Railways stations are an important piece of infrastructure and public space in any given community. To many people, these infrastructures play a significant role to them in terms of enabling them engage in social commitments and work. In addition, for those who do not have personal cars, railways helps in maintaining community links as well as reducing social isolations (Yildirim, Allen and Albright, 2019). In (2012), the International Agency for Research on Cancer (IARC) established that diesel engine exhaust as well as related ambient air pollution was carcinogenic and related with cancer. This harbored serious implications for both occupational and public health especially in railway stations that harbor inadequate ventilations. Furthermore, pollution from vehicles and electric trains also contribute to poor air quality owing to the friction between rail and wheel, production of metal-rich ultrafine particles generated from brake linings as well as overhead pantographs. A number of factors have to be considered and applied in public health management at Railways stations in order to make its implementation effective (Thornes, 2017).
This research is deemed to present insights related to the factors enhancing effective implementation health management and development of strong communities. Therefore, by understanding these factors, managers and leaders at station managers will be able understand the strategies to be used in implementing public health management at railways stations. In practical sphere, policy makers, organizational leaders, and the management at Railways stations will be in a better position to understand how to make the public health management at railways stations more effective. More so, scholars will be triggered to reassess the study angles and embark on conducting a more in-depth search on this topic. In other words, they will be triggered to fill in the gaps.
The purpose of the previous chapter was basically to introduce the research project. It did this through presenting a background of the research, an outline of the research problem, aim and objectives that the study will cover. The present chapter reviews previous literature in line with the topic “Implementation of Public health management at Railway Stations”. The review will be essentially a critical analysis of previous studies regarding implementation of public health management at railway stations, innovation, commitment stakeholder’s role and the challenges. The chapter will conclude with a summary, detailing key points discussed in the review.
3.2 Theoretical Framework
The theoretical framework applied for this research is the stakeholder’s theory. First described by Dr. Edward Freeman in the book “Strategic Management: A Stakeholder Approach” the theory postulates that stakeholder ecosystem entails anyone involved or invested, or affected by the organization (Freeman, 2010). These could be employees, government agencies, vendors, suppliers, environmentalists, among others. According to this theory, the success of any business lies on satisfying all of its stakeholders, not just those who are seeking to gain from its stock (Freeman, 2010). However, this view contradicts those formulated by Milton Friedman who argued that shareholders are the only important stakeholders that a company should care about. In this regard, these shareholders should form a firm’s bottom-line. Friedman’s observation was that companies existed for the sole purpose of making a profit and hence; their core goal was simply to satisfy the needs of shareholders so as to proceed with positive growth (Friedman, 2002). Nonetheless, Freeman contradicts those views by articulating that a company’s stakeholders are those groups or individuals whose absence or lack of support will cause an organization to cease. These groups would be extended to employees, customers, political groups, local communities, suppliers, environmental groups, financial institutions, the media, and many others. This school of thought considers the corporate environment as an ecosystem of associated groups. These groups have to be given attention and satisfied so as to make the organization successful and health both in the short and long term. Dr. Freeman argues that it is not possible for a company to ignore its stakeholders and truly succeed.
3.3 Implementation of public health management
Frieden (2014) argues that innovation is critical for all spheres of public health strategy. It is also required in development of evidence base which is so much required in establishing and refining the technical aspects of implementing a successful program. For instance, the use and implementation of a new microbial genomic bioinformatics and sequencing technology could assist in identification of outbreaks which may not be currently found while also better stopping and preventing the spread of contagious ailments in open and enclosed spaces such as railways stations. The Center for Disease Control (CDC) explains that innovations need not be limited to medicine or science. Instead, they extend to communication techniques, data collection, information systems, or issue framing. These are also important for progress as well as political commitment (CDC, 2019).
3.3.2 Technical package
The technical package comprise of a selected group of related interventions which when combined achieves and sustains synergistic and substantial improvement in a given health outcome (Frieden, 2014). Rakha Abdelmoneim and Farhoud (2013) argue that the use of technical package which is evidence based facilitates and enhances the effectiveness of public health programs. Furthermore it also aids in scalability and cost-implications in healthcare interventions. In support of this observation, Frieden (2014) also notes that polio is successfully being eradicated in the world thanks to the technical package of vaccination and surveillance.
Communication is quite important in the effectiveness of any program. In essence, any organization including that of a railway station must have an effective communication hierarchy for a better functioning. This is because if done well, it can have a positive influence towards change of behavior. Furthermore, effective communication is required so as to engage different stakeholders, as well as in changing the perception of the public regarding a given matter (Frieden, 2014). Ricardo and Telfer (2010) observes that with the rise of communication avenues including the internet and voices, communications in the public health sector could be jeopardized if the communication strategies are not well executed, sustained, well defined and timely to meet the particular goals.
The National Prevention Council (2011) explains that key roles in public health is specifically carried out by the private-public sectors partners which through partnerships strive to improve and sustain the public health. It may not be an easy endeavor for organizations in the health care to partner. According to Vazquez-Brust et al. (2014), this collaboration is quite necessary so as to facilitate advocacy which is so required to support regulatory, legislative or budgetary change as well as in implementing improved and new programs. Programs that require government input have a more likelihood of being sustained and succeeding when organizations that are not part of the government advocate for them (Vazquez-Brust et al., 2014).
Implementation of public health programs is in most cases, a problem of the management. In particular, managing public health operations proves a difficult endeavor. This owes to lack of affordable, accurate and automatic way of tracking the performance of a public health program in real time (Frieden, 2014). In addition, the impact of a certain public health program may come to the fore after some time, making performance evaluations complicated. On the contrary, metrics including sales offer real time feedback on a given program’s performance. Public health programs which are effective necessitate timely, accurate information systems for successful implementation and disease surveillance (CDC, 2019). However, railways stations are not always prepared to deal with public health developments because their core mandate is transportation (Yildirim et al, 2019).
