LOCAL SELF-GOVERNMENT BODIES AS SUBJECTS OF THE IMPLEMENTATION OF PUBLIC POLICY IN THE HEALTHCARE SECTOR
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Published:
Feb 27, 2026
Abstract
The ambiguous impact of decentralization and centralization on public governance mechanisms in the health sector is examined through an analysis of domestic and international experience. The article substantiates the role of local self-government bodies as actors in implementing public health policy under decentralization and martial law. Particular emphasis is placed on the «Health in All Policies» principle and the need to implement it at regional and local levels through the development of a «healthy community». The paper analyses how decentralization/centralization affects sector governance, the regulatory foundations, and the differentiation of local self-government competences (own and delegated) in health care. The methodological framework includes a systems approach, institutional and comparative analysis, and examination of national legislation and international sources. Using the Vinnytsia City Territorial Community as a case study, the article demonstrates the importance of strategic planning and municipal targeted programmes as tools for strengthening population health, ensuring service accessibility, and increasing local system resilience in Ukraine during wartime. Successful international governance practices in selected countries (Switzerland, Norway, Denmark, Finland) are also highlighted. The article concludes that a combination of subsidiarity, clear delineation of competences, and adequate resource provision for communities is a prerequisite for effective implementation of public health policy and for adapting the system to contemporary threats.
How to Cite
Svitlak, I., & Didyk, N. (2026). LOCAL SELF-GOVERNMENT BODIES AS SUBJECTS OF THE IMPLEMENTATION OF PUBLIC POLICY IN THE HEALTHCARE SECTOR. Academia Polonica, 73(6), 183-192. https://doi.org/10.23856/7323
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Keywords
public governance, healthcare system, public policy, transformation, public administration, decentralization, centralization, strategic planning
References
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2. Berdanova, O.V., Vakulenko, V.M., Valentiuk, I.V., & Tkachuk, A.F. (2017). Stratehichne planuvannia rozvytku obiednanoi terytorialnoi hromady [Strategic planning for the development of a united territorial community]. Kyiv [in Ukrainian].
3. Birk HO, Vrangbæk K, Rudkjøbing A, Krasnik A, Eriksen A, Richardson E, Smith Jervelund S. Denmark: Health system review. Health Systems in Transition, 2024; 26(1): i–152. Retrieved from: https://iris.who.int/server/api/core/bitstreams/b0992867-dee5-45fa-80b6-1e008fd353c0/content [in English].
4. Boes S, Weisstanner D, Durvy B (2025). Health Systems in Action (HSiA) Insights – Switzerland, 2024. Copenhagen: European Observatory on Health Systems and Policies, WHO Regional Office for Europe. Licence: CC BY-NC-SA 3.0 IGO. Retrieved from: https://iris.who.int/server/api/core/bitstreams/7d189cca-1094-46c0-8000-116ed4d2928e/content [in English].
5. Boryshkevych, I.I., & Yakubiv, V.M. (2022). Osoblyvosti ta vazhlyvist formuvannia stratehii rozvytku dlia terytorialnoi hromady [Peculiarities and importance of forming a development strategy for a territorial community]. Vcheni zapysky TNU imeni V.I. Vernadskoho. Seriia: Publichne upravlinnia ta administruvannia – Academic notes of the V.I. Vernadskyi TNU. Series: Public management and administration, Vol. 33 (72), 2, 125-131 [in Ukrainian].2022. Tom 33 (72).
6. Dmytryk, O.O. & Tokarieva, K.O. (Eds.). (2022). Hospodarska diialnist ta novitni tekhnolohii: aktualni problemy rehuliuvannia v umovakh voiennoho stanu [Economic activity and new technologies: current problems of regulation in martial law]. Kharkiv: NDI prav. zabezp. innovats. rozvytku NAPrN Ukrainy [in Ukrainian].
7. Hladun, Z.S. (2006). Administratyvno-pravove rehuliuvannia okhorony zdorovia naselennia v Ukraini [Administrative and legal regulation of public health care in Ukraine]. Kyiv: Yurinkom Inter [in Ukrainian].
8. Keskimäki I, Tynkkynen LK, Reissell E, Koivusalo M, Syrjä V, Vuorenkoski L, Rechel B, Karanikolos M Finland: Health system review Health Systems in Transition, 2019; 21(2): 1 – 166. Retrieved from: https://iris.who.int/server/api/core/bitstreams/0e64a5ce-25f5-495a-8e92-9c95cdb17f08/content [in English].
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11. Osnovy zakonodavstva Ukrainy pro okhoronu zdorovia: Zakon Ukrainy vid 19.11.1992 r. № 2801-XII [Fundamentals of Ukrainian legislation on health care: Law of Ukraine dated 19.11.1992 № 2801-XII]. zakon. rada. gov. ua. Retrieved from: https://zakon.rada.gov.ua/laws/show/2801-12#Text [in Ukrainian].
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14. Prohrama «Zdorovia vinnychan na 2022-2025 roky»: Rishennia VMR vid 24.12.2021 r. № 758 zi zminamy vid 14.11.2024 r. № 2654 [Program «Health of Vinnytsia Residents for 2022-2025»: Resolution of the Vinnytsia City Council dated 24.12.2021 № 758 with amendments dated 14.11.2024 № 2654]. vmr.gov.ua. Retrieved from: https://2021.vmr.gov.ua/Docs/ExecutiveCommitteeDecisions/2024/%E2%84%962654%2014-11-2024.pdf [in Ukrainian].
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17. Shevchuk, R.V. (2023). Rozvytok mekhanizmiv publichnoho upravlinnia u sferi okhorony zdorovia v suchasniy Ukrayini [Development of public administration mechanisms in the field of health care in modern Ukraine]. Doctor’s thesis. Kyiv [in Ukrainian].
18. Uhoda pro asotsiatsiiu mizh Ukrainoiu, z odniiei storony, ta Yevropeiskym Soiuzom, Yevropeiskym spivtovarystvom z atomnoi enerhii i yikhnimy derzhavamy-chlenamy, z inshoi storony: ratyfikovana Zakonom Ukrainy vid 16.09.2014 r. № 1678-VII [Association Agreement between Ukraine, on the one hand, and the European Union, the European Atomic Energy Community and their Member States, on the other hand: ratified by the Law of Ukraine dated 16.09.2014 № 1678-VII]. zakon.rada.gov.ua. Retrieved from: https://zakon.rada.gov.ua/laws/show/9 84_011#n967 [in Ukrainian].
19. Zdorova hromada: chynnyky ta mozhlyvosti vplyvu pid chas viiny: Zvit za rezultatamy doslidzhennia v mezhakh ukraino-shveitsarskoho Proiektu «Diiemo dlia zdorovia» [Healthy community: factors and opportunities for influence during war: Report on the results of the study within the framework of the Ukrainian-Swiss Project «Act for Health»]. (n.d.). actforhealth.in.ua. Retrieved from: https://www.actforhealth.in.ua/materialy/zdorova-gromada-chinniki-ta-mozhlivosti-vplivu-pid-chas-viyni [in Ukrainian].
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