As the majority of health care establishments belong to local self-government bodies, they are under great political pressure. In practice it becomes a considerable barrier for decisions, negatively perceived by the public, to be made, e.g., issues of reducing the staff number, health care establishment structure changes with some divisions being closed or their liquidation.

Systemic changes implementation involves different phases, including certain resistance and social tension. It is often used by political opponents, increasing the pressure with information in the mass media, distorting facts. It lasts for several months until the phase of perception. Active resistance stops much faster, so, if local self-government bodies can see potential benefits for the municipality, they should not be afraid of a temporary wave of resistance but enhance the positive outcome.

The material highlights the issues the local self-government should pay special attention to while making politically unpopular decisions.