Medium-sized Municipality Research Articles

Behind the budget: analysing the factors driving sustainable urban development financing in Spain

ABSTRACT This study addresses the factors that determine EU-funded resources in the context of urban development policies in Spain. The interplay of institutional capacity, prior inertia, and local characteristics emerge as determinant variables on Spanish urban financing dynamics. The analysis of the 121 funded cases in the 2021 Spanish call for sustainable urban development reveals the presence of specific local characteristics to be crucial in assessing funding. Stable small and medium-sized municipalities with previous funding experience are more likely to secure funding. The Spanish case emerges as paradigmatic, illustrating how current urban funding frameworks recognise cities with unique characteristics as exemplary models.

Cidade Ideal e Cidade Real: Uma reflexão sobre cidades sustentáveis

According to UN data, the proportion of people living in urban areas has increased from 30% in 1950 to 55% in 2018. This population growth, especially in poorer countries, presents significant challenges for promoting sustainable urban development. Issues such as socio-spatial segregation, inadequate infrastructure, lack of basic sanitation, pollution and aggravated displacement are some of the challenges faced by cities. The UN's 2030 Agenda, with its Sustainable Development Goal (SDG) 11 - "Sustainable Cities and Communities," highlights the importance of making cities inclusive, safe, resilient and sustainable. This article aims to explore the challenges of territorial management in small and medium-sized municipalities in Brazil, considering the fragmentation of management spheres and the need for sustainable solutions. The interdisciplinary methodology involves a literature review, analysis of IBGE data, MapBiomas and evaluation of public policies. The systemic approach of Nature-Based Solutions (NBS) shows promise in promoting sustainable development, with the conservation/regeneration of ecosystem services as a possible complement to sustainable development strategies, providing lasting solutions to urban challenges. The quality of groundwater and surface water in river basins, as well as aspects related to the remaining fragments of native vegetation, show that many environmental problems produced in cities go beyond the limits of the urban area and even the administrative limits of municipalities. This becomes evident when mismanagement of sanitation services and land use in rural and urban areas affect ecosystem services that are essential for the quality of life of the population, the economy of municipalities and the construction of a sustainable city.

The financial sustainability of public services as an instrument to combat depopulation in small and medium-sized municipalities

Previous research identified influencing factors in sustainability of public services but exclusively in large local governments, despite the fact that depopulation is currently a serious problem that affects rural areas of many European countries. However, despite that >80 % of European municipalities have fewer than 5000 inhabitants, more work is needed on the factors influencing the financial sustainability of small local governments, that are being greatly affected by the loss of population. This study identifies influencing factors in the financial sustainability of local governments of different population sizes. We analyse the behaviour of 3625 Spanish municipalities during 2009–2017. Our findings are useful for public managers interested in promoting the financial sustainability of small municipalities as an instrument to fight against depopulation and prevent effects of economics crisis in small and medium municipalities.

Bayesian Modeling and Estimation of Spatial Risk for Hospitalization and Mortality from Ischemic Heart Disease in Paraná, Brazil.

Despite significant advancements in understanding risk factors and treatment strategies, ischemic heart disease (IHD) remains the leading cause of mortality worldwide, particularly within specific regions in Brazil, where the disease is a burden. Therefore, the aim of this study was to estimate the risk of hospitalization and mortality from IHD in the state of Paraná (Brazil), using spatial analysis to identify areas with higher risk based on socioeconomic, demographic and health variables. This is an ecological study based on secondary and retrospective IHD hospitalization and mortality data obtained from the Brazilian Hospitalization and Mortality Information Systems during the 2010-2021 period. Data were analyzed for 399 municipalities and 22 health regions in the state of Paraná. To assess the spatial patterns of the disease and identify relative risk (RR) areas, we constructed a risk model by Bayesian inference using the R-INLA and SpatialEpi packages in R software. A total of 333,229 hospitalizations and 73,221 deaths occurred in the analyzed period, and elevated RR of hospitalization (RR = 27.412, CI 21.801; 34.466) and mortality (RR = 15.673, CI 2.148; 114.319) from IHD occurred in small-sized municipalities. In addition, medium-sized municipalities also presented elevated RR of hospitalization (RR = 6.533, CI 1.748; 2.006) and mortality (RR = 6.092, CI 1.451; 2.163) from IHD. Hospitalization and mortality rates were higher in white men aged 40-59 years. A negative association was found between Municipal Performance Index (IPDM) and IHD hospitalization and mortality. Areas with increased risk of hospitalization and mortality from IHD were found in small and medium-sized municipalities in the state of Paraná, Brazil. These results suggest a deficit in health care attention for IHD cases in these areas, potentially due to a low distribution of health care resources.

