Recipes for Systemic Change - Helsinki Design Lab

The municipalities must abide to the statutory requirements passeddown from the Ministry level, but have broad discretion in determiningthe precise type and scope of services they provide; they are free to design,implement, and operate the various welfare delivery systems as they see fit.Municipalities may deliver welfare services independently or in conjunctionwith other municipalities. Additional procurements may beattained from other municipalities or public and private service providers.Some municipalities may opt to privatize their own operations through theestablishment of a limited-liability company.D4.4 Issues Of Scale And StructureThe complex municipal system in Finland is a product of the powerfulcultural impulse toward local self-governance. However, the scale of localgovernance is not always conducive to the effective management of broaderissues such as social welfare, which often rely on economies of scale to functionfluidly. As a result, many municipalities chose to collaborate in order tomore effectively provide or procure welfare services.The current arrangement of ministries at the national level is lockedinto the so-called "silo" mode of operation. Policies are created withinsingle ministries and steered vertically by them. As a result, there is littlemeaningful lateral interaction between ministries, a organisational structurethat increases the complexity of large programmes like social welfare,which—by definition—span multiple silos.D4.5 Service Delivery SystemFor the provision of health and social services, Finland is broken downinto twenty-one hospital districts. Every municipality is a member of oneof these districts. District health centres and hospitals are the primary sitesfor citizens to receive health and social services, primarily in the form ofoutpatient (health centres) and specialty services (hospitals). Private carefacilities (especially for specialized care), as well as secular and religiousassociations and volunteer groups may provide supplementary services.For the elderly, municipalities manage nursing homes, sheltered housing,and sophisticated networks of home care services. They also providethe funding for informal care outside of the institutional system. The elderlyare entitled to comprehensive care, which encompasses preventivehome visits, coordinated social activities, sophisticated institutional medicalcare, and monthly income grants.The pension delivery system, which is organized according to its owndistricts, offices, and service centres, is superimposed over the welfare servicessystem.298