Fostering collaboration through a problem driven approach : the ASEAN study of health workforce governance

Abstract

In Southeast Asia, collaborative governance is critical given significant transnational challenges such as demographic shifts, epidemiological transitions and frequent natural and human induced disasters. Each of these issues is complex and has significant implications for sustainable and inclusive development and public health. As a result, there are unprecedented demands on government agencies to take action. Despite decades of sustained economic growth in the region, there is need for a renewed approach to monitor problems of policy implementation and collaboration to solve transnational challenges.

How governments collaborate to monitor and solve problems is a persistent challenge worldwide. Given the decentralized nature of government, monitoring relevant outcomes and accountabilities is a complex task. To cope, traditional bureaucracies have transformed into networks of service providers that rely on cross-sector collaboration and a diverse range of actors. This type of collaborative governance now represents a dominant form of how governments get things done.

Collaboration theory suggests that three factors drive collaborative governance – the conditions, collaborative dynamics and outcomes and accountabilities. However, the value of generalized models is challenged by a decentered approach to understanding local stakeholder beliefs, practices, traditions and dilemmas. This thesis proposes that a problem driven approach to collaborative governance can resolve this tension and extend collaboration theory by focusing relentlessly on solving a locally defined, attention-grabbing problem.

This thesis explores how governance networks monitor problems in the Association of Southeast Asian Nations (ASEAN) and how they adapt. Case studies are well-suited for the challenge of exploring a specific context of decision-making, including why, how and with what results such decisions were made. Using a multiple case study design, this research draws on multiple sources of evidence including 20 in-depth interviews with delegates from nine (n=9) countries and confidential meeting records (n=380) on health workforce governance in ASEAN from 2015-2018. The research objectives are to understand how problems are monitored by two governance committees in the healthcare services working group of ASEAN.

Three primary findings include evidence that a problem driven approach can identify relevant areas of inactivity in collaborative governance; that felt needs of delegates provide a more holistic understanding of policy implementation than is currently practiced; and finally, that practitioners are receptive to a problem driven approach and believe it can foster more successful collaboration in ASEAN health workforce governance. A problem driven approach to collaboration is elaborated with potential implications for collaboration theory, evidence-based policy and planning, and monitoring collaboration in health workforce governance in ASEAN.