Adolescent boys’ experiences of mental health and school health services - an interview study from Norway

BackgroundMental health problems among adolescents is a global challenge. During the transition to adolescence, physiological, psychological, and social changes occur, leading to increased vulnerability. Thus, adolescent boys are less likely to seek help for mental health problems, which makes them an undetected group. The aim of this study was to gain a deeper understanding of adolescent boys’ experiences of mental health and school health service.MethodsAn inductive, qualitative design was chosen using three focus group interviews and three individual interviews. The study included 18 adolescent boys in 7th grade, in a school located in a medium-sized municipality in Norway. The interviews were analysed with qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) were followed in this study.ResultsThe overall theme “barriers towards seeking help”, and three categories— navigating stigma and privacy concerns; perceptions of self-responsibility; and lacking knowledge of mental health problems and help-seeking—described the adolescent boys experiences. The awareness and willingness to seek help were present, but there are barriers preventing the adolescent boys from acting on that willingness.ConclusionsLack of knowledge and a non-permissive culture for mental health problems among adolescents contributes to decreased help-seeking behaviour among adolescent boys. The school health service is the most related health service for adolescents and should focus on being available and strengthening empowerment and mental health literacy through the development and implementation of interventions to promote mental health.

The mosaic of Covid-19: unraveling patterns - from the streets of Minas Gerais state to the global stage

COVID-19 is a multifaceted disease whose local impacts align with the global context. In our study, we conducted a comprehensive analysis of the impact of COVID-19 in Lavras, a medium-sized municipality, a regional reference in health, located in the south of Minas Gerais state, Brazil. The data analyzed covered the period from 2020 to 2023, highlighting factors associated with transmission patterns and lethality in comparative terms with the global scenario. Data collection was carried out from official municipal publications, with an emphasis on information regarding the number of confirmed cases, deaths, and lethality rates. Genomic surveillance was conducted based on positive cases during the analysis period, and the results were published on GISAID. In 2020, there was an exponential increase in SARS-CoV-2 cases and associated deaths, with a lethality rate of 3.88%. The year 2021 witnessed a significant escalation, with a total of 8,762 cases and 135 deaths, presenting a lethality rate of 1.55%. The rapid spread of the disease led to high hospital occupancy for almost 90 days. In December 2021, the Omicron variant was identified, preceding a substantial increase in cases in early 2022, triggering a third wave resulting in 21,385 cases and 43 deaths. The lethality rate by the end of 2022 was 0.21%. The results highlight the capacity to confront COVID-19 and the virus's resilience, with a progressive reduction in lethality contrasting with the rise in SARS-CoV-2 infection incidence. This study provides a comprehensive view of COVID-19 patterns in Lavras over three years, emphasizing the importance of epidemiological surveillance and effective public health strategies to reduce the impact on the number of deaths from the disease, providing opportunities to address the disease.

Hospitalizations for Cardiovascular Diseases Sensitive to Primary Health Care in Paraná State, Brazil: A Bayesian Spatiotemporal Model.

To analyze spatiotemporal trends in hospitalizations for cardiovascular diseases (CVD) sensitive to primary health care (PHC) among individuals aged 50-69 years in Paraná State, Brazil, from 2014 to 2019 and investigate correlations between PHC services and the Social Development Index. We conducted a cross-sectional ecological study using publicly available secondary data to analyze the municipal incidence of hospitalizations for CVD sensitive to PHC and to estimate the risk of hospitalization for this group of diseases and associated factors using hierarchical Bayesian spatiotemporal modeling with Markov chain Monte Carlo simulation. There was a 5% decrease in the average rate of hospitalizations for PHC-sensitive CVD from 2014 to 2019. Regarding standardized hospitalization rate (SHR) according to population size, we found that no large municipality had an SHR >2. Likewise, a minority of these municipalities had SHR values of 1-2 (33%). However, many small and medium-sized municipalities had SHR values >2 (47% and 48%, respectively). A greater Social Development Index value served as a protective factor against hospitalizations, with a relative risk of 0.957 (95% credible interval, 0.929-0.984). The annual risk of hospitalization decreased over time; however, small municipalities had the greatest rates of hospitalization, indicating an increase in health inequity. The inverse association between social development and hospitalizations for CVD sensitive to PHC raises questions about intersectionality in health care.

