scholarly journals Decentralization Process in Portugal: impact in the health care system

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Sequeira ◽  
G Quinaz Romana ◽  
A Campos Fernandes ◽  
M Pinho ◽  
E Freire Rodrigues ◽  
...  
Keyword(s):  
Health Services ◽  
Local Governments ◽  
Local Level ◽  
National Level ◽  
Population Characteristics ◽  
Healthy Lifestyles ◽  
Local Health ◽  
Preliminary Results ◽  
Quality Costs ◽  
Quality Life

Abstract Problem Different countries have incorporated models of decentralization in their health reforms to achieve efficiency, by increasing the training of local governments, responsibility and gains in areas such as quality, costs and equity. In Portugal, the 21st government program established the autonomy of local authorities and the democratic decentralization of public administration. Accordingly, a decentralization law was approved and local governments have now a crucial role on health policies. Description of the Problem For this framework, a situational diagnosis and an intersectoral approach to policies are needed. This is an observational, analytical and cross-sectional study developed at council level in two Portuguese municipalities. This study aims to: Adjust responses to health needs at the local level; Set priorities by taking into account installed capacity and responses to populations; Promote the articulation between entities; Strengthen the focus on health promotion and healthy lifestyles; Strengthen health interventions in educational communities; Promote the creation of programs at local level, in conjunction with the national level, to reduce inequalities. Results The preliminary results in health, social and economic indicators show that this framework, while taking in consideration population characteristics, allows the development of local strategies regarding health services coverage, health services type and medication. At council level, the preliminary results also show a lack of data on healthy lifestyles and social indicators. Lessons The implementation of a decentralization process involves a broad range of requirements such as a situational diagnosis, strategies development and a periodic update of quality life and health indicators. Those are needed to assess council level priorities, which allow the development of public policies and interventions, in line with population characteristics, to tackle health inequalities and inequities. Key messages Performance improvement of health system is linked to the implementation of local citizen centred policies. These are actions which promote quality of life through health-friendly ecosystems. The local health intervention has contributed to promote inequalities reduction, increasing equity and dynamize new frameworks of organization with individual and community participation.

scholarly journals Analysis of the Local Health-Enhancing Physical Activity Policies on the French Riviera

2020 ◽  
Author(s):  
Antoine Noël Racine ◽  
Jean-Marie Garbarino ◽  
Bernard Massiera ◽  
Anne Vuillemin
Keyword(s):  
Physical Activity ◽  
Health Services ◽  
Social Services ◽  
Local Governments ◽  
Local Level ◽  
Intersectoral Collaboration ◽  
Local Health ◽  
Key Informants ◽  
Health Enhancing Physical Activity ◽  
French Riviera

Policy is a lever for initiating the structural and environmental changes that foster health-enhancing physical activity (HEPA) promotion. However, little is known about the evidence in support of local governments regarding their HEPA-promoting policies. This study collected comprehensive information on municipal HEPA policies on the French Riviera to gain an overview of HEPA policy development in this territory. Mid-sized cities from the two counties constituting the French Riviera were targeted (n = 17). In each city, a local tool for HEPA policy analysis, CAPLA-Santé, was used to gain information from key informants heading the departments of sports, health services and social services. Data were collected through semi-structured interviews and document analysis. Ten mid-sized cities volunteered to participate. Key informants from the sports (n = 10), health services (n = 5) and social services (n = 6) departments were interviewed. Written HEPA policy documents were formalized in six cities. These documents (n = 14) were mainly from the sports (n = 8) and health services (n = 4) sectors. The key informants reported that support from that national policy, the commitment of elected officials, and large local stakeholder networks facilitated HEPA promotion, whereas the lack of intersectoral collaboration and limited resources were limitations. The results provide insight into the development of municipal HEPA policies, highlighting some of the barriers, facilitators and perspectives. These findings could be valuable to scale up HEPA promotion at the local level.

scholarly journals Analysis of the Local Health-Enhancing Physical Activity Policies on the French Riviera

2020 ◽  
Vol 18 (1) ◽  
pp. 156
Author(s):  
Antoine Noël Racine ◽  
Jean-Marie Garbarino ◽  
Bernard Massiera ◽  
Anne Vuillemin
Keyword(s):  
Physical Activity ◽  
Health Services ◽  
Social Services ◽  
Local Governments ◽  
Local Level ◽  
Intersectoral Collaboration ◽  
Local Health ◽  
Key Informants ◽  
Health Enhancing Physical Activity ◽  
French Riviera

