Abstract
This study aimed to assess the Baixo Vouga sub-region (Portugal) governance system through 15 interviews with leaders of institutions with decision-making power and provide healthcare. The interviews were subjected to a content analysis, organized in matrices by cases, categories, subcategories, and indicators. Recording units were extracted from the interviews to produce data for each indicator. A Collaborative Place-based Governance Framework systematizing operational definitions of collaborative governance was implemented to serve as a benchmark for assessing the collaborative and place-based dimensions. The Baixo Vouga sub-Region governance system is collaborative because it is based on a shared structure of principles that translates into the services provided. It has a multilevel and multisector collaboration, and can undertake shared decisions. These dimensions could be reinforced through increased participation, autonomy, subsidiarity if more place-based information and practical knowledge were sought. The system would also benefit from an extensive adoption of bottom-up methods to formulate and implement policies.
Highlights
Collaborative governance is an arrangement where state agencies directly recruit stakeholders in a collective, formal, consensus-oriented, deliberative decision-making process and aims to establish or implement state policies[1]
This section presents the results of the interviews. It reviews: i) the principles that guide the formulation of healthcare policies; ii) its multilevel and multisectoral integration; ii) consistency between the principles and practices of healthcare; the modus operandi adopted in the formulation of policies; iv) how they integrate stakeholder’s participation; and, v) the levels of vertical and horizontal collaboration
This section discusses the conclusions that help answer the research questions: How do stakeholders perceive the Baixo Vouga Health System governance? considering the stakeholders’ internal perceptions, is the sub-regional Baixo Vouga Health Systems governance collaborative place-based? If so, how (2.1)? If not, why and what is needed todevelop the ‘missing links’?. Principles such as accessibility, equity, respect for the patient, quality, efficiency, innovation and prevention, are part of shared values space among the institutions that integrate the sRBV’s governance system. This rational aggregator is complemented by types of balanced management of financial and human resources allowing for gradual health gains
Summary
Collaborative governance is an arrangement where state agencies directly recruit stakeholders in a collective, formal, consensus-oriented, deliberative decision-making process and aims to establish or implement state policies[1]. We should focus on structures and rules (both formal and informal) governing the supply-demand relationship when questioning the health systems’ building block approach. This means understanding these rules and how individuals, groups, and governments shape, change, monitor, and enforce rules and the corresponding outcomes and consequences. Decentralization has advantages and multiple challenges – keeping enough multilevel coherence and equity, cost-effectiveness, and coordination within a governance system, which considers issues such as bringing healthcare closer to the local populations’ needs (place-based health systems), stronger community ownership, more opportunities for tailoring and bottom-up approaches, and faster and more flexible collaborative decision-making
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