Organization and performance of public preventive health services in Italy: a national web based survey, 2012-2013

Background In Italy since 2001, the progressive devolution of healthcare policy making and responsibilities to the Regions has produced an heterogeneous picture of the regional governance. We report the results of a national survey aimed to describe organization and performances of regional and local public health services in charge of preventive health (SPH) for the years 2010-2012. Methods Main stakeholders (the Ministry of Health, the National Institute for Health, the National Agency for Regional Healthcare Systems, the Regions) decided to focus the study on three areas: prevention of overweight and obesity (POO), disability in the elderly (PDE) and promotion of physical activity (PPA). A web based survey was carried out involving 143 SPH selected as convenience sample within 26 Local Health Authorities (LHA) from 17 Italian Regions (on 21). For each preventive area and through a standardized web administered questionnaire, data were collected about individual SPH organization and performance, and different SPH coordination at LHA level to offer to customers essential preventive health services, mainly based on CDC’s National Public Health Performance Standards Program. The web survey was managed by Survey Monkey and data computed by Epi Info (ver.3.5.3). Results Overall SPH response rate was 64%. Within POO and PPA, 98% of LHAs offered health promotion activities and 90% population surveillance, within PDE respectively 80% and 45%. Tackling inequalities in preventive services was carried out by 46% and monitoring performance quality by 56% of LHAs. An overall 61% of LHAs appeared performing in more than 6 out of 8 components set for an adequate governance of preventive health services. Conclusion Although the moderate response rate suggests prudence, we found that while the majority of LHAs referred performing population surveillance systems and health promotion activities, approaches to control inequalities and plans to monitor performance quality were less represented. PDE seems to be the area where LHAs are less performing compared to POO and PPA. Governance of preventive health in LHAs could be strengthen to improve effectiveness of the public health system at regional and LHA levels.