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At the national scale, almost all of the European countries have already achieved energy transition targets, while at the regional and local scales, there is still some potential to further push sustainable energy transitions. Regions and localities have the support of political, social, and economic actors who make decisions for meeting existing social, environmental and economic needs recognizing local specificities. These actors compose the sustainable energy governance that is fundamental to effectively plan and manage energy resources. In collaborative relationships, these actors share, save, and protect several kinds of resources, thereby making energy transitions deeper and more effective. This research aimed to analyse a part of the sustainable energy governance composed of formal relationships between municipalities and public utilities and to investigate the opportunities to further spread sustainable energy developmentwithin a region. In the case study from South Tyrol, Italy, the network structures and dynamics of this part of the actual energy governance were investigated through a social network analysis and Bayesian exponential random graph models. The findings confirmed that almost all of the collaborations are based on spatial closeness relations and that the current network structures do not permit a further spread of the sustainable energy governance. The methodological approach can be replicated in other case studies and the findings are relevant to support energy planning choices at regional and local scales. ; open

A plethora of new development goals and funding institutions have greatly increased the demand for internationally comparable health estimates in recent years, and have brought important new players into the field of health estimate production. These changes have rekindled debates about the validity and legitimacy of global health estimates. This paper draws on country case studies and personal experience to support our opinion that the production and use of estimates are deeply embedded in specific social, economic, political and ideational contexts, which differ at different levels of the global health architecture. Broadly, most global health estimates tend to be made far from the local contexts in which the data upon which they are based are collected, and where the results of estimation processes must ultimately be used if they are to make a difference to the health of individuals. Internationally standardised indicators are necessary, but they are no substitute for data that meet local needs, and that fit with local ideas of what is credible and useful. In other words, data that are both technically and socially robust for those who make key decisions about health. We suggest that greater engagement of local actors (and local data) in the formulation, communication and interpretation of health estimates would increase the likelihood that these data will be used by those most able to translate them into health gains for the longer term. Besides strengthening national information systems, this requires ongoing interaction, building trust and establishing a communicative infrastructure. Local capacities to use knowledge to improve health must be supported.

A plethora of new development goals and funding institutions have greatly increased the demand for internationally comparable health estimates in recent years and have brought important new players into the field of health estimate production. These changes have rekindled debates about the validity and legitimacy of global health estimates. This paper draws on country case studies and personal experience to support our opinion that the production and use of estimates are deeply embedded in specific social, economic, political, and ideational contexts, which vary at different levels of the global health architecture. Broadly, most global health estimates tend to be made far from the localities where the data upon which they are based are collected and where the results of estimation processes must ultimately be used if they are to make a difference to the health of individuals. Internationally standardised indicators are necessary, but they are no substitute for data that meet local needs and that fit with local ideas of what is credible and useful - in other words, data that are both technically and socially robust for those who make key decisions about health. We suggest that greater engagement of local actors (and local data) in the formulation, communication, and interpretation of health estimates would increase the likelihood that these data will be used by those most able to translate them into health gains for the longer term. Besides strengthening national information systems, this requires ongoing interaction, building trust, and establishing a communicative infrastructure. Local capacities to use knowledge to improve health must be supported.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.Introduction Indonesia, the world's fourth most populous nation, is close to achieving universal health coverage (UHC). A widely-publicised falsified vaccine case in 2016, coupled with a significant financial deficit in the national insurance system, has contributed to concern that the rapid scale-up of UHC might undermine medicine quality. We investigated the political and economic factors that drive production and trade of poor-quality medicines in Indonesia. Methods We reviewed academic publications, government regulations, technical agency documents and news reports to develop a semi-structured questionnaire. We interviewed healthcare providers, policy-makers, medicine regulators, pharmaceutical manufacturers, patients and academics (n=31). We included those with in-depth knowledge about the falsified vaccine case or the pharmaceutical business, medicine regulation, prescribing practice and the implementation of UHC. We coded data using NVivo software and analysed by constant comparative method. Results The scale-up of UHC has cut revenues for physicians and pharmaceutical manufacturers. In the vaccine case, free, quality-assured vaccines were available but some physicians, seeking extra revenue, promoted expensive alternatives. Taking advantage of poor governance in private hospitals, they purchased cut-price 'vaccines' from freelance salespeople. A single-winner public procurement system which does not explicitly consider quality has slashed the price paid for covered medicines. Trade, industrial and religious policies simultaneously increased production costs, pressuring profit margins for manufacturers and distributors. They reacted by cutting costs (potentially threatening quality) or by market withdrawal (leading to shortages which provide a market for falsifiers). Shortages and physician-promoted irrational demand push patients to buy medicines in unregulated channels, increasing exposure to falsified medicines. Conclusion Market factors, including political pressure to reduce medicine prices and healthcare provider incentives, can drive markets for substandard and falsified medicines. To protect progress towards UHC, policy-makers must consider the potential impact on medicine quality when formulating rules governing health financing, procurement, taxation and industry.

