Welfare in the Mediterranean Countries Republic of Cyprus

Welfare in the Mediterranean Countries

Republic of Cyprus

Successes and future prospects for the Cyprus health policy

Introduction

The Cyprus Government committed itself to an active role in social policy when it stated in 1967 that “it recognizes that health, education and other social considerations affect and are interdependent on a vast complex of variables which determine both the social and economic welfare of the island”. At first, the Government had to face the problem of infectious illnesses, spread in a region full of marshy areas. Having defeated malaria and other infectious diseases, Cyprus nowadays faces the same health problems as the other developed nations: how to increase the number of research laboratories and the hospitals; improve the health services; develop technology in medical care. The Government is also investing in health promotion, which is seen as a lifelong benefit for the health of the population. Awareness of the hazards of unhealthy lifestyles is growing amongst the people, not only as a result of the national policies and practices, but also as a result of the diffusion of information at schools and other places and via the media. A major challenge is to reduce the rising costs of health care and the inequalities in access; to improve the quality and financing of the health care system in order to maintain the progress achieved so far in controlling communicable diseases; to reduce the incidence of chronic diseases and to sustain the environment in a way that safeguards the quality of life1. For this reason in 1977 was adopted, and launched at the Alma Ata Conference in 1978, the project “Health for all”2, because the differences in the health of people in different countries and within countries was considered politically, socially and economically unacceptable and was a common concern of all countries3. So, the concept of primary health care (PHC) was proposed as the most important instrument for achieving the main social target of health for all: the attainment, by the year 2000, by all people of the world of a level of health that would permit them to lead a socially and economically productive life4. In the same way, the introduction of a National Health Scheme in Cyprus, for which a comprehensive law was passed in 2001, is expected to place more emphasis on primary health care. In

1 Third evaluation of the implementation of the strategy of Health for All by the Year 2000. Nicosia, Cyprus, Ministry of Health, 1997. 2 Health for All in the 21st Century. (http://www.who.int/archives/hfa). 3http://www.emro.who.int/Publications/EMHJ/0604/22.htm 4 The state of the world´s children 2000. New York, United Nations Children's Fund, 2000.

the meantime, both the number of rural health centres and sub- centres and the number of doctors in the rural areas has increased significantly. This shows that today the central vision for “Health for All” in the 21st Century is the same in Cyprus as in the rest of the world5. The Ministry of Health of Cyprus is committed to the principle that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”. One of the principal objectives of Cyprus for the integration of environment, development and health is to protect and promote human health and well- being. The objectives of primary health care policy are the following: integrating preventive and curative services at the primary health care level; encouraging a team-based practice in rural and urban health centres; providing personal individual and family care; and, establishing a referral system from primary to secondary and tertiary care We also have to consider that the commitment of the Government in the field of welfare is extended into other spheres, such as the improvement of the quality of life for the population; the protection of work and working women; and, finally, the constitution of an equal health system for citizens and refugees from Turkish Cyprus.

1. Social Welfare

A social welfare policy was introduced in Cyprus for the first time in 1946. After independence, social welfare became the responsibility of the Department of Social Welfare Services under the Ministry of Labour and Social Insurance6. By the 1970s, social welfare had evolved into a body of activities designed to enable individuals, family groups, and communities to cope with social problems. In the late 1980s, the State provided five main categories of service: delinquency and social defence; child and family welfare; community work and youth services; social services to other departments; and public assistance. In 1973, when every Cypriot citizen was made eligible for financial assistance “for the maintenance of a minimum standard of living, and the satisfaction of his basic needs”, and promised social services for solving “his personal

