Ensuring access to high-quality and cost-effective key public services requires long-term planning and restructuring. Campania would benefit from adapting its public service provision to the demographic reality through enhanced accessibility and digitalization and consolidation of certain facilities.
Preparing for Demographic Change in Campania, Italy
Abstract
Depopulation and ageing are impacting the provision of public services across OECD regions, including in Campania. The projected acceleration of population ageing is expected to increase the demand for healthcare services in the region, leading to higher per patient treatment costs and placing additional pressure on the healthcare infrastructure. This trend raises concerns regarding the fiscal sustainability in the short to medium term. The decline in the student population is anticipated to elevate the per student education costs, further straining subnational finances. Ensuring an efficient allocation of resources in the healthcare and education sectors will require optimising the facilities network; however, if not carefully designed, such adjustments could significantly and negatively affect accessibility to public services. In light of these demographic shifts, Campania requires innovative and multi-faceted policy responses to enhance the cost-effectiveness, quality and accessibility of its public services.
Accessibility refers to the ability of individuals to reach, use and benefit from services and opportunities without barriers, and can be physical or digital. As demographic change unfolds in Campania, maintaining accessibility to public services will require innovative policy approaches that, for example, leverage the economies of scale and network effects or use joint delivery models. Digitalisation presents an opportunity to bridge gaps, complementing the physical public service provision.
Campania’s transport infrastructure connects residents with opportunities
In Italy, the national government oversees the transport planning and infrastructure through the Ministry of Infrastructure and Transport, including airports, civil ports, motorways, and national road and railway networks. The regional government of Campania in turn coordinates transport policies within its jurisdiction and manages the regional road network and the regional and local railway networks. Municipalities are responsible for the local transport services and the maintenance of local roads within their jurisdictions (OECD/UCLG, 2022[1]). Transport infrastructure plays a critical role in enabling the effective and timely provision of public services by facilitating accessibility and the movement of people and goods.
Campania benefits from a dense multimodal transport network, granting connections at the regional, national and trans-European levels. The region has two airports and important maritime connections. The Naples International Airport (Capodichino) is the largest one in Campania, connecting the region with numerous European cities, as well as some intercontinental destinations. It is the fourth largest airport in Italy (and the 38th in the European Union) by passengers carried (12.4 million in 2023), after Roma Fiumicino (40.3 million), Milano Malpensa (25.9 million) and Bergamo Orio al Serio (close to 16 million).1 The Salerno Costa d’Amalfi Airport is a smaller regional airport, providing additional air connections since July 2024. In addition, the port of Naples is among the largest in the Mediterranean for freight, serving as an important connection to the rest of Europe and North Africa. In 2023, it was the 55th largest in the EU in terms of volume with 13 392 thousand tonnes. The port of Salerno, even if smaller in volume with 4 755 thousand tonnes in 2023, is also important for freight and links Campania with other major European ports.2
By rail and road, Campania is directly integrated into the Scandinavian Mediterranean corridor, linking southern Italy with northern Europe, and is further connected to the Baltic-Adriatic Sea and Mediterranean corridors (European Comission: Directorate General for Mobility and Transport, 2024[2]). At the national level, high speed trains (Frecciarossa and Italo) connect Naples and Rome in approximately an hour, providing further links to other major Italian cities. New high-speed and high-capacity rail lines, such as the Naples-Bari and the Salerno-Calabria lines, and the upgrading and electrification of existing lines promoting accessibility and sustainable mobility are planned under the National Recovery and Resilience Plan (Piano Nazionale di Ripresa e Resilienza or PNRR in Italian) leveraging strategic investments from the European Regional Development Fund (ERDF).3 The region is also well served by motorways, with the A1 (Autostrada del Sole) connecting Naples to Rome and Milan, the A3 linking Naples to Salerno, and the A2 (Autostrada del Mediterraneo) extending southward into Calabria. Road links with other southern regions, such as Puglia, further strengthen Campania’s connections. Within the region, well-developed local roads, expressways and regional and local railway services provide connections within cities, and with and within rural areas.
Overall, the performance of Campania’s existing transport infrastructure, as measured by the share of opportunities accessible within a given distance or time, exceeds both the Italian and EU averages (Figure 5.1), largely due to the region’s denser transport network. In 2022, Campania ranked third among Italy’s 21 large (TL2) OECD regions in motorway density and second in railway density.4 However, maintaining this extensive network represents a growing challenge as ageing infrastructure requires increased upkeep, especially in rural areas.5 In urban areas, especially Naples, deteriorating road infrastructure combined with above-average population density lead to severe traffic congestion (Agenzia Campana Mobilità Infrastructure e Reti[3]).
Infrastructure pillar of the EU Regional Competitiveness Index 2.0, 2022 (EU27=100)
Note: The infrastructure pillar is based on measures of road and rail transport performance, measured by the share of population accessible within 1h30 by road and rail in a neighbourhood within a 120km radius, and accessibility to passenger flights as measured by the daily number of passenger flights.
Source: Infrastructure pillar, EU Regional Competitiveness Index 2.0, 2022: https://ec.europa.eu/regional_policy/assets/regional-competitiveness/index.html#/IT/ITF3.
Physical accessibility by public transport is still limited despite ongoing improvements
The governance of public transport in Campania is structured across strategic, administrative and operational levels.6 The General Directorate for Transport and Mobility defines the regional transport strategy and regulatory framework, including accessibility standards such as the minimum coverage radius for public transport. For example, the 2020 Campania Regional Transport Plan establishes that public transport services must be accessible within a radius of 500 meters in urban areas and 1.5 km in rural areas. The Directorate-General for Mobility is responsible for the allocation of funds, the implementation of the Mobility Masterplan and the development of related Sectoral Plan with the Strategic Environmental Assessment procedure for the Regional Cycling Mobility Plan, the Regional Freight Transport and Logistics Plan and the Regional Tourism Mobility Plan in different stages of development, as well as for monitoring activities to ensure compliance with service standards.
