Piano Nazionale della Prevenzione 2020-2025

Objectives

Italy’s National Prevention Plan 2020–2025 provides the shared framework for collective prevention and public health, linking national health and equity goals to macro-objectives, strategic objectives, intervention lines, Essential Levels of Care and indicators.[1][2]It seeks to protect population health, prevent disease, promote health and strengthen preparedness for current and future health threats.[2][3]

• Apply One Health, Health in All Policies, life-course, settings-based, gender-sensitive, person- and community-centred approaches, recognising links between human, animal and ecosystem health and between health, sustainable development and the 2030 Agenda.[4][5][6]
• Reduce social and geographical health inequalities through evidence-based and equity-oriented prevention, health literacy, empowerment, participation and targeted action for vulnerable populations.[7][8][9]
• Address chronic non-communicable diseases and modifiable risks, including tobacco, alcohol, unhealthy diets, physical inactivity, obesity, hypertension, mental health and environmental and socioeconomic determinants.[10][11]
• Promote health from pre-conception and throughout the life course, prioritising the first 1,000 days, healthy family lifestyles, schools, workplaces, communities, municipalities and healthy ageing.[12][13][14]
• Strengthen organised prevention for cancer, including breast, cervical and colorectal screening, while improving equitable participation, quality and pathways for higher-risk groups.[15][16][17]
• Prevent substance-related and behavioural dependencies, tobacco and alcohol harms through integrated action on supply, demand, risk reduction, early identification, treatment, rehabilitation and social inclusion.[18][19][20]
• Reduce domestic, road and occupational injuries and diseases through safer environments, behaviour change, risk-based prevention, inspection, surveillance and cross-sectoral safety policies.[21][22][23]
• Protect health from environmental, climatic, chemical, radiation, water, waste and contaminated-site risks, while supporting sustainable cities, buildings, mobility, food systems and climate resilience.[24][25][26]
• Strengthen prevention, surveillance and control of infectious diseases, including pandemic threats, vaccine-preventable diseases, HIV, sexually transmitted infections, tuberculosis, zoonoses, food-borne and vector-borne diseases, viral hepatitis, healthcare-associated infections and antimicrobial resistance.[27][28][29]

Implementation

Implementation is based on coordinated national, regional and local planning. The Ministry of Health provides stewardship, direction, promotion, coordination and technical support; Regions and Autonomous Provinces translate the framework into Regional Prevention Plans and support delivery by health authorities and local services.[30][31]Regional programmes must reflect local epidemiological, demographic, socioeconomic, behavioural and organisational conditions while contributing to common national objectives.[32][33]

• Organise Regional Prevention Plans around mandatory Predefined Programmes with common indicators and expected values, alongside Free Programmes addressing locally relevant objectives not fully covered by the national programmes.[33][34]
• Use the mandatory web-based planning platform to submit, document, monitor, evaluate, revise and, where applicable, certify Regional Prevention Plans and their programmes.[35][36]
• Integrate prevention departments, primary care, hospitals, social care, local authorities, schools, workplaces, environmental agencies, veterinary services, laboratories, civil society, employers, professional bodies and communities into coordinated delivery networks.[37][38][39]
• Strengthen territorial and primary-care services through multidisciplinary organisations, community-based professionals, integrated social-healthcare action, continuity with hospitals and proactive work in people’s living environments.[40][41]
• Develop workforce capacity through action-oriented, intersectoral training for prevention staff, general practitioners, paediatricians, occupational-health professionals, educators and other relevant actors.[42][43][44]
• Use communication and social marketing as planned public-health tools to improve knowledge, trust, health literacy, empowerment, informed decisions, access to prevention and engagement with services.[45][46]
• Apply Health Equity Audit methods by developing health and equity profiles, identifying populations or areas with higher exposure or vulnerability, adapting programme design and resource allocation, and assessing impacts on inequalities.[47][9]
• Base interventions on evidence of effectiveness, documented good practice, sustainability, equity, transferability and cost-effectiveness, with attention to population coverage and disease burden.[48][49][50]
• Strengthen surveillance, registers, information systems, laboratory networks and interoperable data flows to support risk assessment, early warning, planning, outbreak response, service improvement and evaluation.[51][29][52]
• Measure implementation and outcomes using SMART indicators, including process, coverage, outcome, early-outcome, health and equity measures, stratified where possible by sociodemographic characteristics.[53][54]
• Assess progress annually at national and regional levels against expected indicator values and certification requirements; the required share of certification indicators meeting annual expectations rises from 60% in 2022 to 90% in 2025.[30][55]

