be the major barriers to data use. The study also revealed that there are no institutional or national-level regulations or policies on the accountability mechanisms related to health data. The community-level Health Development Army programme was found to be a strong community engagement approach that can be leveraged for data verification at the source of community data.
CONCLUSIONS: The culture of using routine data for decision-making at the local level was found to be low. Strengthening the capacity of health workers and performance monitoring teams, introducing incentive mechanisms for data use, engaging the community in data verification and introducing accountability mechanisms for health data are essential to improve data use and quality.

In an editorial, the editors note how crucial the role is of public health activism in enforcing efficient and effective public health management. The government is the lead institution in any national response to the pandemic and to ensure transparency on its end, it is important for any network of health organizations and associations not to shy away from embracing an activist role. In this correspondence, the author explores the case of the Alliance of Health Workers, a union of government and private health workers, and its advocacy towards an empowered status of healthcare professionals in the Philippines.

BACKGROUND: Globally, there is a growing concern with accountability and health systems. This has been attributed majorly to discontent with health system performance. Within the Nigerian health system, weak accountability has been consistently singled out as a key challenge underpinning the poor performance of the immunisation programme. In preparation for the 2017/2018 Measles Vaccination Campaign in Nigeria, the National Measles Technical Coordinating Committee (NMTCC) was inaugurated with one of its key mandates being to ensure accountability in the conduct of the 2017/2018 MVC. This paper aims to share the innovative measures applied in the 2017/2018 Measles MVC to improve accountability and to highlight the contribution of the accountability framework to improving measles vaccination coverage.
METHODS: We identified gaps in accountability from the post-campaign coverage reports and reviews of previous campaigns. We adapted an accountability framework developed by the Nigeria National Routine Immunization Strategic Plan (2013-2015),- which cuts across all levels. Selected indicators were used to monitor the implementation of the framework. Administrative actions such as sanctions and rewards were taken as necessary.
RESULTS: We found that the implementation of the accountability framework was highly instrumental in achieving a high level of coordination among all stakeholders and to improving efficient utilization of resources. We also found that the implementation of the accountability framework in the 2017/2018 MVC contributed to the improved performance of states in terms of measles vaccination coverage compared to the 2015/2016 campaign.
CONCLUSIONS: We have demonstrated that the implementation of the accountability framework in the 2017/2018 MVC led to a considerable reduction in the misuse and abuse of resources and also contributed to remarkable improvement in the measles vaccination coverages across states compared to the 2015/2016 MVC.

Global and national accountability for maternal, newborn and child health (MNCH) is increasingly invoked as central to addressing preventable mortality and morbidity. Strategies of accountability for MNCH include policy and budget tracking, maternal and perinatal death surveillance, performance targets and various forms of social accountability. However, little is known about how the growing number of accountability strategies for MNCH is received by frontline actors, and how they are integrated into the overall functioning of local health systems. We conducted a case study of mechanisms of local accountability for MNCH in South Africa, involving a document review of national policies, programme reports, and other literature directly or indirectly related to MNCH, and in-depth research in one district. The latter included observations of accountability practices (e.g. through routine meetings) and in-depth interviews with 37 purposely selected health managers and frontline health workers involved in MNCH. Data collection and analysis were guided by a framework that defined accountability as answerability and action (both individual and collective), addressing performance, financial and public accountability, and involving both formal and informal processes. Nineteen individual accountability mechanisms were identified, 10 directly and 9 indirectly related to MNCH, most of which addressed performance accountability. Frontline managers and providers at local level are targeted by a web of multiple, formal accountability mechanisms, which are sometimes synergistic but often duplicative, together giving rise to local contexts of \'accountability overloads\'. These result in a tendency towards bureaucratic compliance, demotivation, reduced efficiency and effectiveness, and limited space for innovation. The functioning of formal accountability mechanisms is shaped by local cultures and relationships, creating an accountability ecosystem involving multiple actors and roles. There is a need to streamline formal accountability mechanisms and consider the kinds of actions that build positive cultures of local accountability.