Decentralization, policy capacities, and varieties of first health response to the COVID-19 outbreak: evidence from three regions in Italy

Abstract

Effective response to a pandemic depends not only on national dynamics and characteristics but also on the features of a country's political and administrative decentralization and on the organizational capacities of the health system. As a result, different policy capacities can be present in the same national health system, and this variance allows us to understand local policy actions and their outcomes. Based on this assumption, this paper compares the process and the content of the initial policy response in three Italian regions (Lombardy, Veneto, and Emilia-Romagna). These three regions simultaneously experienced the most intense diffusion of infections and adopted very different strategies to mitigate the transmission of the virus. Our comparison reveals how the characteristics of Italy's decentralized health system and the consequent differentiation in terms of health policy capacities have clearly driven very different regional first health policy responses and outcomes with regard to dealing with the spread of COVID-19.

Lessons learnt of the COVID-19 contact tracing strategy in Islamabad Capital Territory, Pakistan using systems thinking processes

“…In contrast, an Italian study has argued that an effective national preparation and coordination is crucial in a decentralized system, where the strengths and weaknesses of local organizational capacities of the districts are exaggerated in times of crisis. This was the case of Italy, where decentralization mattered both in a negative (as in Lombardy), as well as in a positive way (as in Veneto and in Emilia-Romagna) ( 31 ). Lastly, the example of Indonesia shows that a coherent response strategy from district and municipal governments helped drive coordinated contract tracing regimes and set up their own social support services ( 32 ).…”

Is regional emergency management key to containing COVID-19? A comparison between the regional Italian models of Emilia-Romagna and Veneto

“…Veneto appeared to establish a hierarchical order in terms of key objectives and operational measures (Glaus, 2021), focusing on "identifying, confirming and rapidly isolating" (key-objective 2-3) both in terms of public health and health assistance through a greater number of swabs and a better ratio of home-based patient care/hospitalization. The strategy therefore has two characteristics: (1) strict subordination and clear chains of command ranging from the regional control room to the emergency team guaranteeing a straightforward, uniform response in line with a coordination model that had already been tested in ordinary conditions (Takeda and Helms, 2006), (2) it was influenced by Crisanti's expertise (see 2.2), turning into medical priorities in operational measures (Capano and Lippi, 2021).…”

“…guaranteeing a straightforward, uniform response in line with a coordination model that had already been tested in ordinary conditions (Takeda and Helms, 2006), (2) it was influenced by Crisanti's expertise (see 2.2), turning into medical priorities in operational measures (Capano and Lippi, 2021).…”

“…He also recommended their being extended from the early stages of COVID-19 even to asymptomatic cases, contrary to the rest of the country. The general good results (see Section 3.2) led to the Regional Governor's re-election and to Veneto being considered as a model to emulate (Capano and Lippi, 2021). Furthermore, the reference arena is mainly institutional also in the implementation of the measures.…”

Crowdsourcing and COVID‐19: How Public Administrations Mobilize Crowds to Find Solutions to Problems Posed by the Pandemic

“…A global wicked issue (Moon 2020 ), the pandemic is characterized by complexity and uncertainty (Steen and Brandsen 2020 ), affecting every aspect of life, disrupting social, organizational, and political processes (Dahlke et al 2021 ; Shi et al 2020 ) and highlighting the strong interdependency between social and political systems (Grizzle, Goodin, and Robinson 2020 ; Schomaker, Hack, and Mandry 2021 ). The rapid spread of the pandemic has forced governments to implement multiple, and sometimes unprecedented, measures to prevent the collapse of healthcare systems and national economies worldwide (Bel, Gasulla, and Mazaira‐Font 2021 ; Capano and Lippi 2021 ; Mei 2020 ). These include making substantial investments in areas such as research and development (R&D) for vaccines and treatments, mechanisms to track the spread of infection, and the production of protection and risk reduction devices.…”