Advanced monitoring systems, including GPS tracking, are used to ensure that public transport services comply with the distance and frequency regulations. In addition, the Campania Agency for Mobility, Infrastructure and Networks (Agenzia Campana Mobilità, Infrastrutture e Reti or ACaMIR) manages service contracts with public transport operators, coordinates infrastructure projects such as fleet renewal and digital ticketing systems, and provides technical support to improve the transport system’s efficiency and sustainability. In relation to integrated ticketing and fare systems, since 2000, Campania’s public transport has operated as a multimodal system, enabling passengers to use a single ticket for both rail and bus services. The service is offered at a discounted fee for students, retirees and low-income individuals7, and encompasses 100% of the rail offer and 85% of the road offer in the region. Despite this integrated approach, the public transport market remains highly fragmented with small and cost-inefficient operators coexisting with larger providers that benefit from economies of scale.8 As in the rest of Italy, this fragmentation challenges the efficient provision of public transport in the region (OECD, 2024[4]).9
Although it is limited compared to EU, the public transport use in Campania exceeds the national average, while the reliance on private cars for commuting remains lower. However, the rate of private cars use is increasing at a faster pace challenging the decarbonisation of the transport sector, particularly given the old and highly-polluting car fleet and the low penetration of electric alternatives (OECD, 2024[4]). In Campania, 11% of commutes rely on public transport, slightly above the national average of 9% yet below the EU average10 (17%). While the stock of private cars in Campania (644 cars per thousand inhabitants in 2022) remains below the national average, it is well-above the EU (at 681 and 564 cars per thousand inhabitants, respectively). Furthermore, the private car ownership is growing at a faster rate in the region than in Italy and the EU (from 2018-2022 by 5.9%, 4.4% and 4.8% respectively).11
Public transport is more widely used in Naples than in Benevento and Avellino, the most rural provinces of the region. For instance, only 3% of residents commute by public transport in Benevento, compared to 15% in Naples, where service is more widespread (Figure 5.2). The metropolitan area of Naples is served by multiple modes of public transport, including metro, train and bus12, providing above-average access to opportunities relative to other 13 Italian metropolitan areas (Figure 5.3). However, transport services are notably more limited in areas beyond the city of Naples. The Naples metro serves the metropolitan area and the province of Caserta with 3 lines and 30 stations, but without service in entire neighbourhoods partly due to the rich underground archaeological patrimony of the area that poses constraints on construction (Direzione Generale per la Mobilità, 2023[5]). A commuter rail line runs west to east across the city and four urban funiculars connect the centre with the neighbourhoods in the higher parts of the city. Naples and its surroundings are served by close to 90 urban bus lines. Furthermore, two commuter rail lines connect Naples with other parts of the region (the Circumvesuviana and Circumflegrea). In areas other than Naples the public transport offer is more limited. Cities like Salerno and Avellino are served by a light rail system and urban buses. Caserta and Benevento also have urban buses that serve the cities and their outskirts. These areas are served by intercity buses and regional trains, connecting smaller cities and towns in the region and in 2023, the region introduced additional scheduled transport services to enhance mobility within rural areas and to improve connectivity between these areas and the coast.13
Share of commutes by mode of transport (in %), 2011
Source: OECD calculations based on OECD municipal database.
Transport performance in Functional Urban Areas (FUAs), relative to the country average
Note: Transport performance is proxied by the ratio between the number of people reachable within 30 minutes over the number of people living within a radius of 8 km. The country average is computed using the information for the 13 Italian FUAs.
Source: OECD calculations.
The full potential of digital public service accessibility remains untapped
The digital infrastructure that defines digital accessibility is primarily the responsibility of the national government. The Ministry of Economic Development oversees the policies, regulations, and funding schemes related to digital infrastructure, including broadband and 5G networks.
Campania has made rapid progress in leveraging the benefits of digitalisation. In a 2023 report by the Italian Corte dei Conti on the implementation of the PNRR, Campania was leading among southern Italian regions in digital readiness with a score of 47.1 out of 100 based on a composite index that combines human capital, digital connectivity, integration of digital technology and digital public services.14 There remained potential for further improvement compared to northern Italian regions and opportunities to reduce disparities within Campania itself. While certain areas in Campania, such as Naples, benefit from internet speeds above the national average, the more rural areas experience slower connections (Figure 5.4). The provinces of Benevento and Avellino had the slowest internet speed connections in the region, 31% below the national average in 2023, though they have seen relative improvements since 2019. Further improvements can be expected within the PNRR, which identifies investments in digital infrastructure as key priorities, particularly in southern regions (OECD, 2021[6]). The region has developed an integrated model of regional digitalisation articulated in DGR 226/2023 (digital health), ICT Plan 2023-2025, Digital Strategy 2021-2024, and DGR 360/2024 (PNRR telemedicine). These provisions define governance, tools, infrastructure, and concrete objectives for modernising public services, healthcare, and public administration over the next decade.
Average download speed for fixed devices as deviations from national average (in %), 2019 and 2023
Notes: Gaps in Internet download speed refer to average peak speed tests of fixed broadband internet connections, weighted by the number of tests. The information refers to 2019 and 2023 Q2.
Source: OECD computations based on Ookla data.
The Italian National Health Service provides universal coverage for all residents and operates with a high level of decentralisation. Healthcare is the primary area of subnational government spending in Italy, accounting for almost half of the total subnational government expenditure (50%) in 2021 compared to 19% on average in the OECD (OECD, 2024[7]). The national government allocates general tax revenues for publicly financed healthcare to regions, defines and supervises regional compliance with the delivery of the guaranteed benefits package (known as Essential Levels of Assistance) and exercises overall stewardship. Regions are responsible for the organisation, planning and delivery of health services, including the construction and maintenance of healthcare facilities, the provision of medical equipment and drugs and the staff management. A wide range of preventive, primary and community healthcare services is provided through Local Health Authorities (in Italian Asiende Sanitarie Locali or ASL)15, with general practitioners (GPs) acting as gatekeepers to specialist and hospital care. Hospital and specialist ambulatory care are provided by a mix of public and accredited private providers, with significant variation across regions (OECD/Observatory, 2023[8]).
In Campania, healthcare is the responsibility of the General Directorate for Health Protection and is coordinated by the Regional Health System, through seven ASL, one in each of the provinces except for Naples with three (Naples 1-Centre, Naples 2-North and Naples 3-South). In the region, healthcare accounted for 80% of the region’s total expenditure in 2022 (Chapter 3).16
Limited resources constrain the quality and result in below-average health outcomes
Campania’s healthcare sector operates with fewer resources than both the Italian and EU averages, with shortages in medical professionals and hospital infrastructure (Figure 5.5). In 2022, the region had 2 fewer doctors and 6 fewer nurses per 10 000 inhabitants than the national average, and 1 fewer doctor and 26 fewer nurses per 10 000 inhabitants compared to the EU average. In Italy, the healthcare system has a relatively high number of doctors compared to many OECD and EU countries but lags in nursing staff, with a greater reliance on doctors to perform tasks typically handled by nurses elsewhere (OECD/Observatory, 2023[8]). The increasing demand for healthcare from an increasingly old and multimorbid population results in several regions, including Campania, facing shortages of physicians, which vary significantly in their severity across specialties (OECD/Observatory, 2023[8]). The region also has fewer hospital beds, with 6 fewer per 10 000 inhabitants than the national average and 29 fewer than the EU average.
Number of active physicians, practising nurses and hospital beds per 10 000 inhabitants, 2022 or latest available year
Note: The numbers for the EU27 refer to the latest available year: active physicians and practising nurses (2021) and hospital beds (2018).
Source: OECD Regional Health Database and OECD/Observatory (2023[8]) for the EU27 active physicians and practising nurses.