5 Intercountry consultation on accelerating health for all in the Region, Alexandria, Egypt, 22-29 March 1999. Alexandria World Health Organization Regional Office for the Eastern Mediterranean, 1999 6http://www.country-data.com/cgi-bin/query/r-3501.html

problems and the improvement of his living conditions”. The ultimate objective of these services was to make their recipients socially and economically self-sufficient . By the time of the Turkish invasion in 1974, public assistance expenditure was minimal, given full employment and comparatively high living standards7. The years immediately after the invasion saw a swelling of public assistance services. In fact, the importance of an effective social services system has been especially apparent in Cyprus since the Turkish invasion and military occupation of 1974. The uprooting of a third of the population created many social problems and increased dependence of vulnerable groups on the State. Initially, Government spending focused on meeting the basic survival requirements of refugees and others through cash grants and aid in kind. Since then it has gradually moved towards providing long-term housing services, free secondary education, health services, and a wage-related social insurance scheme, scholarships and loans for needy students to study abroad, infrastructural buildings such as new schools, hospitals and various welfare institutions such as old peoples’ homes, geriatric centres, community welfare centres, children’s and youth homes, hostels and day-care centres. By 1987, when the economy was fully restored, there were only 5,087 recipients of public assistance, half of whom were aged or disabled. Nowadays, the Social Welfare Services are the official agency for the provision and promotion of social welfare services8. They aim to promote the social well- being of individuals, families and communities within the governmental framework for social and economic development in the country. Programmes of the Social Welfare Services are implemented by the following services: 1. The Family and Child Services. 2. The Service for Public Assistance and the Elderly and Persons with Disabilities. 3. Through technical and financial assistance, the Community Work Service encourages the participa tion of civil society in the development of social services such as home-care, support services for substance abuse, day-care for preschool- and school-age children etc. In recent years, there has been an increase in non-governmental programmes due to their capacity to respond more efficiently and effectively to local social needs. 4. The Service for Staff Development and Programme Planning, which implements an ongoing staff training programme in the Services.

7http://www.cyprus.gov.cy/cyphome/govhome.nsf/0/65E78C2D007A54D9C2256A710039974 4?OpenDocument&languageNo=1 8 Social welfare, in http://www.countrystudies.us/cyprus/31.htm

The Social Welfare Services participate in committees and conferences of the European Union on issues related to their field of competence. Legislation, policies and programmes of the Social Welfare Services are already in line with those of the European Union. Nevertheless, there is a continuous effort to improve standards, according to international and European legal instruments, ratified by Cyprus in relation to the promotion of democracy, human dignity and social cohesion, especially now that Cyprus is a member of the EU.

2. Health in Cyprus

Of the various aspects of the welfare system, the Cyprus health organization has had increased attention from the Government and a bigger share of public expenditure for the development of health services.9. Besides, the demand for health care in Cyprus is increasing. The number of elderly people is low but growing and creates new service demands. Technological changes, both in terms of equipment and pharmaceuticals, is rapid. Much of this is integrated and disseminated rapidly due to commercial incentives. Some new therapies, for instance new drug treatments after the onset of heart attacks, offer significant health gains at modest cost. This proves that the standard of health of the Cypriot population compares, nowadays, favourably with that of the population of developed countries. Besides, Cyprus has been successfully freed of common infections and parasitic diseases and Ytheea r pattern2001 of illness resembles that of developed industrial nations, with cardiovascular diseases, malignancies and car accidents predominating as the causes of death. It should be pointed out that Cyprus has successfully eliminated malaria in the past and more recently echinococciasis, through the implementation of special campaigns. Current educational and preventive programmes are proving successful in almost eliminating the incidence of thalassaemia, which was a severe health problem10.

2.1. Health services

9http://www.cyprus.gov.cy/cyphome/govhome.nsf/0/36037CA698754C7AC2256B8300340FD 0?OpenDocument&languageNo=1.10http://www.un.org/esa/agenda21/natlinfo/countr/cypr us/social.htm.

