'A war of a different kind': local municipalities' experiences in managing the COVID-19 pandemic in Israel-a qualitative study

Hilla Nehushtan, Hila Barel, Milka Donchin, Yael Bar-Zeev

Research output: Contribution to journalArticlepeer-review


Objectives In Israel, in 2020, 57/257 local municipalities were part of the Healthy Cities Network (HCN). HCN municipalities have a strong political commitment to health promotion and reducing health inequalities. This research aimed to (1) explore local municipalities' management of the pandemic and (2) assess whether belonging to the HCN impacted this management. Design, setting and participants Fourteen municipalities were chosen - seven HCN municipalities, matched to seven non-HCN municipalities. In each municipality, semistructured telephone interviews were conducted with three to four officials. Interviews were recorded, transcribed and analysed using inductive thematic coding, both in general and specifically to compare HCN and non-HCN municipalities. Results Forty-two interviews were conducted, with five main themes: (1) relationship with the government; with the transference of information to the local municipalities found to be challenging and a strong need for more independence at the local level; (2) contact with residents which was divided into several actions, such as mapping the city population, supporting vulnerable populations and managing volunteers; (3) relationships within the municipality which included a sense of collaboration and community but also a feeling of wear out; (4) difference between the first lockdown compared with following lockdowns; within these themes, no significant differences were found between HCN municipalities and non-HCN municipalities and (5) the role of the Healthy City (HC) coordinator which was critical in several municipalities. They served as brokers, had a pre-existing intersectoral network and held a broader vision of health. Conclusions Local municipalities in Israel played an important role in the pandemic response. Municipalities requested a central information source and more independence at the local level. Challenges and responses were similar across municipalities and residents, regardless of their HCN status. However, in some municipalities, the role of the HC coordinator was crucial for the pandemic response due to pre-existing interprofessional and intersectoral networks.

Original languageAmerican English
Article numbere068226
JournalBMJ Open
Issue number3
StatePublished - 15 Mar 2023


  • COVID-19
  • public health
  • qualitative research

All Science Journal Classification (ASJC) codes

  • General Medicine


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