3.3.6 Political Commitment
Political support or lack of it determines the allocation of support and resources required in coordinating, sustaining and implementing public health programs and interventions. These include policy change if necessary (Ashley et al 2015). Public health interventions may affect directly or indirectly different sectors of the society and the economy. These could lead to some groups especially those that will be affected to oppose proposals for public health interventions towards public utilities such as railway stations aggressively. Furthermore, these opponents may happen to be well funded, vocal, and well organized. Moreover, opposition from such interest groups may be strong, irrespective of the benefits such a health program will generate to the society (Hafner, Shiffman, 2013). To overcome these, political commitments are paramount to leverage opposition of a given public health program by specific interest groups including tobacco companies. This also requires clear cut communication with relevant stakeholder’s comprehension of industry trends, public and community engagement in public health initiatives (Ashley et al 2015).
3.4 Stakeholders and Implementation of Public Health Management
Effective implementation of public health management requires collaborations, alliances and partnership with both internal and external stakeholders (Tarkkanen et al, 2015). These stakeholders who include shareholders, patients, the public, and the government and healthcare providers among others harbor divergent interests (Ari-Matti 2017). In public utilities such as railway stations, stakeholders would be travelers, the government authorities, employees, suppliers, and the management and health workers. For the operational environment of public health management to be improved, the different interests of these stakeholders should be analyzed and recognized. Nonetheless, The World Health Organisation (WHO) emphasizes that the various stakeholders in public health need to work together collaboratively (Auvinen et al, 2010).
In today’s approach to public health management, the public are critical for value creation (Ashley et al 2015). It is also widely understood that in healthcare contexts, public are the primary stakeholders (Reijonsaari, 2013). Taking into consideration that an individual’s health behavior is the most important determinant of his or her health, the public health management team need to accord necessary support so as to co-create better health. Co-creation is the approach where exchange and interactions occur between collaborators ((Ashley et al 2015). The essentiality of co-creation stems from its emphasis on the involvement and critical role played by users in creating value, as well as encounters with different actors (Gilson et al, 2012).
The management group in public utilities is also another key internal stakeholder in public health. The role of these managers include instituting policy guidelines, ensuring that public health management is affectively implemented, allocating resources and ensuring that the goals are attained (Reijonsaari, 2013). Moreover, peer groups and staff including service providers, caregivers, are considered critical internal stakeholders. This is because they play a role in promoting health among the public (travelers and their families), as well as providing health services of different nature to promote the well-being of the public (Ari-Matti 2017).
Auvinen et al (2010) points out that the needs of stakeholders including those with low power, but medium or high interest has to be addressed for public health management. This can be done through a selected, consistent distribution of information. The author emphasizes the need to lobby for support from these stakeholders considering their power to influence the perceptions of stakeholders who may be more powerful (Tarkkanen et al, 2015).
3.5 Challenges in the implementation of public health management
Health systems are generally complex across different health service levels and contexts. The capacities required by health leaders and managers in responding to present and emerging issues are yet to be understood. In implementation of public health management, health managers and leaders face a number of challenges (Jeurissen et al., 2016). Among these include but not limited to inadequate funding, misappropriation of funds, poor policy planning and programme implementation, shortage of human resource in health, lack of political will among others (Miners, Hundert and Lash, 2015). In many jurisdictions, there is hardly adequate financial support accorded for public health operations. It should be noted that public health is in competition with equally other critical public functions. This translates to a limited government support in terms of resource distribution. In addition to these financial challenges are particular financial problems such as resource and financial misappropriation in some regions which impedes fair and effective implementation of public health management (Ashley et al., 2015). In other words, funds that are supposed to be used for a particular course/project are directed elsewhere or misappropriated by those responsible leading the program to stall (Jha et al., 2016).
Poor policy planning in public health management is also an obstacle to its implementation. In general, policy planning and implementation in health systems is a difficult endeavor (Ashley et al 2015). Possible explanations for a weak and poor policy implementation include but not limited to unrealistic policy goals, inadequate financial and human resources, and lack of political good will especially towards the health sector (Edmonstone, 2014). There are also issues to do with poor communications between and among different system levels, poor strategies for operational management as well as the means of measuring policy implementations among others. Coupled with these challenges is the intense shortage of human resource in health care to address the prevalent and emerging public health needs. Despite a significant level of increase generally regarding health workforce numbers globally, the challenges of human resources in health is highly varied and complex. These include workforce shortages, imbalances in geographical distribution, and imbalances in skill mix, ineffective utilization of resources, staff burnout, and poor inter-professional partnership (Jha et al, 2016). In this regard, Miners et al (2015), opines that effective workforce management and leadership is essential in effectively addressing the human resource needs within health system as well strengthening capacities at global and regional levels.
From this review, it is evident that there is a number of factors influencing the success on implementation of public health management. Among these are innovation and its applications in public healthy strategy, technical package, effective communication and partnership among stakeholders, effective management of the public health program and political commitment. Furthermore, studies have ascertained the importance of engaging key stakeholders including staff, partners, the government, politicians among others in public health management programs. Lastly, this review also looked into some of the challenges inherent on implementation processes on public health management. Some of the challenges noted included inadequate financial and other resources, misappropriation of resources, and lack of adequate human resources, poor policy planning, poor inter-professional partnership, and lack of political goodwill. However, the review notes a research gap related to case studies on success factors contributing to success of implementations of public health management. It is on this prerogative that the current study seeks to employ China Railways as a case study to determine factors contributing or hindering effective implementation of public health management in the institution.
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