The tertiary or services sector is the fastest growing area and today accounts for about 75.7% of GDP and 70.7% of the gainfully employed population. The sector includes, tourism, transport and communications, trade, banking, insurance, accounting, real estate, public administration, education, business and legal services, and, last but not least, health. The medical needs of the Cyprus population are met through three systems of health services: the government health sector, the private health sector, and a number of schemes covering specific sections of the population. Government Provision: Since independence in 1960, the Ministry of Health has been responsible for improving public health and providing public medical services, as well as overseeing the extensive private health care sector. Health care is provided free through Government facilities to those who are eligible11: Government medical services were available to all at the beginning of the 1990s. The poor were entitled to free services; middle-income families paid for care at reduced rates. These two groups accounted for well over half the population; upper-income persons paid for the full costs of medical services. In addition, there were a number of health plans subsidized by employers and trade unions. Civil servants and members of police and military units received free medical care. Cypriots needing care not available in the republic were sent abroad at government expense. For non-citizens, healthcare services, except emergency treatment, are charged at full cost during the first six months of residence. The range of services offered through the Government health scheme is comprehensive and includes visits to general physicians, specialist consultations, inpatient stays, specialized medical care given abroad not offered in Cyprus and all drugs prescribed. The Department of Medical and Public Health Services12 offers its services in the following areas: Prevention; Primary, Secondary and Tertiary care; Public Health; Other Services i.e. Physiotherapy; Speech Therapy; Rehabilitation Services; Neurophysiology Lab.; Laboratory work; X-ray dept etc.; Health Promotion; Education and Continuing education of the Staff; Epidemiological Research Projects. Furthermore, medical care free of charge is provided in all cases receiving treatment at the accident and emergency departments irrespective of the economic situation or the nationality of the person involved, including visitors. However, if these cases need hospitalisation, subsequent care fees have to be paid.

11 The groups formally covered by this scheme are: government employees, individuals earning less than C£6.000, households earning less than C£10.000 per annum and households with more than three children. Individuals with an income between C£6.000 and C£9.000 and households with an income between C£10.000 and C£14.000 have health care provided at 50% of the prescribed rates. 12http://www.moh.gov.cy/moh/moh.nsf/annual_en/annual_en?opendocument

Government provision of health care is funded out of general taxation. Private health sector: It is open to all those who can afford to pay for their treatment. Private medicine is dominated by a large number of physicians in individual practice. A number of polyclinics have also been established in urban areas with a number of physicians offering a range of medical services. Special Schemes: A number of special schemes cover specific sections of the population. These include: 1) Medical Services provided by the Trade Unions to employees and their dependents. These services provide mostly primary health care. The above schemes use both the government and private sector whenever secondary or tertiary care services are needed, through a partial reimbursement of medical expenses. 2) A number of employer-sponsored arrangements, all of which provide free medical care mainly through public hea lth facilities. Apart from the curative services offered by the public and private sectors, the public services, in cooperation with other Ministries and the Municipal Authorities, deal with the provision of preventative health services in the form of health education, inoculations, control of epidemics and infectious diseases, the disposal of sewage, the control of the quality of drinking water, food etc.

3. Health care reform

Indeed, the standard of health of the Cypriot population can be considered quite high. Already life expectancy at birth has reached 80.4 years for women and 75.3 years for men. Infant mortality rates have been successfully contained to 4.9 per thousand of population. The base death rate stands at 6,9 per thousand of population. Despite this, the reform of the health care sector is a high priority of Government health policy. In fact, the present system of health care has for long been criticized for the fragmentation of its services, the lack of coordination between the public and private health sector, the lack of equity in its financing and in general its inability to respond to the expectations of the population. What's more, there is the necessity of insuring the public health services also in the rural areas, ensuring accessibility through a network of rural hospitals, rural health centres, sub centres and dispensaries. On 20 April 2001, the House of Representatives enacted a law for the introduction of a National Health System (NHS), which has to provide health care free at the time of delivery. It will be universal in its coverage of population and will be financed by contributions from the state, employers,

employees, the self-employed, pensioners and all those who have non- employment incomes. The NHS will be administered by the Health Insurance Organisation, a public law body managed by a tripartite Board. The Organisation will purchase health services from the Government and private medical institutions and services.