Determinants of Implementing an Information and Communication Technology Tool for Social Interaction Among Older People: Qualitative Content Analysis of Social Services Personnel Perspectives.

Older people are particularly vulnerable to social isolation and loneliness, which can lead to ill-health, both mentally and physically. Information and communication technology (ICT) can supplement health and social care and improve health among the vulnerable, older adult population. When ICT is used specifically for communication with others, it is associated with reduced loneliness in older populations. Research is sparse on how the implementation of ICT, used specifically for communication among older people in social services, can be performed. It is recommended to consider the determinants of implementation, that is, barriers to and facilitators of implementation. Determinants related to older people using ICT tools are reported in several studies. To the best of our knowledge, studies investigating the determinants related to the social services perspective are lacking. This study aims to explore the determinants of implementing the Fik@ room, a new, co-designed, and research-based ICT tool for social interaction among older people, from a social services personnel perspective. This study used an exploratory, qualitative design. An ICT tool called the Fik@ room was tested in an intervention study conducted in 2021 in 2 medium-sized municipalities in Sweden. Informants in this study were municipal social services personnel with experience of implementing this specific ICT tool in social services. We conducted a participatory workshop consisting of 2 parts, with 9 informants divided into 2 groups. We analyzed the data using qualitative content analysis with an inductive approach. The results included 7 categories of determinants for implementing the ICT tool. Being able to introduce the ICT tool in an appropriate manner concerns the personnel's options for introducing and supporting the ICT tool, including their competencies in using digital equipment. Organizational structure concerns a structure for communication within the organization. Leadership concerns engagement and enthusiasm as driving forces for implementation. The digital maturity of the social services personnel concerns the personnel's skills and attitudes toward using digital equipment. Resources concern time and money. IT support concerns accessibility, and legal liability concerns possibilities to fulfill legal responsibilities. The results show that implementation involves an entire organization at varying degrees. Regardless of how much each level within the organization comes into direct contact with the ICT tool, all levels need to be involved to create the necessary conditions for successful implementation. The prerequisites for the implementation of an ICT tool will probably change depending on the digital maturity of future generations. As this study only included 9 informants, the results should be handled with care. The study was performed during the COVID-19 pandemic, which has probably affected the results.

Municipal heat provision experiences and expectations in Germany

BackgroundCompared to other sectors, the building sector is seriously lagging in efforts to mitigate climate change. In particular, heat provision needs to move to low-carbon options at greater speed. Municipalities are essential players in the transition to low-carbon heating. However, little is known about their experiences in developing heat provision infrastructure and their expectations of low-carbon options, such as district heating based on renewable energy. To explore how the experiences and expectations of municipalities concerning low-carbon heating are related, we conducted a survey of officers responsible for heating technology in municipal authorities across Germany. The questionnaires were analysed using multiple quantitative data analysis techniques.ResultsOur findings suggest that officers in larger municipalities have more positive expectations of low-carbon heating technologies than those in smaller and medium-sized municipalities. They also have more experience with these technologies. We identified four different clusters of municipalities based on their attitudes towards heating systems. The findings suggest that attitudes and experiences have a significant influence on the desirability and expected feasibility of the expansion of district heating. Furthermore, there are differences between south, north, and east Germany.ConclusionsExchange of experiences and expectations between larger and smaller municipalities could facilitate the transition to low-carbon heating. Public policy could strategically provide spaces for the required exchange, but it also needs to engage with more complex questions of finance and regulation.

Culture circle in primary care: dialogues with managers on health promotion.

To identify health promotion strategies used by managers in primary health care. Qualitative research, of a participant action nature, which adopted the Culture Circle proposed by Paulo Freire as its methodological reference. Eleven primary health care managers from a medium-sized municipality in southern Brazil took part. Nine generative themes emerged, categorized into four themes that highlight the interconnection between health promotion, social determinants and primary health care. These themes highlight preventive approaches, healthy habits and underline the need for a multidisciplinary approach to health care, recognizing the complexity of the dimensions involved, the influence of social determinants, environmental and health issues. These aspects call for intersectoral policies and actions, demonstrating the viability of health promotion in line with the principles of the Unified Health System. The autonomy of professionals working in primary health care services is highlighted, especially that of nurses, who play a central role in connecting and organizing health promotion actions.