In recent years, the disparities between the regional and national averages in terms of physicians and hospital beds per capita have widened, although progress has been made in narrowing the gap in the number of nursing professionals. The availability of hospital beds in Campania has declined faster than the national average, with a 3.1% reduction between 2018 and 2022 compared to a 1.9% decrease nationally. This decline exacerbates an already low number of hospital beds, highlighting the persistence of the region's healthcare infrastructure gaps. Between 2018 and 2022, the number of doctors per capita in Campania grew by 4.7%, below the national average (5.7%). In contrast, the number of nurses per capita increased significantly by 30% in the region, compared to a national growth of 13%. The increases in the number of medical professionals reflect broader trends in medical education in Italy, with student intake in medical programmes rising from approximately 10 000 in 2012 to nearly 15 000 in 2022, resulting in a 49% increase in medical graduates per capita17 (OECD/European Commission, 2024[9]). However, Italy faces pronounced shortages of health workers (OECD, 2024[4]) with important emigration of medical staff to other EU countries (OECD/Observatory, 2023[8]), affecting more strongly Campania as the region has recorded the closure of emergency rooms due to staff shortages. To address the shortages of medical professionals while retaining locally trained talent, the region has proposed an agreement between the union and the health profession orders in Naples, which regulate the professional conduct of specific healthcare roles, to train young healthcare professionals and offer them immediate employment opportunities in Campania.
The limited resources in the healthcare sector constrain the quality of care in the region, in turn, leading to below the national average health outcomes in the region. The life expectancy at birth was 81 years in 2022 in Campania, 1.8 years below the national average and infant mortality rates, the number of deaths of infants under one year of age per 1 000 live births, have been above national average in recent years (2016-20).18 To identify and address regional disparities in healthcare provision, the national government introduced the New Guarantee System in 2020, a revised compliance monitoring framework designed to ensure that health services align with the Essential Levels of Assistance and meet national standards for effectiveness, appropriateness and uniformity. This system assesses regional performance across three key areas: prevention and public health, outpatient care and hospital care and an assessment in 2023 concluded need for further improvement in several areas in Campania (Agenas, 2023[10])
Healthcare accessibility
Hospital access is limited in certain areas of the region
In Campania, residents can access the closest hospital with less than 20 minutes of driving time in half of the municipalities and within a 30-minute drive in 85% of the municipalities. These municipalities are either in the province of Naples, connected to the other provincial capitals or in the coastal areas of the region where physical accessibility is enhanced due to infrastructure (Figure 5.6).
Average travel time by private car to the closest facility (in minutes), at a time with no traffic congestion
Source: OECD calculations based on GISCO data.
In the area close to the border with Molise and Puglia of the Benevento province or in mountainous Caserta’s Matese area, the region faces accessibility gaps. For example, in the Piedimonte Matese in Caserta travel times can reach up to 50-70 minutes during emergencies (Cittadinanzattiva, 2022[11]). This area is considered a medical desert (Box 5.1), in which resources and accessibility are most constrained.
Medical deserts, areas characterised by the shortage of medical professionals, inadequate medical services and limited territorial assistance, pose significant challenges to health equity. Medical deserts lead to disparities in access to care, delayed diagnoses and lower utilisation of preventive services, ultimately contributing to poorer health outcomes and increased pressure on emergency services. Moreover, medical deserts can exacerbate social and territorial inequalities, as residents in affected areas often face longer travel times to receive care and higher out-of-pocket expenses, and diminish the sense of trust in public institutions. Furthermore, areas with insufficient healthcare services may struggle to retain and attract residents, reinforcing population decline. This, in turn, can create a cycle of depopulation and further service reduction, weakening the long-term sustainability of affected areas.
Addressing these gaps requires a multi-faceted approach that combines workforce planning, investment in healthcare infrastructure, and policies that incentivise the provision of medical services in underserved areas. Tackling medical deserts also presents an opportunity to introduce innovative models of care. The expansion of telemedicine, mobile healthcare units, and multidisciplinary community-based healthcare networks could help bridge service gaps, particularly when combined with financial incentives for healthcare professionals to work in underserved regions. Strengthening coordination between national and regional health authorities, leveraging European funding mechanisms, and fostering public-private partnerships will be critical to ensuring equitable healthcare access and mitigating the broader socio-economic implications of medical deserts.
Source: OECD/European Commission (2024[9]) and Cittadinanzattiva (2022[11]).
The New Territorial Health plan is expected to enhance physical access to healthcare
The region's New Territorial Health plan, presented in May 2024 and to be fully implemented by 2027, aims to address the limitations in healthcare provision. The New Territorial Health plan emphasises prevention and integrates healthcare and social services (under the competence of the General Directorate for Social and Socio-Health Policies). While the plan does not consider any change in the hospital network of the region, it involves the creation of new types of facilities to support preventive and outpatient care provision that will improve access to healthcare. For instance, the plan involves the establishment of 172 community houses, which will provide primary and specialised care alongside social services and 48 community hospitals, designed as short-term low-intensity care facilities with an average capacity of 20 beds, equipped with basic diagnostic infrastructure.19 To this end, the region foresees the renovation of 151 existing facilities and the construction of 69 new healthcare facilities across all seven ASL and plans an investment of over EUR 380 million, partly funded by the PNRR (Regione Campania, 2024[12]).
The New Territorial Health plan is also expected to enhance digital healthcare access
The New Territorial Health plan also emphasises digital accessibility, with planned investments in the digitalisation of medical records to improve coordination between medical professionals, and teleconsultations and remote monitoring of chronic patients to reduce hospital operating costs, relieve congestion in major hospitals, while addressing indirect costs such as patient travel. Currently, the SINFONIA initiative, encompassing an online portal (Citizen’s Health) and a digital app (Sinfonia Salute), allows access to health and social services through a single platform that centralises the offer of all relevant services, simplifying the access to the information. Moreover, the initiative allows the booking and payment of services, the consultation of medical records or carrying out teleconsultations and has more than one million users in the region.20
The impact of demographic trends on healthcare provision
In Campania, the financial pressure on the healthcare system is projected to increase with demographic change. As the population ages and more people live longer, the need for healthcare will increase driving up healthcare costs (Morgan and Mueller, 2023[13]). The elderly tend to use healthcare goods and services more frequently and intensively, as the incidence of chronic diseases or comorbidities and hospitalisation lengths increase with age. In the EU, 60% of the 65 years or older population reported having at least one chronic condition (OECD/European Commission, 2024[9]). In OECD countries, the healthcare cost progression starts at a moderate pace and in most countries significantly rises by the age of 50.
Given the current population projections, the region’s per capita healthcare expenditure is expected to rise by close to 32% between 2023-80 (Figure 5.7, left), more than 10 percentage points above the increase projected nationally. However, as the region depopulates faster the total expenditure will peak earlier than in Italy (the peak is projected in 2042 in Campania and 2044 in Italy) and it will decrease at a faster rate (Figure 5.7, right). The projections are still a lower-bound estimate of the projected budgetary pressure, as the rise in long-term care needs and the increase in the cost of treatments are not considered. By 2050, however, the share of people requiring long-term care is expected to rise by 30% (OECD, 2024[14]) with most recipients expected to be low-income and unable to cover the costs on their own. Furthermore, the rising cost of innovative treatments, especially in fields like oncology, will likely further strain healthcare budgets (Chapter 3).
