This Chapter provides health policymakers, managers, and care providers with an overview of strategies that enforce the key principles of good governance presented in Chapter 4. Strengthening participatory governance, building policy capacity, institutionalizing procedures to incorporate evidence in policymaking, and building regulatory capacity are critical for strengthening participation, transparency, and accountability and enforcing the rule of law. There is a variety of potential strategies that health system managers can adapt to improve governance of health systems at the policy, institutional, and healthcare professional levels, these include: (1) strengthening effectiveness of decentralization at the policy level; (2) linking accreditation to incentives, such as public funding or contractual agreements, at the institutional level; and (3) professionally led self-regulation at the health care professionals’ level. Control of corruption requires political reforms with a focus on open exchange of information, channels for participation of citizens in policymaking, and penalties for the misuse of power. It is important to note that the evidence on governance strategies in L&MICs remains elusive. Health leaders and managers need to cautiously assess and adapt strategies to their own contexts.

Adaptive management and adaptive governance are key paradigms for improved adaptiveness in natural resource governance. Recent scholarship on adaptive governance highlights the importance of legal tools that provide elements of both flexibility and stability needed to enable collaborative and adaptive natural resource management across scales of socio-ecological organisation. However, a lack of understanding remains around the specific attributes of policies and the capacities needed to design and implement them in multilevel governance contexts where state bureaucracies retain significant authority for natural resource governance. In this chapter, we examine novel policy tools and capacities for adaptiveness in US federal forest management. Drawing on empirical research on collaborative forest restoration and multilevel monitoring for forest planning, we highlight the importance of different dimensions of policy capacity for the design and implementation of policy tools for improved adaptiveness. Our analysis underscores the importance of incorporating considerations of policy capacity into conceptualisations of institutional flexibility and draws attention to the importance of administrative policies, and agents in state bureaucracies, for more adaptive forms of governance.

In this chapter I bring together the findings of the five case studies to offer answers to the research questions about the distribution of authority in statistical systems. I also outline the implications of my study for our understanding of practices of knowledge production and utilisation in policymaking, as well as the role of experts in contemporary liberal democracy. Finally, I consider directions for future research stemming from my study findings.

The changing position of the public service is examined in relation to the growth of ministers’ policy roles. As the political executive assumed greater policy leadership, a stronger emphasis has been placed on the contestability of advice and increasing use of other advisory sources. There is a tendency for public service policy capacity to decline, but there are differences across the policy advisory systems due to country-specific patterns of reforms. The public service has become more disposed to being internally collaborative and externally engaged through policy processes, but regular injunctions for greater connectivity indicate continuing shortfalls. There is a question of whether a restoration of capacity is possible and what the advisory role is for a public service that has been emphasising generalist and process-based functions as a broker and convenor of advisory inputs.