Three Levels of Governance

Italy’s National Health Service is a universal, tax-funded and highly decentralised system, organised across three levels of governance: national, regional and local. Each has distinct responsibilities, while working towards a shared objective: ensuring consistent and equitable healthcare across the country.

At national level, the Ministry of Health provides overall stewardship, setting the general framework, long-term objectives and health benefits package, monitoring the system and working together with Regions and research institutions.

Regions, with legislative and executive responsibilities, govern their regional health systems: they assess population health needs, adapt national recommendations to their specific contexts, allocate resources and define organisational frameworks.

Finally, Local Health Authorities deliver services, including preventive and public health care, as well as primary and secondary care.

From Healthcare Governance to Cancer Screening

Organised cancer screening follows the same multi-level governance structure. Breast, cervical and colorectal cancer screening programmes are part of Italy’s Essential Levels of Care (LEA – Livelli Essenziali di Assistenza) — the set of services and treatments guaranteed by the National Health Service to ensure uniform healthcare across the country — and are offered free of charge to the eligible resident population.

To support consistent implementation across a decentralised system, different bodies with political, technical and operational roles work in close connection, with continuous reciprocal feedback.

ONS

A key technical component of this system is the National Centre for Screening Monitoring (ONS – Osservatorio Nazionale Screening), a network of regional screening coordination centres providing technical support to the Ministry of Health and the Regions.

The Institute for Cancer Research, Prevention and Clinical Network (ISPRO), which is the Italian Competent Authority for EUCanScreen, acts as the operational and administrative hub of the ONS.

Through its Steering Committee and Scientific Committee, the ONS works with a broad range of stakeholders, including the National Institute of Health, scientific societies, and citizens’ and patients’ associations.

Coordination and Action

This collaborative structure turns coordination into concrete action: monitoring screening performance, implementing information systems, contributing to National Prevention and Cancer Plan recommendations, producing national guidelines, defining professional training, supporting quality assurance, promoting research, and strengthening the quality of information and communication.

Collaboration across the network also supports the development of guidance documents, organisational and diagnostic protocols and surveys on priority issues, while facilitating the implementation of research projects.

Connecting National Experience With European Collaboration

This network-based system also supports Italy’s participation in EUCanScreen, creating an exchange that works in both directions.

Practices developed within Italian screening programmes can be collected and shared at European level. One example is the PRECEDE-PROCEED model for screening programme implementation, shared within Work Package 4 on the sustainability of screening programmes. Italy’s experience with a cervical screening protocol based on vaccination status is also being shared within Work Package 9 on risk-stratified screening.

At the same time, European collaboration feeds back into the Italian context. Work within Work Package 6 on barriers and facilitators to screening access among gender minorities prompted the Italian group to conduct a qualitative survey exploring access challenges in Italy. More broadly, comparison with risk-stratified screening experiences across Europe is expected to contribute to shared recommendations and tools for future implementation.

FROM ITALY TO EUROPE — AND BACK AGAIN: ONE NETWORK, SHARED KNOWLEDGE, STRONGER SCREENING!

 #EUCanScreen #CoFunded #CancerScreening #Italy #CountryCampaign