Projected healthcare expenditure per capita (left) and total (right), 2023-80 (2023=100)
Note: The projected healthcare expenditure estimates rely on the estimates of health expenditures by age group in 2018 (relative to average) by Morgan and Mueller (2023[13]), the per capita healthcare expenditure from the OECD Health database for 2022 (last year with available data) and the median population projections from ISTAT.
Source: OECD calculations.
Across provinces, the strains on the healthcare system are projected to be particularly strong in Caserta and Naples, where the number of inhabitants with enhanced healthcare needs, i.e. 65 years or more, is projected to grow the most up to 2043 (Chapter 1). Benevento, in turn, will be the province with the lowest growth in the over 65-year-old population, yet it will still see a substantial increase in the next two decades. From 2023-43, the number of 65-84 years-old is projected to increase by 49% in Caserta, 36% in Naples and 25% in Benevento; and over the same period, those over 85 are projected to increase by 78% in Caserta, 81% in Naples while only 18% in Benevento.
Demographic change will also worsen the shortages of medical professionals in the region due to an increasing demand. Furthermore, the retirement of doctors is expected to peak in 2025, with the retirement rate projected to return to previous levels only by 2030. To mitigate the impact of this anticipated retirement wave, Italy has implemented measures to retain older physicians longer in the system while simultaneously boosting the training of new doctors. In 2024, a legislation was passed to temporarily suspend the obligation for doctors employed by public facilities within the National Health System to retire at age 70, allowing them to remain in the job until 72 years of age. This legislation also enables the ASL to keep medical personnel in service beyond retirement age on a voluntary basis, addressing both the serious staff shortage and the training and tutoring needs of newly hired staff. Additionally, those who have retired since September 2023 can be readmitted to service within these limits (OECD/European Commission, 2024[9]).
Compulsory education lasts 10 years (from 6 to 16 years), with pre-primary education starting from age 3 and nurseries available for children below 3. According to the Constitution of the Italian Republic (Art. 34), education is accessible to everyone and compulsory education is free. While pre-primary education is free of charge, nurseries often involve costs for families (Eurodyce, 2023[15]) with support provided for some families (see below).
In the country, the central government and the regions have concurrent legislative power on early childhood education (ECE), primary and secondary education. However, some aspects of the system fall under the exclusive legislative power of the central government and others under the regions (Eurodyce, 2023[15]). The central government via the Ministry of Education and Merit (in Italian Ministero dell'Istruzione e del Merito) oversees the general rules and fundamental principles of the education system that the regions must respect, and determines the essential conditions that must be guaranteed throughout the country (e.g. institutional funding, teacher salaries, etc.). The regional governments exclusively oversee vocational education and training.
Furthermore, the education provision is decentralised to the local level (Eurodyce, 2023[15]). Municipalities run nurseries, pre-primary education facilities, primary schools and school-related services such as transport, and regions provide secondary education, including vocational education and training. Decisions over the school network (including facility closures) are taken by municipalities for nurseries, pre-primary, primary, and lower secondary education, while provinces decide for upper secondary education (ibid.). At all levels of education, however, schools have significant pedagogical and organisational autonomy. This competence mix and the fact that teaching staff management is under the competency of the central government explains why spending on education by subnational governments is below the OECD average (OECD/UCLG, 2022[1]).
In Campania, ECE and education are overseen by the Directorate General for Education, Training, Employment and Youth Policies. One of the main tools used by Campania to support education has been the Regional Operational Programme ERDF Campania 2014-2020, which has financed numerous projects to improve education facilities. This program has allowed the region to renovate and modernise educational facilities, improve the energy efficiency of buildings and enhance the technological infrastructure, thus ensuring safer and more suitable learning environments. In addition to infrastructure investments, the so-called Three-Year Training Offer has supported the training and continuous education of teachers and school staff in the region.21 ESF+ resources are also utilised to improve the quality, inclusiveness, effectiveness, and labour‑market relevance of education and training systems. This includes supporting professional and technical training and promoting higher technical education.22
Current state of early childhood, primary and secondary education provision
Despite progress made during the 2014-20 programming period, ECE continues to face challenges in the region. Campania has some of the lowest formal childcare coverage rates in Italy, particularly for children under three. In the region, the coverage rate in nurseries in 2022 was 12% compared to 31% in Italy and 36% in the EU, measured by the number of places per 100 children. Campania was with Calabria the region with the lowest coverage rate in Italy (OECD, 2024[16]; European Commission, 2024[17]). In Campania, relatively higher early enrolment rates in kindergartens for two-year-olds, compared to other regions, suggest an underlying demand for expanded nursery coverage (Istat, 2023[18]). For children between 3 and 6, kindergarten enrolment is more widespread, even if still below national and EU averages for the last year for which there is information. Differences in average spending per child in nurseries are reflected in differences in service quality. Although specific data for Campania are not available, average expenditure in southern regions remains below the national average and significantly lower than in central and northern Italy. At the national level, municipal spending per child under the age of three enrolled in a nursery amounts to EUR 909 per year, ranging from EUR 1 520 in central Italy to EUR 282 in the south in 2022 (Istat, 2023[18]).23
Both central and regional governments are working to raise nursery coverage and improve the quality of the service, with positive effects on children’s well-being, learning and development in the first years of life (Heckman, Pinto and Savelyev, 2013[19]; Braga, Checchi and Meschi, 2013[20]; OECD, 2022[21]), especially for children from low-income families (Phillips et al., 2017[22]). Through the PNRR, the central government has planned the expansion of nursery coverage that, if fully implemented, could align coverage with that of other parts of Italy. In turn, the region is providing vouchers to families in need to help cover the nursery costs, through the European Social Fund Plus (ESF+) supporting the implementation of the European Child Guarantee (e.g. the effort of the European Commission to ensure children at risk of social exclusion can access basic services like healthcare and education).24 However, the cultural reliance on informal care and traditional gender norms that limit the demand for formal ECE services and constrain the employment rates of new parents (Chapter 1) threaten to limit the impact of these policies if they are not directly addressed. Additional ESF+-funded initiatives are underway to support parents. One such initiative is “Genitori si diventa” (Becoming Parents), which aims to support family responsibility and children's rights through active inclusion measures with an integrated multi-action approach and personalised social integration services. These services also include formal services that can facilitate job search for parents. This intervention is currently being implemented in conjunction with the “secondogeniti” (second-born children) voucher, a one-off voucher of EUR 600.25
The challenges in ECE are coupled with a low performance of the primary education system and high dropout rates, constraining Campania’s economic potential. Although there is no statistical relevant information for Campania, the eight southern Italian regions score below the national and OECD averages in standardised international tests such as PISA. For instance, in the 2015 science PISA assessment, Campania’s average score was 459, compared to an Italian and OECD average of 480 and 493, respectively (Hippe, Jakubowski and Araújo, 2018[23]). In addition, the low attendance and high dropout rates translate into a high share of young individuals (18-24 years) who at most completed lower secondary education and are not engaged in further education or training, i.e. early leavers.26 In Campania, the early leavers rate was at 16%, 5.5 percentage points above national average and 6.5 percentage points above EU average in 2023 (Figure 5.8). High unemployment and limited employment opportunities in the region (Chapter 1) reduce incentives to remain in education, contributing to early school leaving. This, in turn, increases the risk of economic and social exclusion and further weakens prospects for employability and job creation.
