As part of the European Semester, Finland received country-specific recommendations (CSRs) in 2013-2020 that encouraged the reform of national social and health services. These recommendations were part of efforts to balance public finances and implement public-sector structural reforms. Finland has been struggling to reform the national social and health care system since 2005. Only on 1 January 2023 did the new wellbeing services counties become liable for organizing social, health, and rescue services. Studying the CSRs for Finland enables us to understand better what genuinely occurs at the EU member state level. This data-driven case study aims to disclose the relevance of the European Semester for Finland in the pursuit of a national social and health system reform. The mixed-method approach is based on the research tradition of governance, and the study contains features of data sourcing and methodological triangulation. Empirically, the research material consists of Finland\'s official policy documents and anonymous semi-structured elite interviews. The study highlights that although the received CSRs on the need to restructure social and health services corresponded to Finland\'s views, their influence to national reform efforts was limited. The CSRs were administered according to the established formal routines, but separately from the national reform preparations. The CSRs, however, delivered implicit steering, which were considered to affect social and health policy making in various ways.

BACKGROUND: Improving access to mental health data to accelerate research and improve mental health outcomes is a potentially achievable goal given the substantial data that can now be collected from mobile devices. Smartphones can provide a useful mechanism for collecting mental health data from young people, especially as their use is relatively ubiquitous in high-resource settings such as the United Kingdom and they have a high capacity to collect active and passive data. This raises the interesting opportunity to establish a large bank of mental health data from young people that could be accessed by researchers worldwide, but it is important to clarify how to ensure that this is done in an appropriate manner aligned with the values of young people.
OBJECTIVE: In this study, we discussed the preferences of young people in the United Kingdom regarding the governance, sharing, and use of their mental health data with the establishment of a global data bank in mind. We aimed to determine whether young people want and feel safe to share their mental health data; if so, with whom; and their preferences in doing so.
METHODS: Young people (N=46) were provided with 2 modules of educational material about data governance models and background in scientific research. We then conducted 2-hour web-based group sessions using a deliberative democracy methodology to reach a consensus where possible. Findings were analyzed using the framework method.
RESULTS: Young people were generally enthusiastic about contributing data to mental health research. They believed that broader availability of mental health data could be used to discover what improves or worsens mental health and develop new services to support young people. However, this enthusiasm came with many concerns and caveats, including distributed control of access to ensure appropriate use, distributed power, and data management that included diverse representation and sufficient ethical training for applicants and data managers.
CONCLUSIONS: Although it is feasible to use smartphones to collect mental health data from young people in the United Kingdom, it is essential to carefully consider the parameters of such a data bank. Addressing and embedding young people\'s preferences, including the need for robust procedures regarding how their data are managed, stored, and accessed, will set a solid foundation for establishing any global data bank.

BACKGROUND: The use of temporary doctors, known as locums, has been common practice for managing staffing shortages and maintaining service delivery internationally. However, there has been little empirical research on the implications of locum working for quality and safety. This study aimed to investigate the implications of locum working for quality and safety.
METHODS: Qualitative semi-structured interviews and focus groups were conducted with 130 participants, including locums, patients, permanently employed doctors, nurses and other healthcare professionals with governance and recruitment responsibilities for locums across primary and secondary healthcare organisations in the English NHS. Data were collected between March 2021 and April 2022. Data were analysed using reflexive thematic analysis and abductive analysis.
RESULTS: Participants described the implications of locum working for quality and safety across five themes: (1) \'familiarity\' with an organisation and its patients and staff was essential to delivering safe care; (2) \'balance and stability\' of services reliant on locums were seen as at risk of destabilisation and lacking leadership for quality improvement; (3) \'discrimination and exclusion\' experienced by locums had negative implications for morale, retention and patient outcomes; (4) \'defensive practice\' by locums as a result of perceptions of increased vulnerability and decreased support; (5) clinical governance arrangements, which often did not adequately cover locum doctors.
CONCLUSIONS: Locum working and how locums were integrated into organisations posed some significant challenges and opportunities for patient safety and quality of care. Organisations should take stock of how they work with the locum workforce to improve not only quality and safety but also locum experience and retention.