VIOLÊNCIA DOMÉSTICA CONTRA AS MULHERES: VIVÊNCIAS DOS PROFISSIONAIS DA ATENÇÃO PRIMÁRIA A SAÚDE

ABSTRACT Objective: to analyze how Primary Health Care professionals experience domestic violence against women. Method: qualitative research, conducted from January to June 2023, through interviews with 20 Primary Health Care professionals, in a medium-sized municipality in the state of São Paulo, Brazil. The data obtained were interpreted using the Content Analysis Technique, thematic modality. Results: professionals emphasize the need for a sensitive approach and early identification, expressing feelings of perplexity and powerlessness during care. The impacts of violence are perceived by the victims, families, and society, causing physical, psychological, and social consequences. Challenges include lack of training, fear of reprisals, and lack of institutional support. The limitations faced by women in confronting violence are linked to lack of information, financial and emotional dependence, generating fear and insecurity. Conclusion: professionals experience the complexity of providing health care to women who are victims of domestic violence, and it is inferred that investments in professional training, institutional protection, and the creation of spaces that can support women are necessary to prevent re-victimization.

Fiscal austerity and municipal health spending: an interrupted time series study.

To analyze the impact of the fiscal austerity policy (PAF) on health spending in Brazilian municipalities, considering population size and source of funds. The interrupted time series method was used to analyze the effect of the PAF on total expenditure, resources transferred by the Federal Government, and own/state per capita resources allocated to health in the municipalities. The time series analyzed covered the period from 2010 to 2019, every six months. The first semester of 2015 was adopted as the start date of the intervention. The municipalities were grouped into small (up to 100,000 inhabitants), medium (101,000 to 400,000 inhabitants), and large (over 400,000 inhabitants). The data was obtained from the Sistema de Informações sobre Orçamentos Públicos em Saúde (Information System on Public Health Budget). The results for the national average of municipalities show that the PAF had a negative impact on the level of total expenditure and own/state resources allocated to health in the first half of 2015, without causing statically significant changes in the trends of any of the indicators analyzed in the period after 2015. Small municipalities saw a drop in total expenditure, while large municipalities saw a drop in own/state resources, and medium-sized municipalities saw a drop in both variables. There was no statistically significant drop in the volume of funds transferred by the Federal Government in the immediate aftermath of the implementation of the PAF in any of the municipal groups analyzed. In the medium-term, the PAF only had a negative impact on the large municipalities, which saw significant reductions in the trends of own/state resources and those transferred by the Union for health. In general, the impact of the PAF on health financing in municipalities was immediate and based on the decrease in own/state resources allocated to health. In large municipalities, however, the impact lasted from 2015 to 2019, mainly affecting health expenditure from federal funds.

The construction behind chosen names of transgender individuals and related aspects in a medium-sized city in the South of Brazil

This study analyzed the construction process of the chosen name and related aspects among transgender individuals from a medium-sized municipality in southern Brazil. Qualitative data from a descriptive and exploratory mixed-method study was used. Self-declared trans people aged 18 or over were included. Three focus groups were conducted with ten participants. These individuals, aged between 19 and 52 years, have a documented chosen name, but half have not yet changed their civil records. The content analysis technique produced two categories: "construction of the chosen name as an instrument for validating the transgender identity" and "impacts of the construction of the chosen name on self-acceptance and on family and social relationships." The results reinforce the importance of respecting the name as a way of contributing to the gender affirmation of transgender individuals. The name was linked to the experiences, individuality and values of these individuals. Its proper use, much more than respect for legislation, meant respect for the different possibilities of human existence. It is expected that the results presented can be used as a tool for recognizing the issues and nuances that permeate the construction of the chosen name and contribute to identity validation.