Share of 18-24 years old with at most lower secondary education and not engaged in further education or training, 2003 and 2023
Source: OECD Regional Education database.
Reducing the early leavers rate to below 10% is a key policy target and Campania has made progress during the last two decades, in line with the national average and above the EU average. For example, the region is dedicating ESF+ resources to expand the educational offerings for children across the region through initiatives like “Scuola Viva” (or alive school in English)27, which also functions as a means to combat early school leaving, as well as to increase school attendance and provide necessary skills to the young living in crime-affected communities such as in Caivano and the North Naples area, as well as to support their families and their labour market integration.28 Another incentive to keep young people in school is Vocational Education and Training Pathways (IeFP), a programme to which the region has committed EUR 105 million of the PR Campania ESF+ 2021-2027 – Youth Employment Priority. Furthermore, complementing these efforts are national-level initiatives funded with the ESF+ support, such as the “Free to choose” project that provides children in Campania, Calabria and Catania healthy social and educational experiences. The initiative aims to address the root causes of unlawful behaviour, with a focus on prevention and community resilience.29
Early childhood, primary and secondary education accessibility
National regulations establish criteria for student travel times, and particularly regarding school transport. According to Legislative Decree 13 April 2017, no. 63 Regulations regarding the right to study and education, travel times for students should not exceed 60 minutes, although variations may be applied based on local characteristics. Student travel times are monitored by municipalities and local school administrations in charge of the provision, organisation and supervision of school transport services. Information is collected periodically and verified to ensure that travel times comply with current regulations.
Education facilities are within walking distance in most municipalities
In Campania, residents in half of the municipalities have access to early childhood educational facilities within walking distance. The closest kindergarten is accessible in four minutes of travel time in half of the municipalities, and in three in four municipalities in less than six minutes (Figure 5.9).
Average travel time by private car to the closest facility (in minutes), at a time with no traffic congestion
Note: The accessibility analysis includes kindergarten facilities (ISCED 2011 level 02) targeting children from 3-6 years. Comparable data for nursery facilities (ISCED 2011 level 01) targeting children from 0-3 years are not available.
Source: OECD calculations based on GISCO data.
Similarly, in half of Campania’s municipalities, residents can access to primary and secondary schools within walking distance or a four- and five-minute drive, respectively (Figure 5.10). However, accessibility is more limited in certain areas. For both primary and secondary schools, most municipalities in the province of Salerno exhibit comparatively longer travel times. In the case of primary schools, the Letino-Gallo Matese in Caserta and Aquilonia in Avellino also face relatively longer travel times to the nearest educational facilities.
Average travel time by private car to the closest facility (in minutes), at a time with no traffic congestion
Source: OECD calculations based on GISCO data.
To address physical accessibility gaps and improve student mobility, the region launched a call for expressions of interest in 2024 to allocate electric school buses to small municipalities under the Regional Operational Programme ERDF Campania 2021-2027. As a result, 87 new electric buses will be delivered in 2025 to the selected municipalities with less than 15 000 inhabitants, including 16 buses to be shared among two or more neighbouring municipalities. The allocation includes 41 buses to municipalities in the province of Salerno, 21 in Avellino, 14 in Caserta, 8 in Benevento and 4 in Naples.30
Digital access to education is not available to all students in the region
Digital accessibility to education is limited, particularly for students from low-income families and in the rural provinces of Benevento and Avellino with the slowest internet connections in the region. The COVID‑19 pandemic exposed significant challenges in digital accessibility to education in Campania among secondary school students. A study conducted in Naples between April and May 2020 found that approximately 20% of students lacked access to computers, effectively excluding them from distance learning opportunities (Ferraro et al., 2020[24]). This digital divide not only disrupted educational continuity but also heightened the risk of adolescent disengagement, with potential long-term social consequences. To address this identified need, financial support for childcare during the suspension of educational services and schools, including vouchers of up to EUR 500 for the purchase of personal computers (EUR 14 million total), are now available for families residing in Campania with children under 15 years old.
The impact of demographic trends on early childhood education and education provision
Shrinking school-age populations are leading to reduced enrolment and increases in the cost per student of delivering education, particularly in rural and depopulating areas. These, in turn, result in school closures or consolidations in Campania. The region has implemented several policies over the last ten years to adapt the school network to a decreasing number of students. However, the share of school closures has been lower than the drop in the number of students, leading to a decline in the school sizes and increasing the cost of providing education per student. From 2019 to 2022, the student populations decreased by -4.1% for pre-primary schools, -6.2% for primary schools and by -2.8% and -3.7% in lower and upper secondary education respectively; while the number of schools decreased by -1.7% and -1.5%, for pre-primary and primary schools respectively and increased by 1.6% and 0.8% for lower and upper secondary schools.31
In the next two decades, as the number of students continues to decline more efforts to adapt the school network are to be expected. Across provinces, the decrease in ECE-age children is projected to range from nearly a fifth in Caserta (-19%) to almost a quarter in Benevento (-23%) from 2023-43. Similarly, for primary school students, the decline is projected to range between -23% in Caserta and up to -27% in Naples and Avellino. The decline among secondary school-age children is projected to be even more pronounced, ranging from -28% in Salerno to -35% in Naples.32
Bottom-up decisions on how to improve the efficient use of resources, including through engagement of local administrates and school principals can be an effective way to adapt necessary consolidations to the needs of different areas. Gathering and leveraging local knowledge can support more tailored solutions than a top-down approach.
Build expertise in the public administration to guide the demographic change adaptation
Campania should strengthen its administrative capacity to manage the population decline. Enhancing the use of data and analytical methods, including for ex ante and ex post policy impact evaluation, would enable Campania to design more effective policies, targeting investments with the highest return in a context of limited and decreasing resources. Campania can consider reforms to the recruitment processes to ensure a competitive and merit-based system in compliance with national legal frameworks, transparency rules and fiscal constraints, while prioritising hiring professionals with the skills needed to address emerging demographic and economic challenges. These efforts would be aligned nationally with the PNRR prioritising structural reforms to improve the effectiveness of the public administration.
In addition, Campania could train within the regional universities the professionals hired under the PNRR to help build administrative capacity in municipalities. Campania could also request the inclusion of cost-benefit analysis, measurement methods and forecasting within the EC’s training portfolio. The region has previously implemented a regional employment programme, Piano per il Lavoro, co-financed by the ESF+ during 2014-2020 aimed at creating job opportunities for young people, particularly through training and placement in public administration roles, while also addressing staffing shortages and capacity gaps within the public sector (Region of Campania, 2017[25]). Campania is also leveraging the support of the National Technical Assistance Programme “Capacities for Cohesion” (CapCoe) 2021-2027, which aims to strengthen administrative capacity to enhance the effectiveness of Cohesion Policy interventions across Italy. The programme invests in human capital and training, provides specialised technical support for the implementation of Cohesion Policy and facilitates access to tools, information, and knowledge. As part of this programme, an extraordinary recruitment plan has been launched to strengthen municipalities, municipal unions, regional administrations, provinces, and metropolitan cities in less developed regions for the 2021-2027 programming period, including in the Campania.
