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These units received neonates suffering from respiratory distress (a condition requiring referral from the other sites we were working in) from all over Tver Oblast; 4. Implementing policy level changes that facilitated the referral of neonates to higher-level facilities.
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More so than in the past, the local level is key in implementing policy measures.
Instead, in a 'creationist' interpretation – well evident in several regional laws – the DAs were to become subjects to be set up for implementing policies at local level.
Problems of capacity are likely to remain an important concern under localization: the weak capacity of local actors will pose a significant obstacle to identifying problems, designing and evaluating solutions, and implementing policies at the local level.
Instead, countries need to focus on how they can create an adequate supply by implementing policies affecting education and training, levels and methods of remuneration, retention and retirement of domestic physicians [ 16].
These included government documents as well as documents from non-governmental organizations that were implementing policies and programs at a provincial level.
The challenge of preventing abuse in an institutional setting is not about formulating policy, but rather fostering a culture that respects and implements policy at all levels.
Theory is often neglected as a tool for providing evidence to inform better practice; in this study we investigated the reasons for poor implementation of the policy in Ghana using Lipsky's theory of street-level bureaucracy to better understand how providers shape and implement policy and how provider-level barriers might be overcome.
The feedback loop is important to improvise and implement policy effectively at the local level.
Gaps in priority setting and synchronicity across departments were reported (Sri Lanka), as well as the need for capacity building at local level to implement policy (Bangladesh).
Importantly, recommendations were also made for introduction of the guidelines into the community: 'Public, private, and community organizations should work collaboratively at national, state, and local levels to implement policy and environmental changes…' [ 190].
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