The quality of social-health services and the role of social activism in Tuscany

The Associations for Social Advancement (ASAs), instituted in Italy with the law no. 383/2000, have their own specificity, in terms of advocacy, within the Third Sector, in relation to their specific activity of social intervention on behalf of the collective population in various sectors, among which the social-health sector.

Because of this formal recognition, the ASAs have taken on an increasingly relevant role in the current mix of welfare services as well as in governance of social-health, assuming in some cases as citizen/users representatives, like in Tuscany. With the emergence of the public health consortium called “Società della Salute” (SdS) that is, from 2008 (law no. 80), the ordinary form of management and programming of the regional social-health system, Tuscany intended to propose a redistribution of powers among the different actors in the field – the medical profession, the state, the health-industrial complex, the citizen/users (Light, 1995) – to orient the Priority Setting to the citizens’ needs and to improve the quality of services.

Our paper critically considers this configuration through an analysis of the role of  ASAs in the governance of SdS (Contandriopoulos, 2004) and of the “type” and “level” of ties between these associations and the local community in connection with an evaluation of the ASAs’ management of power, through the category of gender.

The analysis has led to highlight as too often the APS play a role that is almost completely autonomous from the local community, in that they tend to represent yet a further pole of attraction of power within the “field”, transforming the tetrahedron of Light into a hexahedron, in which the portion of power gained by the ASAs is subtracted from the other actors; and how this trend is in inverse relation to the active participation of women in the ASAs' management (Biancheri, 2000).