A plethora of new development goals and funding institutions have greatly increased the demand for internationally comparable health estimates in recent years, and have brought important new players into the field of health estimate production. These changes have rekindled debates about the validity and legitimacy of global health estimates. This paper draws on country case studies and personal experience to support our opinion that the production and use of estimates are deeply embedded in specific social, economic, political and ideational contexts, which differ at different levels of the global health architecture. Broadly, most global health estimates tend to be made far from the local contexts in which the data upon which they are based are collected, and where the results of estimation processes must ultimately be used if they are to make a difference to the health of individuals. Internationally standardised indicators are necessary, but they are no substitute for data that meet local needs, and that fit with local ideas of what is credible and useful. In other words, data that are both technically and socially robust for those who make key decisions about health. We suggest that greater engagement of local actors (and local data) in the formulation, communication and interpretation of health estimates would increase the likelihood that these data will be used by those most able to translate them into health gains for the longer term. Besides strengthening national information systems, this requires ongoing interaction, building trust and establishing a communicative infrastructure. Local capacities to use knowledge to improve health must be supported.

__Background:__ Track and trace systems are increasingly being implemented as a technological solution to secure pharmaceutical supply chains. Turkey was the first country to implement a full pharmaceutical track and trace system throughout the entire regulated domestic supply chain. This article explores the emergence and functioning of this system and the consequences for substandard and falsified medicine with a focus on the underlying political and economic factors. __Methods:__ This study uses an explanatory case study approach that combined interviews with purposefully selected key informants and document analyses. __Results:__ The main drivers for implementing the pharmaceutical track and trace system in Turkey centered on the elimination of reimbursement fraud and the prevention of falsified medicine in the regulated supply chain. Although stakeholders experienced both physical and software-related problems in implementation, the alignment of incentives of all stakeholders with the power of the state, along with leeway for adaptations, ultimately resulted in a successful process. This track and trace system provides a clean regulated supply chain, minimizes reimbursement fraud, facilitates fast market recalls, and can flag likely medicine shortages. Staff previously engaged in pharmacy inspections now concentrate on ensuring production quality, which reduces the risk of substandard medicines. __Conclusions:__ In Turkey, 4 factors drove the successful implementation of pharmaceutical track and trace: the political determination to eliminate reimbursement fraud, a large pharmaceutical market dominated by a single payer, medicine reimbursement being contingent on verified dispensing and prescription, and flexibility to adapt the system according to the needs of stakeholders during implementation.

The Italian forest sector is facing significant changes and challenges. Changes have recently occurred in the policy, institutional and legislative framework (e.g. the function-shifting from the Forest Corp to the Carabinieri Military Police and the approval of the new National Framework Forest Law). Meanwhile expanding forest resources and territories/communities depending on them have suffered climate change-related challenges (e.g. fires, Vaia windstorm) and the reduced management of mountain areas. Within such a dynamic/critical context, rethinking and (re)activating forest management (FM) is recognised as a priority. However, different possible development paths are debated. Timber/biomass production remains important within the transition to a bioeconomy. Meanwhile initiatives aiming to value multiple ecosystem services (ES) have been launched and strong rewilding/conservation interests have emerged too. Such different positions reflect on dual FM approaches, i.e. integrated and segregated FM. Implications of these approaches shall be analysed in terms of policy tools and governance arrangements they imply as well as possible results/impacts. The paper identifies relevant policy tools and initiatives in Italy and analyses them concerning their potential implications in terms of supporting integrated/segregated FM approaches. Three cases are analysed in depth, in order to cover a range of situations in terms of geographical scale (national/regional/local), promoters/actors (public/private) and approaches (multifunctional/specialised): -The National Forest Strategy, being developed within the Ministry of Agriculture, Food and Forest Policies; -The Lowland Forest Association, a public-private initiative operating across regions in Northern Italy and involved in the world-first application of the FSC ES Procedure for certifying a set of five ES; and -The Val di Sella (Northern Italy), home of a permanent land-art exhibition and developing additional initiatives in the field of cultural ES. The paper builds on a qualitative content analysis. By framing policy tools and initiatives, it aims to provide an up-to-date picture of possible directions/trends in future FM developments in Italy. By analysing three selected cases and their expected/on-going implications for the promotion of integrated or segregated FM, different factors, drivers and barriers are discussed. This two-steps analysis will contribute gaining a better understanding of Italian policies and tools and might contribute to inform future research and policy-making.

