Healthcare decentralisation is a model of public service management founds on the wider distribution of the decisional power about healthcare. The decision power is split by central government also with the local health authorities. Since the 1980s, at worldwide level this reform has being applied for guaranteeing equity, efficiency, quality and financial sustainability in the healthcare services provision. In the last years, healthcare decentralisation is happening especially in low‐middle income countries. With regard to the analysis of the effectiveness of decentralisation in healthcare, the obtained results are mixed. This study aims to investigate the contribution of management in the first steps of decentralisation's implementation for reducing health inequalities in Tunisia. To have the management's point of view, a survey was sent to all directors of the Tunisian regional hospitals. Health management was able to offer operative and timely solutions to the homogenisation and the improvement of healthcare services supply in Tunisia. For healthcare managers the guarantee of an equal and effective Tunisian healthcare system is into the application of a differentiated decentralisation. The differentiated decentralisation of healthcare system allows to resolve regional issues in Tunisia. These interventions permit to obtain consistent positive results about the satisfaction of Tunisian population health needs. The differentiated decentralisation of healthcare system could also be useful for similar countries, for example, of MENA are of low‐middle income countries.
After the COVID-19 pandemic, reforms in healthcare systems have the purpose to fully recover the relationship of healthcare organizations with their patients. For centuries, art was used throughout Europe in the healthcare context for its power to engage and support patients in their illnesses. This approach can be rediscovered by utilizing the cultural heritage owned by Local Health Authorities. In this context, tradition, art, innovation, and care coexist. This study aims to investigate the interest in developing projects for the humanization of care by the top management of Italian Local Health Authorities, in particular exploiting their cultural heritage. The evaluation of the proposal was conducted using semi-structured interviews with the top management of two Local Health Authorities, in which the Santa Maria Nuova hospital in Florence and the Santo Spirito in Sassia Hospital in Rome are located, as the two selected cases for this study. The interviewees welcomed the proposal to develop humanization of care projects involving the use of their cultural heritage. Moreover, they expressed their desire to invest human, economic, and structural resources in the development of these initiatives. The implementation of humanization of care projects using cultural heritage owned by Local Health Authorities is useful to apply specific policies to enhance the governance of the cultural heritage according to the health mission. On the other hand, it permits the search for additional or ad hoc resources. Finally, it is possible to humanize and improve patients’ experience while increasing awareness among the health workforce and trainees.
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