Health policy reforms often fail due to design flaws, implementation gaps, and political barriers. This paper examines the role of government stewardship in addressing these barriers drawing on lessons from healthcare reforms in Sanming, China, a city that has become a nationally recognised model for comprehensive health system reform. Employing a qualitative approach, the analysis traces how six core stewardship functions – strategic visioning, institutional alignment, instrument design, partnership management, accountability reinforcement, and learning facilitation – enabled Sanming’s government to control costs and improve service delivery and health outcomes. Sanming’s experience illustrates the potential for local government stewardship to catalyse reform in the face of constraints. Interviews indicated that strengthened stewardship enabled the government to set strategic direction for the health system, mobilise stakeholders, formulate workable policies, and adapt to changing needs during implementation. However, participants identified persistent challenges, including uneven distribution of capacity across agencies, changes in the external policy environment, and deficient stakeholder feedback loops. While specific to the local context, the core stewardship competencies identified in the paper offer a generalisable framework for strengthening reform governance in other settings. As countries seek to build resilient and equitable health systems, the lessons from Sanming’s stewardship model provide a timely contribution to the global health reform discourse.

Borrowed capacity builds upon institutional capacity scholarship to discuss how interactions between government agencies and interest groups can increase agency resources and scope during agency formation and development. Equal Employment Opportunity Commission scholars often note the lack of capacity to implement Title VII of the Civil Rights Act of 1964 during the first years of the agency. I argue that current assessments of the agency’s capacity between 1965 and 1968 are incomplete by expanding the definition of capacity to include borrowed and nontraditional forms of capacity, reviewing congressional allocations to the agency and agency budgets, and considering the active roles state and local agencies as well as interest groups played in the early implementation of Title VII. I demonstrate the agency amassed not only claims but also capacity during its early years.

With the evolution towards more service-intensive social investment welfare states across Europe, research on the institutional capacities of subnational welfare provision is increasingly relevant. Based on a comparative case analysis of three post-industrial municipalities in Europe, this article harbors a two-pronged objective: first, empirically, to show how regional and local governance capabilities are crucial to effective SI policy delivery; second, more positively, to bring out the proficiency of vertical coordination between national administration and subnational layers, alongside the critical role of horizontal policy discretion at the local level to align social benefits and capacitating services for the success of SI delivery; and, by implication, the overall responsiveness of national welfare systems to the changing nature of 21st century socioeconomic risks.

One of the most prevalent rationales for public healthcare policies is a human right to healthcare. Governments are the typical duty-bearers, but they differ vastly in their capacity to help those vulnerable to serious health problems and those with severe disabilities. A right to healthcare is out of the reach of many developing economies that struggle to provide the most basic services to their citizens. If human rights to provision of such goods exist, then governments would be violating rights without doing anything wrong. I argue that such variable ability to provide healthcare depends not only on financial resources, but on institutional capacity, and that the latter represents a more fundamental challenge to the existence of a human right to healthcare than previously recognized. This challenge does not imply that government has no obligations to protect and improve the health of their citizens, but that it is best to think of such obligations as generated by conventional rights, namely rights arising from local legal and social conventions, which require governments to pursue health-related moral goals such as reducing suffering, closing opportunity gaps for the disadvantaged, and preventing the spread of contagious diseases. We need not think of such moral goals in terms of human rights.