Financing is not specified through a consolidated budget, allocations or funding formula in the supplied material. The framework nevertheless treats efficient use of available resources, cost-effectiveness, coordination across sectors and investment in prevention as decision-making principles.[53][49][56]

Monitoring & Evaluation

The National Prevention Plan 2020–2025 establishes a national, regional and local monitoring and evaluation architecture linking macro-objectives, strategic objectives, programmes, Essential Levels of Care and health and equity indicators. It assesses both implementation processes and health outcomes, with verification through the New Guarantee System and certification of Regional Prevention Plans.[1][30][57]

• Apply common, impact-oriented indicators selected for relevance, validity and measurement quality, drawing primarily on surveillance and information systems and stratifying results by available sociodemographic characteristics to assess inequalities.[1][53][57]
• Monitor mandatory Predefined Programmes using shared indicators, coverage measures and expected values across Regions, while allowing Free Programmes and additional regional objectives to address local priorities.[33][34][58][59]
• Use a mandatory web-based platform for Regional Prevention Plan submission, planning, annual reporting, monitoring, evaluation, certification where applicable, document storage and statistical analysis.[35][36][60]
• Assess annual programme progress against expected values using SMART indicators, supported by indicator sheets specifying formulas, data sources, interpretative guidance and, where possible, five-year trends or point values.[36][54][47]
• Certify regional prevention planning progressively: formal plan adoption in 2020, compliance with regional planning criteria in 2021, and achievement of annual expected values for 60% of certification indicators in 2022, 70% in 2023, 80% in 2024 and 90% in 2025.[30][55]

Surveillance is a core implementation mechanism across prevention areas. The framework strengthens disease, mortality and cancer registries; infectious-disease notification and laboratory surveillance; occupational-risk information systems; environmental-health monitoring; and population surveillance of risk factors and lifestyles.[51][29][40][23][61]

• Integrate epidemiological, laboratory, human, veterinary and environmental surveillance to quantify disease burden, identify determinants, investigate outbreaks and assess preventive interventions.[29][52][62]
• Maintain specific surveillance arrangements for breastfeeding, vaccination coverage, cancer screening, antimicrobial resistance, healthcare-associated infections, domestic injuries, road injuries, occupational diseases, climate risks and contaminated sites.[63][64][65][28][66][23][67]
• Use community health and equity profiles, Health Equity Audits and locally disaggregated data to identify vulnerable groups, set priorities, inform resource-allocation choices and assess whether interventions reduce inequalities.[7][32][47][9]
• Link accountability to assigned responsibilities, expected outputs, annual implementation reporting and formal coordination among the Ministry of Health, Regions, Autonomous Provinces, health authorities and cross-sectoral stakeholders.[68][30][31][69]

Evaluation is intended to support continuous improvement, identify barriers and successful practices, enable adjustment of Regional Prevention Plans and distinguish between weaknesses in intervention design, implementation and contextual conditions.[70][71][72][73]

Costing & Financing

The Plan does not provide an overall budget, programme-level expenditure envelope, financing formula, quantified funding gap or detailed economic assumptions. It nevertheless frames prevention as an investment in health, supports evidence-based and cost-effective prioritisation, and calls for coordinated use of resources within and beyond the health system.[53][48][49][56]

• Use cost-effectiveness, expected health impact, equity, transferability, sustainability, target-population coverage and available implementation resources when selecting interventions.[74][49][56]
• Assess economic value through intervention costs, savings from avoided events, wider social benefits and return on investment, without providing monetary estimates or decision thresholds.[56][50]
• Support regional and Autonomous Province plans for gambling-disorder prevention, treatment and rehabilitation through the national pathological gambling fund, although no monetary value or allocation formula is specified.[75][76]
• Recognise substantial economic and social burdens from injuries, substance dependence, tobacco use, dementia, environmental risks and healthcare-associated infections, but generally provide no quantified implementation costs.[77][21][78][79][80]
• Identify laboratory networks, integrated programmes, workforce development, information systems and cross-sectoral coordination as means of improving resource use, without stating associated funding.[29][53][81]

Explicit economic estimates are limited. Road traffic incidents are estimated to have economic consequences of between 1% and 3% of national gross domestic product, while a construction-notification threshold of 30,000 Euro is specified for occupational-health planning rather than as a programme allocation.[82][83]

A Ministry of Health and National Centre for Disease Prevention and Control-funded project supported evaluation modelling, but the funding amount is not specified. Dedicated resources may also be required to apply evaluation models systematically, with no cost stated.[72][73]