Policy is a lever for initiating the structural and environmental changes that foster health-enhancing physical activity (HEPA) promotion. However, little is known about the evidence in support of local governments regarding their HEPA-promoting policies. The aim of this study was to collect comprehensive information on municipal HEPA policies on the French Riviera (Alpes-Maritimes and Var counties) to provide an overview of the development of these policies in this territory. Mid-sized cities from the two counties constituting the French Riviera were targeted (n = 17). In each city, a local tool for HEPA policy analysis, CAPLA-Santé, was used to gain information from key informants heading the departments of sports, health services, and social services. Data were collected through semi-structured interviews and document analysis. Ten mid-sized cities volunteered to participate. Key informants from the sports (n = 10), health services (n = 5), and social services (n = 6) departments were interviewed. Written HEPA policy documents were formalized in six cities. These documents (n = 14) were mainly from the sports (n = 8) and health services (n = 4) sectors. The key informants reported that support from national policy, the commitment of elected officials, and large local stakeholder networks facilitated HEPA promotion, whereas the lack of intersectoral collaboration and limited resources were limitations. The results provide insight into the development of municipal HEPA policies, highlighting some of the barriers, facilitators, and perspectives. These findings could be valuable to scale up HEPA promotion at the local level.

scholarly journals Seducing for Truth and Justice: Civil Society Initiatives for the 1965 Mass Violence in Indonesia

2013 ◽  
Vol 32 (3) ◽  
pp. 115-142 ◽  
Author(s):  
Sri Lestari Wahyuningroem
Keyword(s):  
Civil Society ◽  
Transitional Justice ◽  
Local Governments ◽  
Central Government ◽  
Local Level ◽  
National Level ◽  
Policy Reforms ◽  
Mass Violence ◽  
The World

The article examines both civil society initiatives that seek to address the mass violence of 1965 and 1966 and the state's responses to them. Unlike other political-transition contexts in the world, a transitional justice approach is apparently a formula that state authorities have found difficult to implement nationally for this particular case. The central government has, through its institutions, sporadically responded to some of the calls from civil society groups and has even initiated policy reforms to support such initiatives. Nevertheless, these responses were not sustained and any suggested programmes have always failed to be completed or implemented. Simultaneously, however, NGOs and victims are also voicing their demands at the local level. Many of their initiatives involve not only communities but also local authorities, including in some cases the local governments. In some aspects, these “bottom-up” approaches are more successful than attempts to create change at the national level. Such approaches challenge what Kieran McEvoy refers to as an innate “seductive” quality of transitional justice, but at the same time these approaches do, in fact, aim to “seduce” the state to adopt measures for truth and justice.

scholarly journals Qualitative analysis of the coordination of major system change within the Colombian health system in response to COVID-19: study protocol

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Simon Turner ◽  
Natalia Niño
Keyword(s):  
Health Service ◽  
Health Services ◽  
Health System ◽  
Case Studies ◽  
Health Systems ◽  
National Level ◽  
System Change ◽  
Service Planning ◽  
Local Health ◽  
Health Service Planning

Abstract Background Coronavirus (COVID-19) is posing a major and unprecedented challenge to health service planning and delivery across health systems internationally. This nationally funded study is analysing the response of the Colombian health system to the COVID-19 pandemic, drawing on qualitative case studies of three local health systems within the country. The approach will be informed by the concept of ‘major system change’—or coordinated change among a variety of healthcare organizations and other relevant stakeholders— to identify processes that both enable and inhibit adaptation of health services to the challenges presented by COVID-19. The study will collect information on capacity ‘bottlenecks’ as well as successful practices and forms of innovation that have emerged locally, which have the potential for being ‘scaled up’ across Colombia’s health services. Methods/design This qualitative study will be undertaken in two phases. In the first, up to 30 stakeholder interviews will be conducted to ascertain immediate challenges and opportunities for improvement in response to COVID-19 that can be shared in a timely way with health service leaders to inform health service planning. The stakeholders will include planning, provider and intermediary organizations within the health system at the national level. In the second, up to 60 further interviews will be conducted to develop in-depth case studies of three local health systems at the metropolitan area level within Colombia. The interview data will be supplemented with documentary analysis and, where feasible, non-participant observation of planning meetings. Discussion The study’s findings will aid evaluation of the relevance of the concept of major system change in a context of ‘crisis’ decision-making and contribute to international lessons on improving health systems’ capacity to respond to COVID-19 and future pandemics. Study findings will be shared among various stakeholders in the Colombian healthcare system in a formative and timely way in order to inform healthcare planning in response to COVID-19 and future pandemics. Conducting the study at a time of COVID-19 raises a number of practical issues (including physical distancing and pressure on health services) which have been anticipated in the study design and research team’s ways of working.

