Citizen Participation in Healthcare Decision-making on Local Level // Въвличане на гражданите във вземане на решения, свързани със здравеопазването на местно ниво

[EN] Over the past 30-40 years the idea of citizen involvement in health care decision-making process is undergoing steady progress as a result of different social, economic and political changes. In the 70s of the 20th century it evolves from an opportunity to rights and responsibility, and, as a requirement and principle enshrined in the health policies of many countries. The converse processes of centralization and decentralization of state power marking the past become an important factor in forming citizen participation in health care today. Legislation does not hold conceptually complete disposition in terms of citizen participation, and is scattered in different degrees and legally binding instruments which have mostly wishful character and do not stand as a sufficient condition for the effective participation of citizens in decision-making related to health care locally. Limited notions of the three constituent concepts - citizenship, health care and local government, creates difficulties in public’s perception of them as an overall concept. Techniques for citizens’ participation can be classified into several levels (information, consultation, partnership and domination), according to their influence on the health care decision-making process, but their expedience is limited (under 10% of the sample for each particular technique) and not efficient enough (only 27% designate a given technique as a favorite). Most familiar are the traditional techniques for providing information by submitting suggestions and complaints (67%) and least known and applicable are the techniques potentially deemed to turn into a partnership through direct interaction with the governing bodies in the form of standing committees to the Municipal Council (13%) and public committees (11% in Preslav, and 26% in Varna). There is a gap between citizen, health experts and local officials in terms of preferred techniques. The level of citizen participation in decision-making related to health care is poor and associated mostly with providing information and advice to local authorities, which in turn results in minor to moderate influence on the decision making process. In spite of using mainly individual ways of participation, citizens become aware that collective forms of association and the intermediary role of NGOs in health care provide a better chance of being heard. The preferred level of citizen participation in decision-making related to health care depends on the individual perspective, appurtenance to an interested group and issue. Exercising monitoring and control over decisions (69.2%) and defining healthcare priorities and planning (71.5%) are the preferred areas by citizens and health experts to embark on as partners and advisory party. The most significant barriers to citizen participation in health care decision-making are relevant to the citizens themselves and their perception and motivation, such as pessimism (61%); lack of interest in participating (41%); least important are some organizational factors related to municipalities limited resources (8%) and participation options (14%). Citizen participation would be facilitated mostly by greater transparency, awareness and improved interaction between citizens and governing bodies, by better publicity for measures undertaken, mechanisms and results of citizen participation (60%), media involvement on hot topics (38%), and an open dialogue based on mutual respect (37%). Negative experience directly affecting the individual bears a stronger motivating force than positive experience and altruistic motives.

Authors dc:creator

• Atanasova-Pieterse, Desislava
• Атанасова-Пийтърсе, Атанасова

• health care
• decision-making
• citizen
• local government
• techniques
• participation
• Социална медицина и организация на здравеопазването / Social Medicine and Organization of Healthcare

Repository record dc:identifier

http://repository.mu-varna.bg/handle/nls/173

OAI identifier oai:identifier

oai:repository.mu-varna.bg:nls/173