The objective of this quantitative study was to examine the impact of selected factors on the level and state of public health capacities in local self-government units in 2021. This survey included 77 out of 145 local self-government units in the Republic of Serbia and examined six dimensions defined by the Law on Public Health. The results of the Pearson correlation showed that there were statistically significant correlations between the effectiveness of the realized program budget and microbiologically defective drinking water samples from the so-called village water supply systems, defective samples of drinking water from public taps, unsatisfactory analyses of wastewater samples, and the number of mandated fines issued. The results of the logistic regression model showed that the local self-government units that received assistance from the Standing Conference of Towns and Municipalities were 5.6 times more likely to perform analyses of their health status. The results confirmed the effectiveness of implementing health councils in the areas of promotion and prevention, as well as in the organization and functioning of the healthcare system. In future works, LSGU should be supported in their choices of effective programs and priorities. Although a large percentage of local governments reported having an institutionally provided advisor for the protection of patients’ rights, a small number of patient complaints indicated that it is necessary to empower citizens to exercise their rights guaranteed by law.
On the other side, the results of the study can be considered relevant to the regular monitoring and evaluation of indicators in the field of public health and in regard to health improvement at the local level, as well as assessing the capacities of cities and municipalities to implement their given responsibilities. The survey comprehensively assessed self-government units’ competencies in all areas of public health. The results obtained from the analysis of the work of the health councils, the selected indicators for each area of public health, and the effects of the support of the SCTM and the representatives of the public health institutes provided clear guidelines for establishing effective monitoring systems, planning the activities of the actors involved (LSGU, the SCTM, and public health institutes) and evaluating their effects.
Areas of public health that were identified as needing special support included the environment, workplace environments, and emergency situations. The environment is the most complex area and probably the most important because it includes the entire population in each local self-government area. First of all, it is necessary to conduct health risk assessments in each municipality and adopt special environmental improvement programs based on the unit’s priorities. In general, the most important issues identified was water—the provision of proper drinking water in cities and small village waterworks, the availability of proper water in public facilities, as well as providing solutions regarding wastewater for both communal and industrial facilities. The second most important issue was air pollution measurements, which must be conducted continuously and for specific pollutants, and which were provided in less than a third of the LSGU.
It is necessary to help local self-governments to develop plans for the care of the population in crisis and emergency situations because the occurrence of unwanted events (such as floods, mass migrations, chemical spills, and pandemics) is becoming more frequent. The results of this study showed that the participation of public health representatives in the councils resulted in the councils having better access to analyses of health status and indicators of various areas of public health. Establishing good communication between partners at the local level contributes to the improved effectiveness of the activities undertaken.