A cross-sectional analysis of local government health and wellbeing plans and priorities in Victoria, Australia

2017 ◽  
Vol 23 (5) ◽  
pp. 440 ◽  
Author(s):  
Mark Anthony Alindogan ◽  
Eli Ristevski ◽  
Anske Robinson
Keyword(s):  
Socioeconomic Status ◽  
Low Socioeconomic Status ◽  
Local Governments ◽  
Local Level ◽  
State Level ◽  
Health Priorities ◽  
Local Health ◽  
Low Socioeconomic ◽  
Health And Wellbeing ◽  
Significant Difference

The aim of this study is to explore local health and wellbeing plans and priorities by Victorian local governments (LGs), specifically to: (1) analyse how LG priority areas are described in comparison to the State-level plan; (2) identify differences between regional and metropolitan health priorities; and (3) identify differences between LGs with high and low socioeconomic status. Content analysis of 79 LG health and wellbeing plans was undertaken. Differences in health and wellbeing priorities between LGs were examined using the t-test for two proportions. In total, 20% of the plans did not specify actions to address health priorities. One in three (34%) did not specify how evaluation will be done. Alcohol and other drugs, gambling and housing were prioritised more by metropolitan LGs, whereas disease prevention was prioritised more in regional LGs. There was no significant difference in health and wellbeing priorities of LGs with high and low socioeconomic status except for gambling. State-level health and wellbeing plans should be sensitive to differences in priorities of LGs. There is a need for local plans to commit to specific actions and evaluation. This analysis provides basis for more community-reflective, State-level planning and calls for more emphasis on identifying actions and evaluation in local level planning.

Severed Linkages

2020 ◽  
pp. 139-167
Author(s):  
Jonathan T. Hiskey ◽  
Mason W. Moseley
Keyword(s):  
Health Services ◽  
Performance Metrics ◽  
National Level ◽  
Local Health ◽  
Vote Buying ◽  
Institutional Processes ◽  
Dominant Party ◽  
Political Machines ◽  
State Of The Economy

This chapter focuses on the question of whether individuals living in political machines evaluate their incumbent government in ways that are similar to their counterparts in multiparty systems. Previous chapters established that dominant-party citizens are more likely to be exposed to corruption and vote-buying efforts and tend to be less supportive of basic democratic institutional processes. The expectation is that individuals forced to play the daily game of machine politics will not use common incumbent government performance metrics such as evaluations of the state of the economy, levels of crime and insecurity, and the quality of local health services. Through analysis of self-reported voting intentions, the chapter finds that respondents’ views on these issue areas have little impact on whether or not they will support the incumbent. This severed linkage also appears, to a lesser extent, in the evaluations of national-level politicians made by dominant-party respondents.

scholarly journals HPV vaccine introduction at the local level in a developing country: attitudes and criteria among key actors

2010 ◽  
Vol 26 (5) ◽  
pp. 900-908 ◽  
Author(s):  
Marion Piñeros ◽  
Carolina Wiesner ◽  
Claudia Cortés ◽  
Lina María Trujillo
Keyword(s):  
Decision Making ◽  
Latin American ◽  
Hpv Vaccine ◽  
Local Level ◽  
National Level ◽  
National Policy ◽  
Local Health ◽  
Political Actors ◽  
Vaccine Introduction

In most developing countries, HPV vaccines have been licensed but there are no national policy recommendations, nor is it clear how decisions on the introduction of this new vaccine are made. Decentralization processes in many Latin American countries favor decision-making at the local level. Through a qualitative study we explored knowledge regarding the HPV vaccine and the criteria that influence decision-making among local health actors in four regions of Colombia. We conducted a total of 14 in-depths interviews with different actors; for the analysis we performed content analysis. Results indicate that decision-making on the HPV vaccine at the local level has mainly been driven by pressure from local political actors, in a setting where there is low technical knowledge of the vaccine. This increases the risk of initiatives that may foster inequity. Local decisions and initiatives need to be strengthened technically and supported by national-level decisions, guidelines and follow-up.

scholarly journals The The implementation of CSR in the extractive industries in Indonesia: What is the government’s role?

