Bridging gaps: civil society alliances in Italian community care. Case of sexual health education

Abstract

Italy’s local health system operates within the National Health Service, established in 1978. While the central government defines essential levels of care nationwide, the 21 regions retain considerable autonomy in providing health services through local health authorities (LHA). This decentralised approach has resulted in a variety of models and significant regional disparities, made visible by the COVID-19 pandemic. The 2022 Community-Based Integrated Care reform, supported by €7 billion under the National Recovery and Resilience Plan, has introduced a transformative response to this challenge: it reorganises territorial care around community health centres, community hospitals and territorial operations centres, and recognises co-production with third-sector organisations as organisational standards. By December 2025 only 3.9% of the 1,715 planned community health centres were fully operational. Health promotion and health education are weakly addressed and lack prescriptive workforce standards, particularly affecting young people and vulnerable groups. One striking example is comprehensive sexuality education (CSE) in Italian schools, which remains unaddressed in formal curricula for political, cultural and religious reasons. The EduForIST initiative, funded by the Italian Ministry of Health, showed how community-healthcare partnerships can overcome these limitations, by adapting international standards to local contexts. This multi-sectoral collaboration between universities, LHA and civil society organisations (CSOs) has reached ≥3,000 students in 40 schools of 7 Italian regions. Knowledge increased across all domains, especially STI prevention, and over 80% of students rated the intervention positively. Intervention adaptability was rated high, funding stability low. The initiative built a sustainable network of CSO educators and healthcare workers from local services, offering a transferable model for other public health priorities in Italy and abroad.