Multilevel Governance and the Implementation of the ICARE Migrant-Health Pilot Project in Italy.

This thesis investigates how the EU-funded pilot project ICARE ("Integration and Community Care for Asylum and Refugees in Emergency") was implemented across four Italian regions Emilia-Romagna, Tuscany, Lazio and Sicily between 2019 and 2022, and asks why implementation succeeded despite the regions' sharply different political orientation, healthcare governance model and asylum-reception structure. The analysis combines three theoretical traditions rarely read together: the Political Determinants of Health framework, Multi-Level Governance theory, and Wu, Ramesh, Howlett and Fritzen's implementation framework, adapted into political and technical challenge-variables. Methodologically, the study adopts a single embedded case study design organised around a Most-Different Systems Design logic, treating ICARE as the overarching case and the four regions as structurally heterogeneous sub-units. Evidence comprises 303 coded extracts from the ICARE Grant Agreement, its first Amendment, the CeSPI Evaluation Report, and six semi-structured interviews with the national project manager, four regional coordinators and a political informant, gathered between 2019 and 2023. Findings show that path dependency, institutional flexibility, the legal-constitutional and multilevel-governance framework, and policy learning operated as enabling conditions across all four regions, while political acceptability proved case-dependent. National-level evidence concentrates on legal mandate, EU financing architecture and governance design; regional evidence concentrates on pre-existing coordinating structures, adaptive capacity and post-project institutionalisation. The thesis argues that ICARE's survival beyond its funding cycle absorbed into successor AMIF programming rather than formalised through national legislation illustrates a distinctive, funding-mediated route through which pilot projects can outlive their original mandate.