Executive summary

In this study, CEMR will examine territorial developments that took place across its national associations during the period from 2012 to 2021. It will also explore territorial reform trends and the factors inducing these changes, unleashing the winds of centralisation and decentralisation across a vast swath of CEMR’s members. The unique set of data compiled provides valuable insights into how local and regional governments have been evolving in Europe.


The first-hand information provided by CEMR’s members shows that almost all the countries covered by the study underwent some sort of territorial reform between 2012 and 2021, either on a large scale or a small one. A large share of the reforms and reorganisation took place at the local and municipal tier, where the pace of reforms has even intensified in some cases in recent years.


Different types of reforms have been carried out with a wide range of outcomes: some have led to more decentralisation, others have resulted in better collaboration between levels of governments and, in several cases, they have contributed to making the attribution of responsibilities across different government tiers more complex. Regardless, the most common reasons cited for the undertaking of any reforms are to secure greater cost efficiency or to improve service delivery to citizens.


This paper will also highlight how CEMR’s national associations are effective vital actors in supporting and promoting the governance-in-partnership model in their countries. When necessary, they can also be essential in fostering change at the national level and helping to advance the modernisation of democracy.


Public health care and local and regional governments’ remit and responsibilities in this field will also be investigated in this study. To facilitate this task, a set of 21 health ‘functions’ have been defined and used to compare different types of public health care responsibilities and their attribution across Europe. The information collected is evidence of the wide diversity of LRGs’ responsibilities in this field and how the situation is evolving. 


Over the past decade, European health systems have been the subject of significant reforms as well, which often entailed a review and reorganisation of both the authorities overseeing them – in most cases, subnational governments – and their competences, powers and responsibilities. Our study’s findings reveal an unmistakable trend towards greater decentralisation and a devolution of powers to LRGs in the delivery of public health care. While decision-making for public health remains predominantly role of central governments, LRGs have been witnessing an increase in their responsibilities for delivery of certain types of public health services.


On account of the ongoing pandemic and its dramatic implications for local and regional governments, the impact of COVID-19 on local health systems and governance arrangements remains topical. This study, therefore, delves into how COVID-19 specifically affected the responsibilities of LRGs in the field of public health and whether this provoked any changes to the number or types of tasks that subnational governments had to undertake during the pandemic. Examples directly recounted by CEMR’s members show the central role played by LRGs in the vaccination rollout. Lastly, the study also details how the pandemic transformed governance arrangements between central and local governments in many countries, underscoring how good collaboration between the different levels of governments was crucial in managing the pandemic effectively.