Italy - Political & Administrative
The topic of central-local level decision-making in Italy is particularly complex. The responsibilities of the different sectors are defined in national and regional laws and by laws, and also, there are five regions with special statute, which represent exceptions to the norm. Italian literature on the theory of decision-making and the relationship between policy and government is rather wide. Table 1 presents the example of governance based on Tuscany region and referred to the two field of environment and health, as the most significant when we consider the PA domain.
Table 1: Decision making structure in Tuscany Region on environment and health and National competencies
Responsibilities on environment
Responsibilities on health
Other subjects involvedMinistry exclusive legislative power on: protection of the environment, the ecosystem and cultural heritage exclusive legislative power on: definition of basic level of benefits guaranteed to the citizens throughout the national territory MunicipalityDepartment Management of specific issues Adoption of measures according to Regional legislation Coordination AuthorizationDepartment In Tuscany (only) group of Municipalities are associated with one Local Health Authorities LHA, to harmonise and plan the activities and health management. The Mayor is a public official in charge by the State to protect citizen health (not linked with the responsibilities of the Municipality) -> power of independent decisions and issuance of orders Società della Salute – Health Partnership is the new Body created by associated Municipalities and LHA Province Offices Management in specific domains including the competent area (waste, water) Monitoring and control OfficesOther competent Directions Region Regional Council The Region has concurrent legislative power in relation to: government of the territory; enhancement of cultural and environmental heritage Regional plans and programsRegional Council Regional laws on the health matters, regulations, plans and programs. The Region transfer funds directly to the LHA Other competent Departments
Regional Agency for Environment Protection
(Provincial Departments, Local and Provincial Services)Technical-scientific support. Environmental monitor. Through a network of Provincial Departments, local and sub-provincial Services present on the regional territory, ARPAT guarantees the implementation of regional objectives in the area of prevention and environmental protection. The Agency is supervised by the Region Local Health Authority LHA is managed by: chief executive, administration manager, medical director and Coordinator of Social Services, regulated under public juridical personality The actions developed within the health care regional system of companies are connected with public or private bodies and are part of a permanent consultation activity at the local level. Regional Health Authority Observatory Workgroups
The Ministry of Health is the main Body in the National Health Service, NHS, which has the functions belonging to the State for the protection of human health, the coordination of the National Health System, veterinary health, health protection in the workplace, hygiene and food safety, without prejudice to the exclusive competence of the Regions, implemented by the Local Health Authorities. The Ministry of Health prepares a National Health Plan, and it co-ordinates the activities with the World Health Organization, WHO and the European Agency for the Evaluation of Medicinal Products, EMEA.
The Italian National Health Service, NHS, applying a universalistic model, has the responsibility for public health prevention, cure and rehabilitation for the general population. The organization and functioning of the prevention, cure and rehabilitation services is assigned to regional health systems administered by Regional Governments. Even if the amount of economic resources is planned at national level and it is distributed to each Region on the basis of homogeneous criteria (number of inhabitants, population-age structure), the regionalization of the health system (i.e. devolution of responsibility for management and decision making) is producing wide differences among regions, both in prevention and in health care service, depending on cultural, economic and political factors(2).
(2) United Italy, 150 years later: has equity in health and health care improved?, edit by Giuseppe Costa, Eugenio Paci, Walter Ricciardi, Epidemiol Prev 2011;35(5-6) suppl.2.