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This research examines the impact of three coordination dimensions on health sector adaptation to climate change in the Vietnamese Mekong Delta: cross-scale, cross-sectoral, and cross-boundary. While tasks are divided up between government ministries and departments in Vietnam, there is little collaboration on issues that span mandates. Similarly, while water flows in the Vietnamese Mekong Delta take resource management and health concerns across provincial boundaries, formal mechanisms for interprovincial collaboration are lacking. While decentralization efforts have sought to devolve authority and decision making to lower levels, there is continued state-centered top-down policy making, and this limits collaborative coordination across scales. All three of these issues inhibit health sector adaptation to climate change in the Vietnamese Mekong Delta, and though these coordination issues are recognized by the Vietnamese government, to date there has been little success in addressing them. The authors hope to stimulate further debate and discussion of coordination problems, and conclude that despite some significant challenges, the South West Steering Committee could play a facilitating role coordinating climate change responses in health and other sectors across the Vietnamese Mekong Delta. As an analysis of governance, this research is applicable to other areas and sectors in Vietnam, as well as to other parts of South East Asia. [ABSTRACT FROM AUTHOR]

The long-term character of climate change and the high costs of adaptation measures, in combination with their uncertain effects, turn climate adaptation governance into a torturous process. We systematically review the literature on climate adaptation governance to analyze the scholarly understanding of these complexities. Building on governance literature about long-term and complex policy problems, we develop a conceptual matrix based on the dimensions knowledge and power to systematically study the peer-reviewed literature on climate adaptation governance. We find that about a quarter of the reviewed journal articles do not address the knowledge or power dimension of the governance of climate change adaptation, about half of the articles discuss either the knowledge or the power dimension, and another quarter discuss both knowledge and power. The articles that do address both knowledge and power (1) conceptualize the governance of climate adaptation mainly as a complex system of regulatory frameworks and technical knowledge, (2) assume that regulatory systems can be easily adapted to new knowledge, (3) pay little attention to fluid or unorganized forms of power, e.g., negotiation, and knowledge, e.g., learning, and (4) largely neglect the interplay between the two. We argue that more research on this interplay is needed, and we discuss how puzzling and powering are a promising pair of concepts to study this. [ABSTRACT FROM AUTHOR]