Strengthen service accessibility and emphasise its importance broadly
Maintain roads and decongest car traffic to improve physical access to public services
To improve physical accessibility across the region, Campania should prioritise the maintenance of its most heavily used regional roads, support and enforce the upkeep of local roads by municipalities, and continue investing in the expansion and modernisation of its public transport network to ensure reliable and inclusive mobility for all its residents.
To decongest the urban centres, including that of Naples, the region can also incentivise carpooling initiatives. In urban areas, municipalities can tax single-occupancy vehicles accessing congested urban centres or establish city-level congestion charges as an alternative to improve accessibility, which in turn would further contribute to decarbonisation (OECD, 2024[4]).
Leverage existing resources in areas with limited public transport
The 87 municipalities with less than 15 000 inhabitants that under the 2024 call for interest obtain an electric school bus could repurpose it during non-school commute hours to improve accessibility. Operating costs of electric fleets are low relative to combustion engine buses, due to cheaper electricity than fuel and reduced maintenance expenses (with no oil changes, fewer moving parts and no exhaust system) making its intensive use cost-efficient. This could be piloted as public transport on demand service, informed by other regions’ experiences (Box 5.2) and with the end goal of adapting the service to the local context and needs. With the support of the region and in coordination with municipalities, the service could be piloted in broader areas with each municipal bus covering a specific route connecting them with the closer regional centres with access to essential services. Campania should monitor performance and gather feedback to refine on-demand pilots.
On demand transport has the potential to address transportation needs in depopulating rural areas. In rural areas the demand for transportation is low and not constant, and conventional transportation services cannot meet the transportation needs of rural populations cost-effectively (ITF, 2015[26]). On demand transportation has emerged as a potential solution, offering flexibility and adaptability to local needs, by either providing door-to-door service or using predefined pickup and drop-off points, both operating only when there is demand. Transport on demand serves both as a means of local mobility and as a link to conventional transportation options, such as regular bus network or railway services (ITF, 2015[26]).
In France, transport on demand has been implemented in various regions, including Occitanie, one of the least-densely-populated regions in the country. The service operates based on reservations, following proposed schedules and itineraries, and connect inhabitants to town centres with essential services. The now universal public transport service is open to all at an affordable price. Similarly, in the Spanish region of Castilla-La Mancha, where transport on demand has been in place since 2022, the routes connect inhabitants to town centres with essential services (e.g. hospitals, administrative services and weekly markets) and to other means of transportation (Delgado Urrecho and Martínez Fernández, 2016[27]). Currently, the service cover total 26 areas, including 721 municipalities, with a population of 438,024 people. In practice, the service is requested through a mobile application 15 hours in advance, or by contacting a call centre the previous day, to make a seat reservation. The fees start at EUR 1.3 and are regulated to remain affordable at a maximum of EUR 0.0831 per km, and with discounts for the young and elderly. The transport on demand in Castilla-La Mancha is serviced by 3 minibuses with 10-25 seats each and 10 taxis, with up to 9 seats each, and it operates with 8 drivers and 2 administrative workers. For this project, the government of Castilla-La Mancha received the eMobility Innovation Award in 2023 at the eMobility Expo World Congress.
Source: Castilla-La Mancha’s presentation about on demand sensitive transport during the second OECD mission to Campania (12-15 November 2024).
Support digital public service provision
To ensure Campania can fully grasp the benefits of digital public service accessibility national, regional and municipal governments should ensure a robust digital infrastructure exists in the region, including in rural provinces. To bridge connectivity divides in rural and remote areas, governments can complement efforts to foster market competition and investment, and reduce deployment costs with targeted interventions (OECD, 2021[28]). These might include promoting demand aggregation models to improve the financial viability of infrastructure investments, and advancing public-private partnerships that combine public support with private sector capabilities. Public funding, often allocated through market-based instruments such as reverse auctions, can further incentivise network deployment in underserved regions. Bottom-up approaches, including open access municipal and community-led networks, also contribute to expanding coverage, particularly in areas where commercial incentives are limited. Additionally, addressing persistent “last mile” challenges remains critical, alongside the use of coverage obligations in spectrum auctions to extend wireless connectivity to even the most remote communities.
Campania should ensure digital skills are readily available among all population segments, including the elderly. Campania could consider promoting intergenerational learning initiatives as a means to foster digital inclusion and strengthen social cohesion. Inspiration could be drawn from the Seniors e-connect initiative33 launched by the Toronto Public Library in 2024, which pairs teenagers with residents aged 65 and over to support the development of digital skills among older adults. In addition to enhancing digital literacy, such initiatives contribute to building stronger intergenerational relationships and reinforcing community ties. Campania can leverage ongoing efforts, in particular the national resilience and recovery plan PNRR Measure 1.7.2 – "Network of Digital Facilitation Services" that includes a training programme for citizens on the use of digital tools with more than EUR 15 million of the total EUR 135 million allocated to Campania. By July 2025, Campania has already reached 55% of the planned target to involve 274 000 citizens in training by December 2025, by opening 347 facilitation points across the region.34
Adapt healthcare to meet increased demand and promote preventive care
Address the shortage of medical professionals
Campania should adapt its healthcare sector by, first, addressing the ageing and the shortages of medical professionals the region already faces to be able to accommodate the increased healthcare demand expected over the next two decades. To address the shortages of medical professionals a combination of policies is needed, including continuing to incentivise doctors to extend their careers beyond the standard retirement age, reforming educational and training programmes to increase the number of students in medical programmes, redistributing responsibilities among healthcare workers and recruiting foreign professionals at the national level. Foreign-trained doctors and nurses remain a minority overall in Italy (1% of the total doctors and 3.5% of nurses in 2022, respectively), and their potential to enhance the resilience of the healthcare sector in Campania remains untapped (OECD/European Commission, 2024[9]).
At the regional level, the proposed agreement between the union and the health profession orders in Naples to train young healthcare professionals and offer them immediate employment opportunities in Campania should be implemented, evaluated, and, if effective, scaled. At the national, regional and municipal levels, other policies could include providing financial incentives for practising professionals in rural areas, such as lump sum payments to facilitate installation and/or recurrent payments or bonuses such as general salary increases, which could grow as population density decreases and as the number of years of practice in these areas goes up (OECD, 2021[29]).
Monitor physical medical infrastructure to ensure capacity aligns with demand
Campania should reassess whether the available physical medical infrastructure will be enough to meet the expected increase in demand due to ageing in the next decades, especially in Caserta and Naples, considering the ongoing reorganisation of the healthcare sector under the New Territorial Health plan supported within the PNRR.