In 2013 Indonesia, the world's fourth most populous country, declared that it would provide affordable health care for all its citizens within seven years. This crystallised an ambition first enshrined in law over five decades earlier, but never previously realised. This paper explores Indonesia's journey towards universal health coverage (UHC) from independence to the launch of a comprehensive health insurance scheme in January 2014. We find that Indonesia's path has been determined largely by domestic political concerns - different groups obtained access to healthcare as their socio-political importance grew. A major inflection point occurred following the Asian financial crisis of 1997. To stave off social unrest, the government provided health coverage for the poor for the first time, creating a path dependency that influenced later policy choices. The end of this programme coincided with decentralisation, leading to experimentation with several different models of health provision at the local level. When direct elections for local leaders were introduced in 2005, popular health schemes led to success at the polls. UHC became an electoral asset, moving up the political agenda. It also became contested, with national policy-makers appropriating health insurance programmes that were first developed locally, and taking credit for them. The Indonesian experience underlines the value of policy experimentation, and of a close understanding of the contextual and political factors that drive successful UHC models at the local level. Specific drivers of success and failure should be taken into account when scaling UHC to the national level. In the Indonesian example, UHC became possible when the interests of politically and economically influential groups were either satisfied or neutralised. While technical considerations took a back seat to political priorities in developing the structures for health coverage nationally, they will have to be addressed going forward to achieve sustainable UHC in Indonesia.

__Introduction:__ Substandard and falsified medicines undermine health systems. We sought to unravel the political and economic factors which drive the production of these products, and to explain how they reach patients. __Methods:__ We conducted in-depth case studies in China, Indonesia, Turkey and Romania. We reviewed academic papers and press reports (n = 840), developing semi-structured questionnaires. We interviewed regulators, policy-makers, pharmaceutical manufacturers, physicians, pharmacists, patients and academics (n=88). We coded data using NVivo software, and developed an analytic framework to assess national risks for substandard and falsified medicines. We tested the framework against cases reported to the World Health Organization, from countries at all income levels. __Results:__ We found that increasing political commitment to provision of universal health coverage has led to public procurement policies aimed at lowering prices of medical products. In response, legitimate, profit-driven pharmaceutical companies protect their margins by cutting costs, or withdrawing from less profitable markets, while distributors engage in arbitrage. Meanwhile, health providers sometimes protect profits by 'upselling' patients to medicines not covered by insurers. Cost-cutting can undermine quality assurance, leading to substandard or degraded medicines. Other responses contribute to shortages, irrational demand and high prices. All of these provide market opportunities for producers of falsified products; they also push consumers outside of the regular supply chain, providing falsifiers with easy access to customers. The analytic framework capturing these interactions explained cases in most high and middle-income settings; additional factors operate in the poorest countries. __Conclusions:__ Most efforts to secure medicine quality currently focus on product regulation. However, our research suggests market mechanisms are key drivers for poor quality medicines, including where political commitments to universal health coverage are under-resourced. We have developed a framework to guide country-specific, system-wide analysis. This can flag risks and pinpoint specific actions to protect medicine quality, and thus health.

Abstract Social innovation (SI) impacts are long-term changes that affect different dimensions of territorial capital (i.e., economy, society, environment, governance) for the territory in which SI occurs. Yet, systematic empirical evidence and theoretically sound assessments of the impacts of SI are scarce. This paper aims to fill the gap and assess the different aspects of SI's impacts in European and Mediterranean areas that are characterized by marginalization processes. To assess the impacts of SI in marginalized areas, we use the evaluation framework developed within the Social Innovation in Marginalized Rural Areas (SIMRA) Horizon 2020 project and apply it to nine SI initiatives related to the fields of agriculture, fisheries, forestry, and rural development. Our findings show that SI produces cross-sectoral (societal, economic, environmental, and governmental) and multi-level impacts (on individuals, community, and society), which have improved the societal well-being, and contributed to the reduction of certain forms of marginality, mainly inside the territory in which SI occurred.