Despite the increased importance attributed to distributed improvisation in major crises, few studies investigate how central authorities can promote a harmonic, coordinated national response while allowing for distributed autonomy and improvisation. One idea implicit in the literature is that central authorities could help track and tackle common decision bottlenecks as they emerge across \"improvising\" local authorities as a result of shared, dynamic external constraints. To explore this idea we map central functions needed to roll-out vaccines to local populations and identify and classify bottlenecks to decision-making by local authorities managing COVID-19 vaccine roll-out in Norway. We found five bottlenecks which emerged as vaccine roll-out progressed, three of which could feasibly have been addressed by changing the local authorities\' external constraints as the crisis developed. While the national crisis response strategy clearly allowed for distributed improvisation, our overall findings suggest that there is potential for central authorities to address external constraints in order to ease common bottlenecks as they emerge across local authorities responding to the crisis. More research is to explore alternative centralized response strategies and assess how well they effectively balance centralized and distributed control. The study contributes to the growing literature examining the interaction between local and centralized response in crisis management.

Since 2020, Thailand has experienced four waves of COVID-19. By 31 January 2022, there were 2.4 million cumulative cases and 22,176 deaths nationwide. This study assessed the governance and policy responses adapted to different sizes of the pandemic outbreaks and other challenges.
A qualitative study was applied, including literature reviews and in-depth interviews with 17 multi-sectoral actors purposively identified from those who were responsible for pandemic control and vaccine rollout. We applied deductive approaches using health systems building blocks, and inductive approaches using analysis of in-depth interview content, where key content formed sub-themes, and different sub-themes formed the themes of the study.
Three themes emerged from this study. First, the large scale of COVID-19 infections, especially the Delta strain in 2021, challenged the functioning of the health system\'s capacity to respond to cases and maintain essential health services. The Bangkok local government insufficiently performed due to its limited capacity, ineffective multi-sectoral collaboration, and high levels of vulnerability in the population. However, adequate financing, universal health coverage, and health workforce professionalism and commitment were key enabling factors that supported the health system. Second, the population\'s vulnerability exacerbated infection spread, and protracted political conflicts and political interference resulted in the politicization of pandemic control measures and vaccine roll-out; all were key barriers to effective pandemic control. Third, various innovations and adaptive capacities minimized the supply-side gaps, while social capital and civil society engagement boosted community resilience.
This study identifies key governance gaps including in public communication, managing infodemics, and inadequate coordination with Bangkok local government, and between public and private sectors on pandemic control and health service provisions. The Bangkok government had limited capacity in light of high levels of population vulnerability. These gaps were widened by political conflicts and interference. Key strengths are universal health coverage with full funding support, and health workforce commitment, innovations, and capacity to adapt interventions to the unfolding emergency. Existing social capital and civil society action increases community resilience and minimizes negative impacts on the population.

UNASSIGNED: Street foods are foods and beverages as either ready for direct consumption or minimally processed, prepared, and/or sold by vendors and handlers. The objective of this study was to explore the condition and governance of street foods in Ethiopia.
UNASSIGNED: A qualitative exploratory study was employed from December 2022 to January 2023 in Addis Ababa, Hawassa, Dire Dawa, and Jimma, cities of Ethiopia. Twelve respondents comprised key informants from selected governmental sectors were interviewed. The purposive sampling method was used to recruit study participants. The number of participants interviewed was determined by the information saturation criterion, and data were collected at the interviewee\'s offices. Data were collected by using key informant interview technique and audio recorded. An interview guide was used to facilitate interviews and thematic analysis was employed. The Overall data management process was conducted using Atlas-ti V 8 software.
UNASSIGNED: The result revealed there were 4 thematic areas these were street food vendors and vending process, policy content and implementation, integration and coordination of sectors, and the way forward. The street food vendors prepared their food in an insanitary manner, absence of common working places for the vendors, lack of due emphasis for the street food vendors in the national food and nutrition policy, lack of formalization and legalization of street food vendors, poor coordination among sectors and institutions work on street food governance, and weakness on the implementation of rules and regulations in controlling street food vendors were the prominent gaps that were identified in the policy.
UNASSIGNED: Though Ethiopia has a national food and nutrition policy, the policy doesn\'t adequately address the street food vending sector. Besides, it is not well communicated to the implementers resulting in poor policy implementation. Quantifying socio-economic benefits of street food vending activities in Ethiopia needs further investigation.

