Coordination and Health Policy Responses to the First Wave of COVID-19 in Italy and Spain

Abstract

The Italian and Spanish healthcare systems are ranked among the best in the world, according to the Lancet Ranking and the Global Health Security Index ( 2019). Yet Italy and Spain were the first European countries hit by the coronavirus and did not have the benefit of hindsight and policy learning. A further complication for crisis management and associated policy measures to be adopted and implemented was the highly decentralized policy system. The article analyzes the main policy responses by national governments in Italy and Spain, focusing on their innovative character and on the coordination challenge of these measures for central-regional multilevel governance. The findings suggest that central governments assuming emergency powers need to balance more carefully their policy decisions against the constitutional shared responsibilities acquired by regional governments in highly decentralized policy systems.

Coordination and crisis management. The case of the federal Government and two sub-national governments in Mexico

“…The development of coordination instruments in the health system in Mexico has become a story like a pendulum that goes from centralization to decentralization of functions within a design that has generated conflicts between the different levels of government, and above all in public health areas (Nigenda et al, 2015). On the one hand, the article complements studies on coordination in the first responses that countries have faced to reduce the impact of the crisis in multilevel governments (Mattei and Del Pino, 2021); and on the other, the importance of administrative capacity and leadership of the authority to balance the first decisions with the instruments of governance and legitimacy during a health crisis .…”

“…In the case of health systems such as Mexico, the problem of fragmentation is even more evident, not only because of the characteristics of the health system but also since the recent reforms that have taken place in Mexico in latest years. For instance, problems of fragmentation and weak coordination in the implementation of public programs related to nutrition in Mexico have been notorious (Delgado and Culebro, 2019); other situations of institutional design such as the tension between centralization and decentralization in the response to CO-VID-19 have also been important (Mattei and del Pino, 2021). Though, it does not happen in the same way in the case of interorganizational relationships (Marín-Idárraga and Campos, 2015).…”

A coordinated health policy in response to COVID‐19: A case of Botswana

“…During the HIV and AIDS era, the highest coordinating body was the National Coordinating Agency (NACA) under the Ministry of Health (MOH) and district multi‐sectoral committees. Policy coordination during COVID‐19 was organized in the same manner at the national level to ensure a clear definition of the problem and how it will be addressed (Mattei & Del Pino, 2021). The control of COVID‐19 required a concerted effort and immediate implementation of prevention measures.…”

Decentralization: A handicap in fighting the COVID‐19 pandemic? The response of the regional governments in Spain

“…The growing political contestation, the logistical inefficiencies derived from centralization and the improvement of health indicators, brought a change of perspective (Mattei & Del Pino, 2021 ). With the state of alarm still in force, on 28 April, the Spanish government presented the ‘Plan for the transition to a new normality’ to arrange the end of the state of alarm.…”

“…The initial lack of control experienced prior to the decree of the state of alarm also revealed a lack of coordination and foresight in the early response to the pandemic (Mattei & Del Pino, 2021 ). In spite of having available the recent precedents of China and Italy, which made clear the high level of contagiousness of the coronavirus and the need to apply drastic measures in an early phase in order to control it, the central government and the ACs were unable to organize a unitary, coordinated and efficient response that would have contained the problem before it became a tsunami of uncontrollable cases.…”