The political economy of co-ordination challenges in the National Health Service: a postpositivist evaluation of diabetes policy and governance

The present PhD thesis develops and applies an evaluative methodology suited to the evaluation of policy and governance in complex policy areas. While extensive literatures exist on the topic of policy evaluation, governance evaluation has received less attention. At the level of governance, policymakers confront choices between different policy tools and governance arrangements in their attempts to solve policy problems, including variants of hierarchy, networks and markets. There is a need for theoretically-informed empirical research to inform decision-making at this level. To that end, the PhD develops an approach to evaluation by combining postpositivist policy analysis with heterodox political economy. Postpositivist policy analysis recognises that policy problems are often contested, that choices between policy options can involve significant trade-offs and that knowledge of policy options is itself dispersed and fragmented. Similarly, heterodox economics combines a concept of incommensurable values with an appreciation of the strengths and weaknesses of different institutional arrangements to realise them. A central concept of the field is coordination, which orientates policy analysis to the interactions of stakeholders in policy processes. The challenge of governance is to select the appropriate policy tools and arrangements which facilitate coordination. Via a postpositivist exploration of stakeholder ‘frames’, it is possible to ascertain whether coordination is occurring and to identify problems if it is not. Evaluative claims of governance can be made where arrangements can be shown to frustrate the realisation of shared values and objectives. The research makes a contribution to knowledge in a number of ways a) a distinctive evaluative approach that could be applied to other areas of health and public policy b) greater appreciation of the strengths and weaknesses of different forms of evidence in public policy and in particular health policy and c) concrete policy proposals for the governance and organisation of diabetes services, with implications for the NHS more broadly.

Troubled waters: an institutional analysis of ageing Dutch and American waterway infrastructure

Waterways are one of the oldest systems for the transportation of cargo and continue to play a vital role in the economies of some countries. Due to societal change, climate change and the ageing of assets, the conditions influencing the effective functioning of these systems seem to be changing. These changing conditions require measures to renew, adapt or renovate these waterway systems. However, measures with the sole aim of improving navigation conditions have encountered resistance, as the general public, and stakeholders in particular, value these waters in many more ways than navigation alone. Therefore, a more inclusive, integrated approach is required, rather than a sectoral one. Addressing these contemporary challenges requires a shift in the traditional waterway authorities' regimes. The aim of this study is to identify elements in the institutional setting where obstacles and opportunities for a more inclusive approach can be found. Two major waterway systems, the American and the Dutch, have been analyzed using the Institutional Analysis and Development framework to reveal those obstacles and opportunities. The results show that horizontal coordination and a low pay-off for an inclusive approach is particularly problematic. The American case also reveals a promising aspect – mandatory local co-funding for federal navigation projects acts as a stimulus for broad stakeholder involvement. Improving horizontal coordination and seizing opportunities for multifunctional development can open pathways to optimize the value of waterway systems for society.

Gentrifying the Peri-urban: Land use Conflicts and institutional dynamics at the Frontier of an Indonesian Metropolis

This paper aims to specify the meaning of gentrification in rapidly peri-urbanising metropolitan regions in the context of Indonesia’s rapid transition to decentralisation and democracy. It discusses a case study of conflict over an environmental revitalisation project in a peri-urban area of Bandung City. The analysis focuses on the political processes, tactics and strategies supporting and opposing peri-urban gentrification and their consequences. The analysis illustrates how these political dynamics mediate the interaction between the movement of capital and the spatial reorganisation of social classes. It is argued that in the context of a peri-urbanising metropolis, gentrification needs to be narrated less in terms of class-based neighbourhood succession and more in terms of competing cross-class coalitions emerging at local and regional levels.

Small farmers and sustainability: institutional barriers to investment and innovation in the Malaysian palm oil industry in Sabah

The Malaysian palm oil industry is well known for the social, environmental and sustainability challenges associated with its rapid growth over the past ten years. Technologies exist to reduce the conflict between national development aims of economic uplift for the rural poor, on the one hand, and ecological conservation, on the other hand, by raising yields and incomes from areas already under cultivation. But the uptake of these technologies has been slow, particularly in the smallholder sector. In this paper we explore the societal and institutional challenges that influence the investment and innovation decisions of micro and small enterprise (MSE) palm oil smallholders in Sabah, Malaysia. Based on interviews with 38 smallholders, we identify a number of factors that reduce the smallholders' propensity to invest in more sustainable practices. We discuss why more effective practices and innovations are not being adopted using the concepts of, firstly, institutional logics to explore the internal dynamics of smallholder production systems, including attitudes to sustainability and innovation; and, secondly, institutional context to explore the pressures the smallholders face, including problems of access to land, labour, capital, knowledge and technical resources. These factors include limited access to global market information, corruption and uncertainties of legal title, weak economic status and social exclusion. In discussing these factors we seek to contribute to wider theoretical debates about the factors that block innovation and investment in business improvements in marginal regions and in marginalised groups.