Policy and planning of prevention in Italy: Results from an appraisal of prevention plans developed by Regions for the period 2010–2012

Abstract

Health policies on disease prevention differ widely between countries. Studies suggest that different countries have much to learn from each other and that significant health gains could be achieved if all countries followed best practice. This paper describes the policy development and planning process relating to prevention activities in Italy, through a critical appraisal of Regional Prevention Plans (RPPs) drafted for the period 2010-2012. The analysis was performed using a specific evaluation tool developed by a Scientific Committee appointed by the Italian Ministry of Health. We appraised nineteen RPPs, comprising a total of 702 projects, most of them in the areas of universal prevention (62.9%) and prevention in high risk groups (27.0%). Italian Regions established prevention activities using an innovative combination of population and high-risk individuals approaches. However, some issues, such as the need to reduce health inequalities, were poorly addressed. The technical drafting of RPPs required some improvement; e.g. the evidence of the effectiveness and cost-effectiveness of the health interventions proposed was seldom reported. There were significant geographical differences across the Regions in the appraisal of RPPs. Our research suggests that continuous assessment of the planning process of prevention may become a very useful tool for monitoring, and ultimately strengthening, public health capacity in the field of prevention. Further research is needed to analyze determinants of regional variation.

Health decentralization at a dead-end: towards new recovery plans for Italian hospitals

“…Second, the monitoring of regions' and hospitals' healthcare performance has highlighted a wide gap not only between regions but also between hospitals operating in the same region, both of which are closely linked to weak administrative and management capacities [9,11,13,[15][16][17]. Third, a three-year programme does not demonstrate a longterm view, evidencing the lack of strategic oversight and planning across the health system [9,17,21]. Given these considerations, it is clear that the healthcare system would benefit from a re-organization that pays greater attention to long-term strategic reforms.…”

“…This decline suggests that RRPs are effective tools for improving economic and financial performance in the short term [9,13,16,[18][19][20] with some limitations. Indeed, several authors have observed i) RRPs' limited efficacy in solving the structural causes of the deficits and ii) the lower quality of health prevention projects developed in Italian regions with financial deficits and recovery plans [9,16,21].…”

The Impact of School and After-School Friendship Networks on Adolescent Vaccination Behavior

“…At the same time, a strong concern of the heterogeneity in the distribution of vaccination coverage is observed from country to country [43] and, in Italy, even from region to region. In a recent review of the vaccination regional plans (RPPs), Rosso et al (2015) showed how such variability is not only in the outcomes, but also in the appraisal activity of regional plans, and the initiatives against unequal access to vaccine immunization are still far from an effective implementation [44].…”

The experience of a nationwide Community of Practice to set up Regional Prevention Plans in Italy

“…A study [19] that performed a critical appraisal of the RPPs 2010–2012, found that geographical differences in the quality of the RPPs and the opportunity of assessing the planning process may strengthen public health capacity for prevention. According to our experience, the CoP was felt by RPs as an opportunity for the Regions with less capacity in prevention planning processes to gain experience from others more skilled, even if gaps still exist.…”

“…According to our experience, the CoP was felt by RPs as an opportunity for the Regions with less capacity in prevention planning processes to gain experience from others more skilled, even if gaps still exist. In the future, to set up the next RPPs, it will be advisable to have a national follow-up of some critical steps of the regional planning process to avoid, for example, a lack of consideration of the principles of evidence-based prevention and to effectively tackle health inequalities [19, 20], as well as to retrieve the utmost from the national health behavioural surveillance systems well established in Italy [21] in order to monitor inequalities and outcome progress in prevention.…”