How older adults recovering from substance use problems experience mattering

AimMattering (to feel valued and add value to self and others) is a fundamental human experience and mechanism in recovery. In this paper, we concern ourselves with the recovery of older adults with substance problems. This population is on the rise in many Western countries. To offer mattering enhancing programs for this group, more knowledge about later life mattering in service-assisted recovery processes is needed. This study aims to explore experiences of mattering in older adults receiving services to recover from substance use problems. MethodsA collaborative and deductive reflexive thematic approach was applied in analysing 23 interviews with participants using substance use services. Participants were recovering from different substance use problems: alcohol, medication and illegal substances. The participants were recruited from three different Norwegian social contexts: two urban and one medium size municipality. The age of the sample ranged from 65–80 years, with approximately equal numbers for those aged 60–69 (12 participants) and 70–80 (11 participants). Seven participants were women and 16 men.ResultsThree main themes were identified in the analysis: “relational experiences of mattering and not mattering”, “service-related experiences of mattering and not mattering” and “recovery and psychological sense of community as interrelated phenomena to experiences of mattering”. The findings illustrate various nuanced experiences of mattering and not mattering in later life recovery processes.ConclusionsOverall, the participants’ mattering experiences rested on fair, healthy and positive community relationships and fair and attentive services, where participants could feel valued and also have a chance to add value to others. Experiences of not mattering were precipitated by lack of support, disrespect, devaluation and loss of relationships, and also by being ignored and not receiving fair treatment and help by professionals. Importantly, reciprocal and enhancing relations between mattering, recovery and relational PSOC seem to exist and to be significant for the older adults’ access to substance use services. Several practical implications are suggested to promote the therapeutic and preventive potentials of later life mattering in recovery.

Cluster-Based Multinomial Logistic Regression Model for Health-Related Quality of Life Among People Living with HIV in Brazil.

Improvement in treatment options has increased the survival of people living with HIV (PLHIV). Thus, we evaluated the factors associated with better health-related quality of life (HRQoL) among PLHIV in Brazil. This was a cross-sectional study carried out among 349 PLHIV. Data were collected using an interview-based questionnaire, and HRQoL was assessed by the Brazilian version of the WHOQOL HIV BREF instrument. We used non-hierarchical cluster analysis (K-means) to compile the WHOQOL HIV BREF's overall and domain scores into a unique more multidimensional measure for HRQoL consisting of three clusters: poor, fair and good; associations with clusters of better HRQoL were assessed using multinomial logistic regression models. The mean and median overall HRQoL scores were 15.13 (SD = 3.39) and 16, respectively. The reliability and validity of the Brazilian version of the WHOQOL HIV BREF instrument was confirmed among PLHIV in a non-metropolitan, medium-sized municipality of Brazil, which reaffirmed the cross-cultural validity of this instrument. The factors male sex; heterosexual and asexual orientations; higher individual income; undetectable viral load; absence of any comorbidity and presence of an infectious or a chronic comorbidity, with mental illness as the reference; and never having consumed illegal substances were independently associated with good HRQoL. Thus, the compilation of the WHOQOL HIV BREF's overall and domain scores into a unique multidimensional measure for HRQoL, which this study proposed for the first time, may facilitate more robust interpretations and models of predictors. These differentials could simplify HRQoL as an indicator of health and wellbeing to be routinely used as a key outcome in the clinical management of patients and in the global monitoring of health system responses to HIV.

Hematological parameters: is there a difference between those released by the hematological analyzer and to the customer?

This study aimed to compare the hematological parameters released by hematological analyzers with those released in customer reports. We conducted a descriptive study in the laboratories of a medium-sized municipality in the state of Minas Gerais registered in the National Register of Health Establishments. Interviews were conducted using a questionnaire to obtain information regarding the parameters released by the analyzers and those available in the customer's report. Sixteen laboratories were evaluated, and none of them released all the parameters obtained from the hematological analyzers to customers. The red blood cell distribution width was released in 88% of the laboratories, atypical lymphocytes in 70%, mean platelet volume in 50%, platelet distribution width and platelet count in 20%. No laboratory released information on reticulocytes, fraction of immature reticulocytes and immature granulocytes, nucleated erythrocyte count, immature platelet fraction and reticulocyte hemoglobin, and large platelet rate. All evaluated clinical analysis laboratories had at least one parameter that was not released in the customer's report despite being released by the hematological analyzers. The lack of knowledge on the part of professionals about the clinical importance of each parameter of the complete blood count results in a loss in patient assessment, and it is important to include these parameters in the complete blood count report.

