The responsibility for providing efficient, high-quality, adapted public services rarely falls to a single tier of government. Local and regional governments across Europe are entrusted with a large number of complex roles and responsibilities that require strong, well-developed governance arrangements for well-designed and appropriate policies, which are effectively implemented on the ground. Recent experiences managing the COVID-19 crisis demonstrated the importance of robust governance arrangements in delivering responses tailored to diverse territorial contexts. This survey by CEMR of its members depicts how territorial reforms and decentralisation trends have led to the reconfiguration of relationships between central and subnational governments. These territorial developments have been the subject of numerous studies[1] and the responses from CEMR’s members have now confirmed these shifts. Despite the progress achieved through territorial reforms in devolving more competences and responsibilities to the subnational tiers, these changes have not always led to a corresponding decentralisation towards the fiscal autonomy of LRGs.


As previously stipulated, the data provided by CEMR’s members focused on the period from 2012 to 2021, a time when widespread territorial reforms were taking place across Europe. Although many changes were implemented at the local tier, which underwent a significant decrease in the number of municipalities, the situation remained somewhat static at the regional and intermediate tiers.


These reforms were often initiated in the wake of the 2008 economic crisis, propelled by the need to achieve greater cost savings in the delivery of public services. Yet, there were other motivating factors behind the desire to reorganise territories, such as improving social and health care and procuring quality services closer to the citizens. In any case, this type of restructuring resulted in greater decentralisation and thus affected local and regional competences, responsibilities and resources. This explains in part why national associations of LRGs remain so actively engaged in any discussions concerning territorial and governance reforms. They play an indispensable role advocating for their members in discussions with national governments and help them to adapt to territorial and governance reforms by promoting exchanges of knowledge and good practice. National associations also perform an essential role within federal systems, negotiating with the different tiers of government on budget matters and any LRG-related legislation.


This study also concentrated on European local health systems in order to explore a specific domain in which many LRGs have been entrusted with important competences and responsibilities. In most countries, decision-making responsibilities over health and health care still fall to the central governments. However, recent shifts towards greater decentralisation have also enhanced the role of LRGs in the field of health. The reorganisation of health systems has been an ongoing process since the 1980s[2] and has been motivated not only by the need to instil more cooperation, coordination and modernisation in health care, but also to secure additional sources of financing to fund these systems. Increasingly, having a more patient-centric approach to service delivery is also growing in importance. Despite the level of complexity and variety of the different health systems across Europe, this study has shown that, in most cases, LRGs fulfilled a notable role performing implementation and planning functions, especially with regard to services touching on social care and welfare and general health promotion and prevention.


In addition, the survey revealed that, for more than two-thirds of the countries responding, the global pandemic did have an impact on LRGs’ remit and responsibilities and/or affected their relationship with the central government by increasing collaboration between tiers of government. Although responses indicated that, while LRGs were attributed additional tasks because of COVID-19, in most cases this was provisional and did not result in any official devolution, even if LRGs saw their responsibilities in the domain of health temporarily increase. It is therefore still too early to draw conclusions as to the likelihood of these developments becoming more permanent. That being said, COVID-19 has undoubtedly lit the spark setting off fresh overhauls of Europe’s health systems. The pandemic has both paved the way and accelerated the transition towards digitalisation in this sector, as can be seen in the important advances being made in e-health.


While there was no clear-cut answer as to whether federal or unitary states responded best to the pandemic, effective cooperation was undoubtedly vital in successfully managing the pandemic. The data from the study points to the need for proper coordination and transparency with and across government tiers to ensure the efficient functioning of local health services. Having access to place-based knowledge and expertise as well as recourse to adequate financial support for LRGs were both critical factors in delivering timely and effective responses to the pandemic.


Apart from the health crisis we are facing, many challenges lie ahead, including those related to climate change, biodiversity losses, security of energy supplies, demographic change, citizens’ health and well-being, to name just a few. The quality of our governance arrangements is essential and determinant in producing effective policy outcomes. The post-pandemic recovery calls for effective governance-in-partnership, within and across tiers of governments, as we work to develop equitable, sustainable, green economies, adaptable to future shocks and crises. Yet, it is only by working together, with all tiers of government in a position to fully contribute through autonomous decision-making, that we will be able to achieve the 2030 agenda and its 17 Sustainable Development Goals, in the context of the Paris Agreement. Steering the world towards a sustainable and resilient future requires bold leadership. For Europe to successfully transform in this direction, LRGs need to be further empowered and thus able to invest in the future of their territories.


[1] For further details, read: “A comparative analysis of amalgamation reforms in selected European countries”, R Steiner, C Kaiser, GT Eythórsson; Multi-Level Governance Reforms: overview of OECD Country Experiences, OECD Multi-level Governance Studies, OECD Publishing,; Territorial reforms in Europe: Does size matter?: territorial Amalgamation Toolkit, Centre of Expertise for Local Government Reform, Council of Europe - 2017

[2] “Decentralization in Health Care: Strategies and Outcomes”, R Saltman, V Bankauskaite and K Vrangbaek, European Observatory on Health Systems and Policies Series