Background: In Italy, Departments of Prevention (Dipartimenti di Prevenzione, DPs) are primary organizational units for disease prevention, health promotion, and environmental health. Constitutional decentralization (2001) generated significant regional variability. While national data exist, in-depth regional analyses are lacking. Objectives: To provide a systematic descriptive analysis of organizational structure, governance mechanisms, and workforce composition of DPs in the Triveneto area (Veneto, Friuli Venezia Giulia, Autonomous Provinces of Trento and Bolzano), contextualized within national and international frameworks. Methods: Cross-sectional descriptive study using 2022 Italian Prevention Observatory national survey data. A structured 87-item questionnaire assessed organizational structure, governance, staffing, and quality systems. Results: A total of 10 of 14 DPs participated (71.4% coverage; 5.2 million inhabitants, 87% of Triveneto population). All maintained three mandated core services (Public Health and Hygiene, Veterinary Public Health, and Occupational Health and Safety), employing medians of 35%, 23%, and 14% of staff, respectively. Management Committees were active in 80% of DPs (vs. 77.6% nationally). Quality certification (30%) and institutional accreditation (50%, Veneto only) showed inconsistent implementation. The workforce was predominantly non-executive (65% vs. 67% nationally), reflecting progressive task reallocation. Median staff density: 3235 inhabitants/staff member (vs. 2608 nationally). Conclusions: Participating DPs—predominantly from the Veneto Region—demonstrate comprehensive service coverage and established governance structures, yet face standardization challenges. Findings should be interpreted in light of Veneto overrepresentation (8/10 participating DPs). Alignment with territorial care reforms (Ministerial Decree 77/2022) and National Recovery Plan investments could enhance integration, digital infrastructure, and preparedness capacity.
Sustainable Development Goals (SDGs) emphasize inclusive, equitable, and environmentally sustainable growth, requiring effective localization for meaningful outcomes. Local governments, particularly in developing countries, play a crucial role in translating global goals into actionable strategies at the grassroots level. In India, Panchayati Raj Institutions (PRIs) and Urban Local Bodies (ULBs), empowered by the 73rd and 74th Constitutional Amendments, serve as key agents in implementing SDGs through decentralized planning, resource allocation, and community participation. This research article examines the role of local governments in achieving SDGs in India, with a special focus on Karnataka. Using a narrative review methodology based on PRISMA-ScR guidelines, the study synthesizes findings from 28 empirical studies, government reports, and policy documents published between 2015 and 2026. Evidence suggests that local governance interventions have improved service delivery outcomes by 30–50 percent in sectors such as water management, sanitation, renewable energy, and rural livelihoods. Initiatives such as Gram Panchayat Development Plans (GPDPs), e-Gram Swaraj, and Finance Commission grants have strengthened participatory planning and accountability. However, challenges such as limited fiscal autonomy, capacity deficits among elected representatives, and coordination gaps persist. The study concludes that strengthening local governance through capacity building, financial empowerment, and technological integration is essential for achieving SDGs. Karnataka's innovative practices demonstrate the potential of decentralized governance in driving sustainable development.
The article explores international experience in social services management and outlines directions for its adaptation in Ukraine. The key principles of effective management in social services are defined as decentralization, client orientation, system integration, community participation, and digitalization. Three main international approaches to social services are generalized: the Scandinavian (state-centered and socially oriented), the European (partnership-based and decentralized), and the social innovation approach (inclusiveness, collaboration, and technological focus). The Ukrainian context is analyzed in terms of staffing, financing, management culture, and legal framework. The necessity of systematic integration of international practices into Ukrainian realities is substantiated, considering socio-economic factors, societal values, and community potential. A four-level model of adaptation of international experience is proposed - normative, institutional, professional, and technological. It is concluded that modernization of social service management is an essential component of human capital development and the social resilience of Ukraine.