Identify gaps in telemedicine provision to effectively promote its use
For medical processes that can be delivered remotely, the region should leverage initiatives like SINFONIA or the ongoing digitalisation efforts under the current reform of the healthcare sector to assess what are the gaps in the current provision of telemedicine and what is needed to scale up its deployment, especially in areas where physical accessibility to the nearest hospital is above a 60-minute drive and where expanding telemedicine could significantly improve healthcare access. Identifying who the one million users of the SINFONIA initiative are and how many among them are using telemedicine could provide information about where possible use remains low and what barriers prevent a wider adoption. Furthermore, understanding the profile of users including demographics, location and the types of teleconsultations accessed would help Campania design targeted interventions to close existing gaps. Given that internet connectivity in Naples is above the national average, the city could serve as a pilot to evaluate the effectiveness and limitations of telemedicine in the region in the short run. In the medium run, the region should run additional pilots in rural areas, where telemedicine provision will be most necessary. In addition, if initiatives such as remote monitoring for older adults using wearable devices demonstrate positive outcomes, their scalability should be explored to ensure broader coverage across the region, prioritising areas where healthcare accessibility is most constrained. Furthermore, to address specific healthcare needs, mobile clinics could be used. However, in the context of shortages of healthcare professionals, alternatives should be prioritised to avoid long travel times that would further reduce the effective working time of medical professionals.
Invest in preventive care to promote healthy ageing and reduce the incidence of chronic disease
Promoting healthy ageing requires a preventive approach that encourages individuals to remain physically and mentally active throughout their lives. Investing in preventive care can help mitigate the projected rise in healthcare expenditures, particularly as the population ages. Campania can build on the interventions that are already underway, including those implemented with joint funding from the PR Campania ESF+ 2021–2027 and the PR Campania ERDF 2021–2027, which aim to carry out structured and co-ordinated actions to promote adequate physical activity among older people and persons with disabilities living in conditions of socio-economic disadvantage and vulnerability, groups that are typically less active and harder to reach,35 and the National Equity in Health Programme 2021-2027 (for interventions aimed at cancer prevention). Investing in prevention can help mitigate the projected increase in healthcare spending, particularly as the population ages. Expanding screening programs for high-prevalence diseases in the region can further reduce future pressure on the healthcare system by enabling early diagnosis and intervention.
Preventive care should target all provinces, with a particular focus on Caserta and Naples, where the share of the population aged 65 and over is expected to increase the most over the next two decades. In practice, Campania can also leverage digital tools like the SINFONIA initiative to promote physical and mental activity among users, with reminders of their importance for health. Social services could run informative campaigns to promote active ageing in the region and to ensure preventive care measures reach those most in need, leveraging Campania’s ongoing investment in telemedicine.
Optimise resources in the education sector
Optimise the network of primary and secondary schools strategically
The creation of school clusters (i.e. the sharing of the school administration across schools) or co-locating grades (e.g. integrating primary, lower and upper secondary education within the same building) can help maintain the levels of accessibility to primary and secondary education, align service provision with demand and improve cost efficiency. Optimisation is necessary across all provinces, and particularly in Naples and Avellino where the school-age population is projected to decline the most in the next two decades, to prevent further increases in the cost per student while ensuring continued physical accessibility to educational facilities.
School closures should be tailored to minimise adverse impacts on communities and prevent further depopulation in underserved areas. Where the closure of underutilised schools is necessary, municipalities should prioritise closing secondary schools, as primary schools influence residential choices and sustain the vitality of local areas (Di Cataldo and Romani, 2023[30]). Decisions on school closures should also aim to minimise negative effects on access to education in areas already characterised by below-average physical accessibility, such as the Letino-Gallo Matese in Caserta and Aquilonia in Avellino for primary schools, as well as across the province of Salerno for both primary and secondary schools.
With the support from the Ministry of Education and Merit, Campania could pilot the adoption of online or blended learning models, integrating the benefits of digital and in-person teaching that ensure student engagement and preserve the social dimension of learning, to expand education opportunities in areas of Campania where physical accessibility is most constrained (OECD, 2023[31]). To fully harness the benefits of these models, Campania should ensure equitable access to a reliable internet connection, a digital device and supportive home and community learning environments, particularly for low-income students.
Increase coverage rates in nurseries and support ECE
Campania should support municipalities in increasing the current coverage rate of nurseries and aligning it with actual demand, considering the projected decline in the number of children of ECE age in the next two decades. Ensuring the continuity of financial support mechanisms, such as the vouchers for low-income families, could encourage greater use of nurseries once spaces are available, particularly among low-income households. Through the PR Campania ESF+ 2021–2027 vouchers reducing the cost of nursery schools are available for families meeting specific Equivalent Economic Situation Indicator (ISEE) requirements. As of 2024, 2 151 applications met funding criteria and 916 vouchers were issued. About 45% were issued to households in the Province of Naples, 28% to those the Province of Salerno, approximately 11% each in the Provinces of Benevento and Caserta, and 5% in the Province of Avellino.36 Campania should assess the need for training additional ECE professionals and promote the training for additional childcare workers. Campania could incentivise the surplus kindergarten and primary school teachers to retrain and transition to nursery work. In small municipalities, Campania could support piloting inter-generational facilities offering both childcare and elderly care in the same facility.
Complement the public service provision by supporting bottom-up initiatives
Municipalities can support community-led initiatives by allocating underutilised public spaces to organisations that contribute positively to the service provision locally. Leveraging community-led initiatives can complement public service provision and enhance social and economic resilience, particularly in regions experiencing demographic decline. Community cooperatives and local NGOs, such as Cooperativa La Paranza in Naples’s Rione sanità working to revitalise the neighbourhood and create learning and job opportunities for young people, play a key role in fostering local development.
In more rural areas, bottom-up initiatives can address service gaps too as they do in other countries and regions (Box 5.3). In Pietraroja (Benevento), for example, local residents had opened their farms to host children, partially offsetting the lack of formal ECE facilities with the financial support of the municipality. Other initiatives include promoting agritourism, which creates new economic opportunities and sustains local economies. The social economy, including the involvement of churches in education, healthcare, and social services, remains essential for community cohesion in the region, particularly for the elderly.
In Japan’s rapidly ageing society, a traditional form of mutual assistance (yui) plays a vital role in supporting older adults. Community-driven networks rooted in yui provide informal care, helping elderly individuals maintain their independence while fostering social inclusion. Local volunteer groups, neighbourhood associations, and intergenerational initiatives offer assistance with daily activities, emotional support and emergency response. These informal support systems complement formal care services, mitigating social isolation and enhancing the well-being of older individuals.
Historically, yui referred to cooperative labour arrangements among villagers, particularly in agriculture and house construction. Beyond its practical function, yui fostered strong social ties and a collective sense of responsibility. While modernisation has transformed social structures, the principles of yui remain deeply embedded in Japanese communities, particularly in times of crisis. The continued relevance of these mutual aid networks underscores the role of community-led approaches in addressing the challenges presented by an ageing society.
Source: (Haapio-Kirk, 2024[32])
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← 1. Eurostat, passengers carried (excluding direct transit), https://doi.org/10.2908/AVIA_PAOA.
← 2. Eurostat, gross weight of goods handled in all ports by direction, including all goods loaded and unloaded, https://doi.org/10.2908/MAR_GO_AA.