Integrated Place-Based Primary Interventions (IPPIs) are considered an innovative response to the challenges and complex issues faced in disadvantaged areas where traditional institutional services have difficulty reaching people in vulnerable situations. IPPIs are an innovative approach to the delivery of in services, conceived as an original community-based local care and service pathways. However, these intervention practices require adaptive modes of governance. In this article, we explore how and to what extent the mode of governance of IPPIs influences the performance of community-integrated pathways. To this end, using a qualitative exploratory multiple-case study design (observation and semi-structured interviews), we describe 4 IPPIs in 3 territories in Quebec. This includes an examination of the levers of action and tensions related to their governance and the performance levels of the community-integrated pathways. We conclude that collaborative and shared multilevel governance, despite its demanding nature, appears to contribute to the longevity of the actions and benefits of IPPIs and could prevent their relevance from being questioned.

BACKGROUND: Youth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system.
METHODS: We conducted 42 interviews (November 2020 to March 2022) with health and social care professionals and managers in the youth mental health system in Sweden. Interviews explored participants\' experience and understanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergent study design using reflexive thematic analysis.
RESULTS: The analysis produced three themes. The first shows that collaboration is considered as essential and important, and that it serves diverse purposes and holds multiple meanings in relation to professionals\' roles and responsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, and target levels, and the third captures the challenges and criticisms in collaborating across the youth mental health landscape, but also in growing possibilities for future development.
CONCLUSIONS: We conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system.

UNASSIGNED: The ageing population poses significant challenges to healthcare systems, necessitating the establishment of high-functioning, integrated frameworks for elderly healthcare. This study aimed to explore the key challenges associated with the stewardship of elderly care in Iran and to develop a holistic stewardship framework.
UNASSIGNED: For this qualitative study, thirty semi-structured interviews were conducted with key Iranian healthcare stakeholders, utilizing purposive and snowball sampling during 2021-2022. Inductive open coding was utilized to generate new concepts related to key stewardship challenges. The World Health Organization\'s conceptual framework, outlining the three stewardship tasks, served as the basis for crafting a tailored framework for elderly healthcare stewardship in Iran.
UNASSIGNED: Fourteen main challenges and 38 sub-challenges were identified for elderly healthcare stewardship in Iran, categorized according to the WHO framework\'s three stewardship tasks. Challenges related to WHO stewardship task 1, involving health policy formulation and vision definition, included challenges in vision definition, planning, policymaking, and intergovernmental institutional superiority. Challenges related to WHO stewardship task 2, delineating governance and stewardship through control and regulation, encompassed issues such as support for the elderly, system responsiveness, behavior of healthcare providers, organizational structure, and cross-sectoral leadership challenges. Challenges associated with WHO stewardship task 3, about the use of collective intelligence, explored stakeholder collaboration, information for decision-making, and challenges within the elderly information system, covering data documentation, reporting, analysis, accessibility, distribution, and circulation. Subsequently, a framework was developed, covering areas like defining the vision and direction of health policy, managing information systems, evidence-informed policymaking, and delivering elderly health services with a holistic approach.
UNASSIGNED: The present framework shows how a management information system, guided by evidenced-informed policymaking and the formulation of customized health policies, can facilitate the provision of elderly health services based on identified needs. It presents a governance and stewardship pathway that can be adopted by Iranian health policymakers and similar middle-income countries facing analogous challenges in ageing and aged care system stewardship, serving as a model for developing their own frameworks.

CO2 emissions have increased exponentially in recent years, so measuring and quantifying carbon sequestration is a step towards sustainable forest management and combating climate change. The overall goal of this study is to develop an accurate model for estimating carbon storage and sequestration for forest areas of the Atlantic Biogeographic Region. Specifically, the modelling and field sampling are carried out in the municipality of Baiona (Galicia, NW Spain), which was selected as a representative biome of this region. The methodology consists of carrying out two object-based image analysis (OBIA) classifications in spring and autumn to observe possible stocks of seasonal differences. Two carbon storage and sequestration models are built up (model 1 and model 2): model 1 for forest areas only and model 2 including all other land cover in the study area. Sentinel-2 geospatial data for 2021, Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) tools and geographic information systems (GIS) are used. A Kappa index of 0.92 is obtained for both classifications, thus ruling out any notable seasonal differences in the images used. The results from both models indicate that it is land covers associated with forest uses which store the most carbon in the study area, accounting for >50 % more than the other land covers. It is concluded that the methodology and data used are very useful for quantifying ecosystem services, which will help the governance of the region by implementing measures to mitigate some of the effects of climate change and help to create silvicultural models for the sustainable management of the Atlantic Biogeographic Region.