Designing a Health Strategy at Local Level: A Conceptual Framework for Local Governments

Abstract

This article addresses a gap in the literature regarding the design and implementation of health and well-being strategies by local governments. It presents a conceptual framework that can help local governments to include health and well-being among their political priorities by promoting the participation of local stakeholders and the community in general. The article also highlights the important role that local governments play in public health, especially in times of crisis, such as the COVID-19 pandemic. To demonstrate the approach, the manuscript explores the recent shift toward decentralization in Portugal and the resulting emphasis on local governments leading new approaches to health governance. The planning process for Arouca’s Health Strategy, an inland municipality, is used as a case study to demonstrate the approach, which emphasizes the meaningful participation of the entire local community. The article concludes by noting that there is still significant room for improvement in all areas related to health and well-being and a need to adopt new multistakeholder governance arrangements to sustain the institutional capacity for upcoming strategies.

The Impacts of Health Decentralization on Equity, Efficiency, and Effectiveness: A Scoping Review

“…Within the healthcare sector, the evidence on the benefits of decentralization is far from conclusive. Three theories, which underpin the rationale for decentralization, help us grasp its impacts on healthcare systems [5,6]. Based on Tiebout's [7] seminal work on local public goods, the "voting with your feet" theory elucidates how decentralization can either exacerbate or mitigate existing disparities in resource distribution, as people are able or not to choose their residency based on potential fiscal benefits or services.…”

“…Applying these theories to the analysis of decentralization in healthcare offers a means to identify its advantages and disadvantages, despite the ongoing controversy in the literature [5,6]. Some scholars argue that decentralization contributes to enhanced equity in healthcare, improved service efficiency, effectiveness, and resource utilization [2,3].…”