2020 ◽  
Vol 5 ◽  
pp. 161-169
Author(s):  
Anif Fatma Chawa
Keyword(s):  
Local Governments ◽  
Local Level ◽  
National Level ◽  
Extractive Industries ◽  
Systemic Review ◽  
Role Of Government ◽  
Social Agent ◽  
Functional Perspective ◽  
The Government ◽  
Negative Impacts

This article aims to illustrate the role of government in the implementation of CSR in the extractive industries. The extractive industries need support from the government to resolve various problems which have emerged in conducting their CSR. These problems have arisen because of the contradiction and tension in the role or framework of business communities of the extractive industries, as an economic and social agent. To address those problems, based on a structural functional perspective, the extractive industries need other institution primarily government to establish policies or regulations in conducting their CSR. This study employs systemic review method reviewing 70 journal articles of research studies which focus on the implementation of CSR in the extractive industries in Indonesia. This study found that government has an important role to stipulate several regulations mostly at a national level. The regulations require the extractive industries to implement CSR to specifically address various negative impacts, socially, culturally and environmentally, on the affected communities. This study, however, also found that there is insufficient guideline at a local level in relation to CSR. Consequently, the extractive industries have no guidelines in how to establish their CSR activities, to what extend they should involve the local communities as well as the local governments in these activities and to address various problems which have emerged in the implementation of CSR. The lack of guidelines has also given rise to the different perception of the local governments on how they should be involved in the implementation of CSR.

scholarly journals Decentralization, legitimacy, and democracy in post-Soviet Central Asia

2021 ◽  
pp. 187936652110685
Author(s):  
David Siegel
Keyword(s):  
Local Governments ◽  
Political System ◽  
Local Level ◽  
National Level ◽  
Field Research ◽  
Ordinary People ◽  
Political Decentralization ◽  
Level I ◽  
Soviet Central Asia

During the 1990s, a conventional wisdom emerged, based on literature going back decades, that political decentralization might be among the most effective forces for democratization. If ordinary people could participate in autonomous local governments, democracy would be built from the ground up, ultimately shaping the entire political system. Once decentralization reforms were implemented across the world, however, the results were disappointing. Authoritarianism not only thrived at the local level, it could also undermine democratization at the national level. Thus, local-national transference still held, but sometimes as a poison. In this context, the case of post-Soviet Kyrgyzstan is an anomaly. Here, the relative success of political decentralization—rather than its failure—nevertheless failed to spur democratization at the national level. I argue that this is because decentralization allowed national authorities to appease international donors while they consolidated their own power. Moreover, while decentralization empowered local communities, it did so in ways that personalized local authority and pitted local and national authorities against one another, resulting in intense localism and antagonistic center-local relations that undermined any democratic transference. The case study findings are based on ten months of field research, which includes interviews with local and national officials, ordinary villagers, and representatives of NGOs and international organizations.

Understanding government discourses on social media: Lessons from the use of YouTube at local level1

2021 ◽  
pp. 1-14
Author(s):  
Osiris S. González-Galván
Keyword(s):  
Social Media ◽  
Citizen Participation ◽  
Local Governments ◽  
Local Level ◽  
National Level ◽  
The Past ◽  
Communication Processes ◽  
The World ◽  
Digital Methods ◽  
Use Of Social Media

Local Governments around the world have taken advantage of social media during the past ten years to improve transparency and to provide public services. Challenges related to information management and citizen participation have emerged, namely at the local level where the diffusion of social media has been slower compared to initiatives launched at the national level. This paper analyzes how the use of social media can reflect a change in the discursive exchanges established between local governments in Canada and Mexico and citizens. To achieve this goal, the use of YouTube by the municipalities of Quebec and Morelia was examined by using digital methods and content analysis. The author proposes the emergence of new conditions between government and users, which are changing the discourse, identity, and communication purposes of the municipalities. However, the development of more dialogic communication processes supported by social media is still a promise, at least on YouTube.

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