3.1. Rural health centres

The New Government13 announced that the first phase of the new Primary Health Care would soon be under way at rural health centres across the island, in order to give better care to patients. The Health Minister14 wanted to have doctors and pharmacists available at Health Centres, and for someone always to be on duty. The objective, in the first phase of the Primary Health Care, was opening Health Centres in rural areas of Cyprus and having doctors on call. And in fact, new hospitals in Larnaca, Paphos and Limassol were built and the building of the new Nicosia General Hospital has already started. A new hospital for Famagusta has also been planned. Now the health centres in the rural areas are staffed with doctors, dentists, pharmacists, nurses, health inspectors and health visitors who ensure the provision of adequate services. So, at the end of 2001 the number of persons per doctor in Cyprus stood at 381, while for dentists it was 1106. There were 44 general and specialised hospital beds per 10.000 people and the ratio of persons per bed was 229. The Government also promoted plans to implement preventive medical programmes at schools in association with residents and local authorities, and added that there were other elements to the new system of Primary Health Care, such as the re-organisation of health centres as well as new protocols and visits by specialists. Health education activities have continued and have been strengthened in the field of non-communicable diseases, as well as in HIV infection. There are more than 50 non-governmental organizations actively involved in health promotion activities, which indicates the breadth of intersectorial collaboration and community participation in the field. In the Government development budgets, US$ 400.000 per year, has been specifically allocated to health education and promotion since 1993. New legislative reforms have recently been introduced in relation to tobacco and smoking and drugs and drug abuse.

13In office since 28 February 2003. 14Mrs Constantia Akkelidou.

The Health Minister also said that the State system would not sever ties with the private sector through the new Primary Health Care, but added there was a shortage of private doctors available in rural areas. Therefore, Government provision of Primary Health Care in the urban areas is nowadays concentrated in the outpatients departments of hospitals. In the rural areas, primary health care is provided through 23 rural health centres and 217 sub-centres, to which general physicians (usually one or two) are permanently attached. Finally, concerning the control of communicable diseases, an immunization programme (EPI) for the prevention of communicable diseases has been developed with high levels of immunization coverage.

4. e-Health and Citizen’s Charter

The last step in the development of welfare in general, and health in particular has been the adoption of e-Health. e-Health refers to the use of modern information and communication technologies to meet needs of citizens, patients, healthcare professionals, healthcare providers, as well as policy makers. An action plan15 just adopted by the European Commission shows how information and communication technologies can be used to deliver better quality health care Europe-wide16. The “e-Health action plan” covers everything from electronic prescriptions and computerised health records to using new systems and services to cut waiting times and reduce errors. The proposals will contribute to better care at the same or lower cost. The action plan sets out the objective of a “European e-Health Area” and identifies practical steps to get there through work on electronic health records, patient identifiers and health cards, and the faster rollout of high speed Internet access for health systems to allow the full potential of e-Health to be delivered. To

15http://www.telepa.it/telepaeurope/index.jsp?pageCen=DettagliNews.jsp?id=111&Tipo=&Set tore=&descSettore= 16 Ministerial Declaration Brussels, 22 May 2003, Ministers of EU Member States, Acession and EFTA countries met on 22nd May 2003 in the framework of the e-Health 2003 conference organised jointly by the European Commission and the Greek Presidency of the Council, in http://www.moh.gov.cy/moh/moh.nsf/0/4248c466c298e4fec2256d67002df876/$FILE/eHealth 2.doc. On this occasion, Ministers expressed their commitment to the development of national and regional eHealth implementation plans as an integral part of eEurope 2005. Ministers declared their willingness to work together towards best practices in the use of Information and Communication Technologies (ICT) as tools for enhancing health promotion and health protection, as well as quality, accessibility and efficiency in all aspects of health care delivery.

