'Emergency situation of the public health service in rural areas.'

As an employer and as a service provider, the public service today faces complex challenges as a result of demographic developments. The Public Health Service (ÖGD) bundles these challenges as if under a magnifying glass. Based on an empirical study of the 22 health authorities in Thuringia, the article shows which control options state ministries have to meet these challenges. The hierarchical organization of the ÖGD in the German multi-level system requires multi-track governance strategies which, on the one hand, are aimed at increasing the attractiveness of jobs in the ÖGD in accordance with theories of personnel management (attraction-selection-attrition theory, public service motivation and personnel economics); on the other hand, governance instruments (regulation, incentives or centralization of competencies) have to influence local employers. Although ministerial actors are in various dependencies, if the spectrum of networking and coordination options is used strategically, there is the possibility of structural improvements despite tight budgets.