ABSTRACT

Public health nurses in Japan work in a vertical local government health system. There are public health nurses working at the prefectural and municipal-level health centers. The Community Health Act in 1994 assigned the prefectural health centers to provide specialized services (e.g., home visits for low-birth-weight infants) and to supervise municipal health centers that provide more common services (e.g., child health checkups) (Hirano et al. 2011). Since the autonomy of cities has been strengthened after the Omnibus Decentralization Act in 2000, even the home visit program for low-birth-weight infants was transferred to the municipal level in 2012.