BackgroundPolicy making, translation and implementation in politically and administratively decentralized systems can be challenging. Beyond the mere sub-national acceptance of national initiatives, adherence to policy implementation processes is often poor, particularly in low and middle-income countries. In this study, we explore the implementation fidelity of integrated PHC governance policy in Nigeria’s decentralized governance system and its implications on closing implementation gaps with respect to other top-down health policies and initiatives.MethodsHaving engaged policy makers, we identified 9 core components of the policy (Governance, Legislation, Minimum Service Package, Repositioning, Systems Development, Operational Guidelines, Human Resources, Funding Structure, and Office Establishment). We evaluated the level and pattern of implementation at state level as compared to the national guidelines using a scorecard approach.ResultsContrary to national government’s assessment of level of compliance, we found that sub-national governments exercised significant discretion with respect to the implementation of core components of the policy. Whereas 35 and 32% of states fully met national criteria for the structural domains of “Office Establishment” and Legislation” respectively, no state was fully compliant to “Human Resource Management” and “Funding” requirements, which are more indicative of functionality. The pattern of implementation suggests that, rather than implementing to improve outcomes, state governments may be more interested in executing low hanging fruits in order to access national incentives.ConclusionsOur study highlights the importance of evaluating implementation fidelity in providing evidence of implementation gaps towards improving policy execution, particularly in decentralized health systems. This approach will help national policy makers identify more effective ways of supporting lower tiers of governance towards improvement of health systems and outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2179-2) contains supplementary material, which is available to authorized users.

No abstract

No abstract

The emerging challenge of managing increasing volumes of urban sewage has resulted in municipalities pursuing sustainable ways to manage urban biosolids and their byproducts. Using content analysis of public debates, and situating the debate within science, policy and facility siting literature, this study examines claims and counterclaims relating to the siting of a biosolid processing facility in rural Ontario. The equivocal evidence on the health and environmental effects of biosolids resulted in a heated "expert versus lay" debate. The study critically evaluates the importance of trust and the shifting role of scientific evidence in politicised settings, while making relevant policy recommendations.