Health Security in the Hands of Local Authorities – Cooperation, Planning, Crisis Management
Are local authorities and institutions ready to meet the challenges of health security—from everyday access to services, through epidemiological crises, to military situations and CBRNE threats?
The resilience of the healthcare system was discussed during the Forum of Local and Regional Authorities in Zakopane by participants of the panel “Health Security in the Hands of Local Authorities – Cooperation, Planning, Crisis Management”, which included Prof. Andrzej Matyja — Vice-President of the Kraków Chamber of Physicians, former President of the Supreme Medical Council (2018–2022), Joanna Bogacz — Director of the Health Department of the Małopolska Voivodeship Office, Anna Czech — Director of the Provincial Hospital of St. Luke in Tarnów, Paweł Wesołowski — Deputy Director of the 5th Military Clinical Hospital with Polyclinic in Kraków, and Michał Tuczabski — Executive Director of the National Program for Mental Health Rescuers. The discussion was moderated by Natalia Miller from the Medical University of Warsaw.
Prof. Andrzej Matyja emphasized that health security is a fraction of public security, but it must be understood broadly and daily: it includes both resilience to crises (epidemics, wars, disasters) and continuous access to services, health education, and promotion of a healthy lifestyle. The professor pointed out lessons—or rather the lack thereof—from the COVID-19 pandemic: despite vast experience, there is no nationwide report or coherent guidelines to systemically organize conclusions for the future. In his view, the key elements remain cooperation, planning, and management—these worked better in Małopolska during the pandemic than in some other regions, translating into real effectiveness of decisions.
Director Joanna Bogacz outlined two dimensions of operation: the routine functioning of medical entities and extraordinary situations, in which the role of the voivode increases. During the pandemic, voivodes made decisions on opening COVID beds; today, their portfolio also includes planning to increase hospital beds during wartime, and a novelty is the Plan for Increasing Medical Rescue Teams for Defense Purposes. Director Bogacz highlighted the system structure: in Małopolska there are approximately 100 hospitals, of which 38 are public SP ZOZ hospitals; together with companies with majority State Treasury participation, this accounts for about two-thirds of all beds (approximately 10,000 out of 15,000) in the hands of public entities. This is important because, in a crisis, the voivode has statutory instruments mainly toward public entities, facilitating resource management. She also stressed the importance of State Medical Rescue (PRM) as the “first line of the front” — and limitations resulting from PRM financing returning to the National Health Fund (NFZ), which hinders the voivode from quickly increasing the number of teams without allocated funds.
Director Anna Czech presented a comprehensive set of measures implemented at the Provincial Hospital of St. Luke in Tarnów. The hospital regularly exercises scenarios tailored to the local risk landscape. Exercises included, among others, an ammonia leak and mass-casualty events: immediate role allocation, decontamination, parallel actions during traffic accidents, as well as ICU evacuation “in 6 minutes” with full intensive care equipment, and a cyberattack scenario: working “analog” (transporting samples to the lab manually, paper circulation of results) to maintain continuity of diagnostics and treatment.
Director Paweł Wesołowski emphasized that the 5th Military Clinical Hospital regularly participates in exercises with the voivode and services, including mass-casualty events and CBRNE threats. Conclusions from exercises are transformed into procedures with precise allocation of tasks and responsibilities.
Prof. Andrzej Matyja noted that although regional procedures and cooperation in Małopolska are strong, the lack of a unified nationwide standard remains a real risk for the coherence of actions across the country.
In 2025, the long-awaited Act on Civil Protection and Civil Defense was passed, along with a financing program accompanying its implementation. In Małopolska, the voivode has 388 million PLN for activities in this area (two-year plan), of which approximately 40 million PLN this year will support medical entities — primarily hospitals operating within the PRM system and managers of medical rescue teams. A team for CBRNE cooperation was also established, tasked with developing and improving procedures and training.
The number one need according to practitioners: “Money, money, and money again” — as Director Wesołowski put it — for equipment, infrastructure, training, and simulations. The new act, for the first time, realistically detaches planning from mere paperwork, providing funds for implementation.
Michał Tuczabski from the National Program for Mental Health Rescuers pointed out that social resilience in crises requires not only efficient hospitals but also strong mental health in entire communities. His program is based on peer support in schools: training leaders/ambassadors within student communities who can recognize peers’ difficulties, provide support, and direct them to specialists (psychologists/pedagogues). This is a non-medical element of first psychological aid and building empathy in classrooms.
Prof. Matyja, as chairman of a team under the Minister of Justice, emphasized that patient safety cannot be guaranteed without the safety of healthcare professionals. The team aims to develop guidelines and systemic solutions ensuring a rapid, predictable response from law enforcement and courts to hate speech and aggression — both physical and symbolic. The goal is for the hospital to remain a “place of hope, not fear,” and for clinicians to treat according to current medical knowledge, not under the shadow of fear of attack.
Anna Czech recalled the long-standing need raised by the community for a health coordinator at the voivodeship level — not only in crises (as during the pandemic, when the voivode’s competencies were expanded) but also in everyday policy of the service network and competency development. Coordination between the marshal (who has their own entities), voivode, counties, and cities is often difficult; a permanent, substantive role of a coordinator could reduce “divergent priorities” and accelerate rational development of services, including preparation for extraordinary situations.
In summary, panelists agreed that procedures are important, but daily cooperation and goodwill determine effectiveness. In Małopolska, communication channels between the Health Department, hospital directors, and managers of medical teams are stable and tested — which panel participants repeatedly confirmed.
