Since 2002, the Healthcare Plans of the Tuscany Region included a special section appointed to international cooperation interventions, and since 2006 the Tuscany Region has adopted an annual IHC strategy in which the political and operational elements that are essential for the implementation of the activities have been outlined.

The Tuscan Health Cooperation System provides for three design methods:

• The Regional Initiative Projects: managed by the Healthcare and University Hospitals of the SSR and the Tuscan universities, the terms of which will be defined by a specific annual notice;
• The Call for Proposal Projects: a method aimed at supporting initiatives proposed by the Local Authorities, other public entities, or private non-profit entities based in Tuscany;
• The projects of Strategic Regional Initiative represent the main tool available to the Region for the implementation of actions which are recognized as having particular relevance in the context of the health cooperation strategy and are entrusted to the Global Health Center;
• The approval of the Integrated Plan of International Activities (Piano Integrato delle Attività Internazionali) 2012-2015 and the significant reduction of the funds allocated to IHC have led to a shift in priorities;
• in terms of greater availability of resources – to the PIRs of Healthcare Agencies, as well as structuring a project common to the International Activities Sector of the Tuscany Region. This brought to the creation of a third class of projects, the “Structuring Projects” aimed at promoting the ‘strategic’ development of the Tuscan System of International Activities in specific geographical areas.

As project leader, the main beneficiary/recipient/donee of the IHC funds was the Tuscan Healthcare System and in particular the Healthcare Agencies, as they can make use of the necessary human resources without additional costs on the project resources – by virtue of the DRG 300/2008 – and often – thanks to the partnerships they have managed to maintain over the years – they also promote themselves autonomously in cooperation initiatives. When the healthcare agencies are project leaders, universities and research centers have been involved in more than 60% of the projects, bringing benefits to the SST in terms of organizational innovation. The pilot research experiences that see universities confronting social and health systems and therefore organizational models and assistance schemes differing from ours, provide continuous critical and self-critical ideas which, if learned and valued, could push the system to a continous improvement .

The objective to which the initiatives of international cooperation contribute is the strengthening of healthcare systems as a whole, to be achieved with reforms aimed at equity, solidarity and social inclusion regarding universal coverage, the provision of efficient and safe healthcare services, through:

• technical-institutional support to public health systems;
• improvement of primary care services as a platform to organise the healthcare delivery, from communities to districts and to hospitals, in an effective, efficient, appropriate and sustainable way;
• training of human resources in the healthcare sector;
• enhancement of scientific research, development and innovation of the health sector in projects countries, but in Tuscany as well, on issues of global health and international health cooperation;
• strengthening of the migration and development component within its international health cooperation projects.

The commitment of the Tuscan Health Cooperation is mainly focused on the maternal and child health, in compliance with the priorities outlined by the regional health cooperation strategy and the Sustainable Development Goals (SDGs).