← 3. Within Campania’s ERDF Regional Operational Programme 2021-2027, Priority 2bis focuses on promoting multimodal and sustainable urban mobility, while Priority 3 seeks to enhance mobility infrastructure by developing the Trans-European Transport Network (TEN-T) and reinforcing local, regional, and national transportation systems.
← 4. The density of the transport system is among the highest in Italy. Increasing the need for maintenance, efficiency and security issues. For example, the motorway density by regions in 2022 (measured by km of motorways per 1 000 km2) was 37 (ITF3), only after 70 (ITC3) and 40 (ITH3) among the 19 regions with data available, with an average of 28.2 (Sardinia and Trento province excluded from the average). Furthermore, the railway density by regions in 2022 (measured by km of motorways per 1 000 km2) was 80 (ITF3), only after 90 (ITC3) for the 20 regions with data available, with an average of 56.3.
← 5. This is a challenge throughout southern Italy, where investment in infrastructure has traditionally lagged behind. On average, over the last decade, the per capita amount of public investment has been approximately EUR 780 for southern and island regions, compared to over EUR 940 for central and northern regions (Bucci et al., 2021[33]). Italy’s PNRR is addressing these investment gaps.
← 6. Regulated by the regional Law No. 3 of 28 March 2002.
← 7. As defined by the Equivalent Economic Situation Indicator (Indicatore di Situazione Economica Equivalente – ISEE).
← 8. The local public transport companies integrated are EW ABCD MOBILITÀ, AIR CAMPANIA SPA, ANM, BUSITALIA CAMPANIA, ATC, CONSORZIO CIAV, COSAT SCARL, DAV, EAV, SITA SUD, TRENITALIA, TROTTA BUS SERVICE, AUTOLINEE EREDI ARTURO LAMANNA, FRANCESCO & GIUSEPPE MANSI and MAZZONE TURISMO (https://www.unicocampania.it/aziende).
← 9. Steps to reduce fragmentation are underway. Current plans are that from 1 January 2026 the new management and organisational framework is fully operational. It envisages the launch of public transport services awarded through the net cost tender procedure carried out by ACaMIR, with a ten-year duration, covering four lots of the Regional Single Optimal Basin. This reform is expected to drastically reduce the number of service contracts, from the current approximately 90 to the four currently being finalised with the winning operators of the tender, in addition to the operators of the urban lot of Naples.
← 11. Eurostat, stock of passenger cars per thousand inhabitants. Source: https://doi.org/10.2908/TRAN_R_VEHST (Campania and Italy), https://doi.org/10.2908/ROAD_EQS_CARHAB (EU).
← 12. https://urban-mobility-observatory.transport.ec.europa.eu/resources/case-studies/sump-naples-metropolitan-area_en (accessed on 30 April 2025).
← 13. Regional Law No. 11 of 5 July 2023.
← 14. https://www.corteconti.it/HOME/StampaMedia/Notizie/DettaglioNotizia?Id=6b5b7a77-3d20-4295-8e0f-a73a66092631 (accessed 29 July 2025)
← 15. Local Health Authorities are population-based health management organisations through which part of healthcare is provided.
← 16. Like in the rest of Italy, Campania has both public and private providers, with the public healthcare being funded by taxes and accessible to all residents, and the private healthcare typically covered by private insurances or paid out-of-pocket.
← 17. In Italy, the number of medical graduates per every 10 000 inhabitants increased from 11.1 (in 2012) to 16.7 (in 2022) and above the EU27 average (from 11.1 in 2012 to 15.5 in 2022). OECD Health Statistics 2024 and Eurostat (hlth_rs_grd, hlth_rs_grd2).
← 18. Eurostat & OECD Regional Health Database.
← 19. The plan also considers the establishment of 58 territorial operational centres to strengthen the coordination of health services across the region as per Campania’s answer to the questionnaire prepared by the OECD in the context of this project (2024) and https://europa.regione.campania.it/en/la-nuova-sanita-territoriale/ (accessed 12 December 2024).
← 20. https://sinfonia.regione.campania.it/ and https://europa.regione.campania.it/en/premio-dei-premi-dellinnovazione-al-sistema-di-sanita-digitale-della-campania-sinfonia/ (accessed on January 2025).
← 21. Campania’s answer to the questionnaire prepared by the OECD in the context of this project (2024).
← 22. Information provided by Campania.
← 23. The average municipal spending per child in nurseries was EUR 1 390 in the north-east, EUR 921 in the north-west and EUR 366 in the Islands in 2022.
← 24. https://employment-social-affairs.ec.europa.eu/policies-and-activities/social-protection-social-inclusion/addressing-poverty-and-supporting-social-inclusion/investing-children/european-child-guarantee_en contains details on the European Child Guarantee.
← 25. https://sinfonia.regione.campania.it/preview/vouchermamme (accessed 29 July 2025)
← 26. Lower secondary education is the equivalent to ISCED 2011 level 2.
← 27. https://www.scuolavivacampania.it/ (accessed 7 March 2025).
← 28. Decree Law No. 123 15 September 2023.
← 29. https://european-social-fund-plus.ec.europa.eu/en/projects/italian-project-helps-young-people-live-life-free-crime (accessed on 7 March 2025).
← 31. ISTAT. The school counts refer to publicly managed schools. In line with the age distribution by grades and to avoid double counting, the population counts consider children from 3-6 years old for pre-primary schools, from 7-11 years old for primary schools, from 12-14 years old for lower secondary schools and from 15-19 years old for upper secondary schools.
← 32. ISTAT. The children of ECE age include children between 0-4 while in practice, ECE age goes from 0-5; children of primary school age include children between 5-9 while in practice, primary school age goes from 6-11 and children of secondary school age include children between 10-19 while in practice, secondary school age goes from 10-19.
← 34. Digital facilitators at dedicated points support citizens in learning basic notions in using the main digital services provided by the public administration, including individual support for assistance in using the internet, SPID, digital communication, cybersecurity, device selection and use, and collective training courses and workshops to acquire basic skills according to the European DigComp model (site, file management, privacy, home working, digital PA). In addition, training on the use of the Campania Region's digital services is provided, primarily those related to digital health, i.e. the Citizen's Health Portal and the Sinfonia Salute App, which allow citizens to consult their electronic health record, book a healthcare service with the regional single CUP, choose or change their general practitioner, pay tickets online, and consult prescriptions for medicines.
← 35. With Regional Council Resolution No. 207 of 19 April 2023, the Campania Region allocated a maximum amount of EUR 27 000 000 for the implementation of projects in support of older people and persons with disabilities. These projects aim to promote personal autonomy, social interaction, social skills, cultural engagement, and social inclusion, as well as health prevention through sport. The initiative also includes the upgrading and technological improvement of sports facilities. The overarching goal is to enhance access to cultural and recreational services—including sports activities—also through infrastructure interventions on facilities used for programmes targeting older adults and people with disabilities.
← 36. Figures provided by Campania based on https://surf.regione.campania.it/surf (accessed July 2025).