Theory of change for implementing matrix support in mental health

Objective: To describe the process of development of the theory of change for the implementation of Matrix Support in a medium-sized municipality in São Paulo and to reflect on the contributions of this approach to the planning and evaluation of this intervention, considering the potentialities and challenges from its execution remotely. Methods Qualitative study performed through participatory workshops and construction of narratives with workers and managers of the Psychosocial Care Network following the recommendations of a guide for the development of the theory of change in complex interventions. Results: The implementation of Matrix Support configures one of the three distal results that culminate in the possibility of establishing the logic of shared care related to the activation of intersectoral network and the implementation of a Continuing Education Committee. External components that should be guaranteed by the organizational context for the effective achievement of some intermediate and long-term results were also recognized. Conclusion: The development of the theory of change was effective in delimiting objectives and implementation components from the perspective of the actors involved, establishing indicators for its monitoring and evaluation based on context conditions, and enabling the direction of workers’ efforts towards its consolidation.

Form and Structure of the Knowledge Framework for Urban Planning: Methodological Approach and Assessment Issues: The Case Study of the Municipality of Fondi Urban Plan

Analysing the formation of the Knowledge Framework (KF) for the Municipality of Fondi, a medium size municipality in central Italy, this research explains the methodology used to describe and interpret its specific territorial condition, aiming to delineate a series of operative guidelines for further implementations in other contexts. The article deals with comparisons with several urban planning approaches, transposing them to the study area, through the filter provided by the approach of Regional Design. The objective of the research is to produce a comprehensive KF for urban planning containing all the necessary information to unravel the assessment issue to put in place planning actions oriented toward sustainable spatial development. The research reorganizes the information legally required to define a Knowledge Framework into five Systems, articulated in analytical and synthetic products that as a whole aim to innovate the Knowledge Framework by recognizing it not only as an analytical process but also as a fundamental urban planning tool.

Typification and factors associated with violence among the homeless in a municipality of Minas Gerais, Brazil

The scope of the study was to typify the violence suffered by the homeless population and analyze the associated factors in a medium-sized municipality in Minas Gerais. A cross-sectional study was conducted and data about sociodemographic status, health, risk behaviors and occurrence of violence among the homeless was collected. Multivariate logistic regression was performed to verify the association between exposure and outcomes. Of the 85 respondents, the majority were male (75.3%), aged between 40 and 59 years (59.5%), non-white (86.3%), smokers (69.4%), alcoholics (80.7%) and drug users (53.6%). The overall prevalence of violence was 62.3%. The types of violence most reported were verbal and physical aggression and threats. Being a woman (OR 42.1; 95%CI 27.8-638.0) and being non-white (OR 9.02; 95%CI 1.33-61.1) were associated with a higher risk of experiencing violence. Having no morbidity (OR 0.14; 95%CI 0.03-0.62) and living on the streets for up to five years (OR 0.17; 95%CI 0.04-0.71) revealed a negative association. It was observed how violence is present in the urban context associated with sex, race, self-reported morbidity and time living on the streets.

Institutional Blendscapes: The Suburban Governance Role of the Diputación de Barcelona

The analysis of suburbanization patterns and processes necessarily implies looking beyond towns and cities. Suburbanization is a blendscape because it occurs within the transition zone between urban and rural areas surrounding urban centres. Therefore, a tension emerges between the growth expectations of small- and medium-sized municipalities and the supra-local authorities (e.g. metropolitan, provincial or regional public bodies) that provide essential (mostly financial) support to those municipalities. Supra-local authorities hence perform the governance role of institutional blendscapes because they can mediate between those growth expectations and more efficient, area-wide land management. By using the Barcelona Province as a case study, this paper examines three inter-related issues in suburbanization processes: (i) the question of land transformation; (ii) the relation between municipal size and suburban pa erns; and (iii) the role of supra-local authorities in the management of suburban areas in the city outskirts. Findings show that, overall, while municipalities up to 9,999 inhabitants have a housing stock that is predominantly suburban in character (i.e. 76.5 per cent single-family dwellings), it is small-/mid-sized municipalities between 10,000 and 49,999 inhabitants that have the highest proportion (31.2 per cent) of suburban residential areas within the Barcelona province. These small- and mid-sized, often rural, municipalities tend to rely on financial and technical support from the supra-local authority of the Barcelona Diputación – a key governance actor in suburbanization processes. As an institutional blendscape, on the one hand, the Barcelona Diputación can steer a more efficient land allocation and management through environmental protection and assistance in developing (supra-)local spatial plans. On the other hand, by distributing essential financial help to provide basic public services in small- and mid-size suburban municipalities, it also partially mitigates the planning, construction, and maintenance of suburbanity in (very) small- and medium-size municipalities 'far from the city' and rural areas.