Laura Cambra‐Rufino, Andrea Brambilla, José León Paniagua Caparrós, Stefano Capolongo
AIM: The research sheds light on the challenges and limitations of Spanish and Italian hospital design by looking at the gaps between education and practice. BACKGROUND: Hospital design plays an important role in providing high-quality and cost-effective facilities for any healthcare system. Spain and Italy face contemporary challenges (i.e., elderly population, staff retention, and obsolete healthcare facilities) and have similar issues of life expectancy, health expenditure, hospital beds provision, and decentralized tax-financed healthcare systems. METHOD: A cross-sectional, mixed-method study was used. This involved two different data collection strategies and analysis for each area of investigation: (i) education and (ii) practice. For the former, educational programs were reviewed via a web search; for the latter, an online survey of 53 architectural/engineering offices involved in hospital design was conducted. RESULTS: Hospital design education is limited to 0/58 in Spanish and 2/60 courses in Italian universities, although each country offers three postgraduate courses. The practitioners' survey shows that even though their offices have a long history of healthcare design, only 48% in Spain and 60% in Italy have received specific university training. Office staff lack employees with medical backgrounds, which hinders any partnership between health and design fields either for design practice or the education fields. Laws, national regulations, technical guidelines, and previous experience are the most useful information sources, while international scientific publications appear underused by practitioners. CONCLUSIONS: Italian and Spanish healthcare architecture could be improved by promoting multidisciplinary teams (in practice and education) and improving the education offer by tailoring it to national needs.
INTRODUCTION: This article reports the results and the lessons learned from implementing the decentralized approach to tuberculosis (TB) detection and treatment, embedded with Human Immunodeficiency Virus (HIV) co-infection in health district. The objective was to increase the TB screening indicators in the district using the common ways for offering care to patients in health district. METHODS: Conducted from August 2006 to July 2007, this large-scale intervention using Non-experimental study Designs has implemented a decentralized approach for fighting against TB in Orodara Health District (OHD), Burkina Faso. Pretest-posttest design has been used for quantitative part using indicators in one hand, and postests-only design for the qualitative part in other hand. In the pretest-posttest design, the TB indicators from years before 2006 (from 2002 to 2005) were used as earlier measurement observations allowing examining changes over time. The decentralized approach was incorporated into the annual planning of the OHD. For the quantitative study design, indicators used were those from National TB Program in Burkina Faso: TB detection rate, incidence density of TB per 100,000 inhabitants per year, and HIV prevalence in incident TB cases with positive smears. Data entry and analysis employed Microsoft Access and Excel software. For the qualitative, in-depth interview was used in which a total of 16 persons have been interviewed. Discussions were tape-recorded and transcribed verbatim for analysis using the computer-based qualitative software program named QSR NVIVO. RESULTS: There were a total of 99,259 outpatient visits during the study period: the7,345 patients (7.43%) presented with cough. Of the 7,345 patient having cough, 503 cases (6.8%) were declared chronic coughing. These 503 patients were screened for TB, including 35.59% whose coughing had lasted 10 to 15 days. We observed an increase in a measured variable was observed. The TB detection rate and incidence-density rate based on positive smears were 16.11% (11.00% in 2005) and 10.42 per 100,000 inhabitants per year (6.88 per 100,000 inhabitants in 2005), respectively. There were 29 patients positive for TB: 41.37% of these had cough lasting 10 to 15 days, 10.34% were also positive for HIV, and 68.97% were from rural areas. Health workers and patients reported satisfaction with the intervention. It was found that implementing a decentralized approach to TB prevention in rural areas is plausible and effective under some conditions: considering that health district system is functional; carefully designing the intervention for TB case management; setting up and implementing of decentralized approach including strong monitoring; and taking into account the all financing, community and volunteer involvement, evaluation of the cost savings from integrating specific donor funding, and being supported by regional and central levels including National TB program. CONCLUSION: The study has shown that TB detection rate can be increased by implementing a decentralized approach to primary care. When carefully implemented, a decentralized approach is a suitable approach to TB and HIV prevention in rural and inaccessible settings.