Local implementation of public health policies revealed by the COVID-19 crisis: the French case

Table 2 The three levels of local implementation of health policies: the French case

Feature of each level	Administrative implementation	Organizational implementation	Operational implementation
Actors	- ARS^a - Representative of the State - Local elected officials	- GHT^b - CHU^c - Hospitals - EHPAD^d	- Heads of department - Health care managers - Health care staff (physicians, nurses, care assistants, maintenance staff)
Implementation designers	Ministry of Health	-GHT -CHU	Department heads Managers
Implementation drivers	ARS	GHT	Managers and Health care staff
Steering	Vertical	Vertical	Horizontal
Forms of coordination	- Systemic	- Organizational - Functional	- Professional - Normative - Clinical

^aRegional health agency (ARS) are public administrative establishments of the French State in charge of the implementation of health policy in its region. Their aim is to ensure a unified management of health in the region, to better respond to the needs of the population and to increase the efficiency of the health system
^bTerritorial hospital groupings (GHT) are a contractual arrangement, mandatory since July 2016, between public health establishments in the same geographical area, by which they undertake to coordinate around a common and graduated patient care strategy, formalised in a shared medical project
^cUniversity Hospital Centers (CHU) are public health establishments, which have signed an agreement with a university, or possibly with several universities. They have a triple mission of care, teaching and research. but also prevention, health education and the fight against social exclusion
^dEHPAD are Housing institutions for elderly dependents. They are the most widespread type of French Residential care for senior citizens

ISSN: 1748-5908