add momentum, Member States should develop national and regional e- Health strategies, and work needs to progress to allow measurement of the impact of e-Health technologies on the quality and efficiency of services, as well as overall productivity. By the end of the decade, e-Health will become commonplace for health professionals, patients and citizens. The action plan is the third element of the Commission’s recent activities in the health area (IP/04/508). The two other activities address patient mobility and the benchmarking of national reforms in health care, long-term care and social protection17. In the way of participation in the E.U., Cyprus has been promoting a system of e-health. Seven departments of the Ministry of the Interior, which offer services to citizens, have drawn up a Citizen’s Charter with a view to providing fuller information and quicker services to the public. This important innovation marks the start of a new era in the relations between the Ministry of the Interior and the citizens, a relation based on mutual respect, understanding and cooperation and mainly on the provision of substantive, immediate and impartial services to the public. The departments that have prepared and implemented the Citizen’s Charter are: Land and Survey Department, Town Planning and Housing Department, Migration Department, Registration Department, Special Service for the Care and Rehabilitation for the Displaced and Management of Turkish Cypriot Properties. The Citizen’s Charter has been published in many copies, which are available at the Ministry of the Interior, its departments and at the District Administrations18. The Citizen’s Charter is a bond of honour between the public service and citizens and safeguards the right of citizens to enjoy quality and high -standard services. At the same time, it helps make public servants feel satisfaction for the services they provide to the public. The Citizen’s Charter is not a document which contains only theoretical and general principles and aims. On the contrary, it contains specific provisions and sets out specific obligations for the public services, the period of time within which the department has the obligation to reply, the type of information to be given etc. On the basis of the Citizen’s Charter, public services are obliged to inform the public in detail on the kind of services they provide; to define and publicise standards of services; to be easily accessible and friendly to the citizen and to provide adequate information; to explain the options afforded and give correct advice to the public; to be courteous and forthcoming in providing services and to rectify mistakes.

17http://europa.eu.int/information_society/qualif/health/index_en.htm 18http://www.cyprus.gov.cy/cyphome/govhome.nsf/Main?OpenFrameSet

The Ministry of the Interior has undertaken the following obligations: 1. All letters should be replied to promptly and clearly. Every department should set its aims/standards of service and publicise at specific intervals the progress achieved. 2. Appointments between government officers and citizens should be held without any delay. (Delays should not exceed ten minutes.) 3. To give specific and clear information on the services the department is providing and at least one telephone number to ring for information. 4. Government officers should regularly ask the opinion of the public about the level of the services provided and the results achieved. 5. To define procedures and to adopt appropriate measures, which ensure easy and unimpeded access to the services, provided to all citizens19 e-Health, better health and healthcare through the use of information and communications technologies. With the e-health system patients will benefit from the use of information and communication technologies in healthcare. Patients need to contact their family doctors, doctors need to talk to hospitals, and hospitals need to interact with clinics and research centres, all with the aim of providing better care for patients and effective solutions for health care systems20.

5. Health and safety at work

Another permanent policy of the Government is the continuous improvement of the conditions and environment of work, which is implemented by appropriate legislation. The enforcement of this legislation is effected through a System of Inspections which are carried out by properly trained inspectors of the Department of Labour Inspection21. The Pan Cyprian Safety and Health Council plays an important role in the general effort for the improvement of the conditions and the environment at work and for the establishment of a safety behaviour at all levels of work. This

19http://www.pio.gov.cy/ministry_interior_eng/index.html 20 Now, new and concrete actions will be taken forward as part of the action plan: •By 2005 Member States should develop their own roadmaps for e-Health, and an EU public health portal should be up and running to provide a one-stop shop access to health information. •By 2006 work should be well advanced on key issues such as developing a common approach to data allowing patients to be identified and putting standards in place which mean that all the different parts of healthcare networks can talk to each other and read and exchange patient information. •By 2008 health information networks should be commonplace, delivering services over fixed and wireless broadband networks and making the most of networks within so called "Grids" to boost computing power and the interaction between different systems. 21http://www.cyprus.gov.cy/cyphome/govhome.nsf/Main?OpenFrameSet

Council is a tripartite Body with an advisory to the Government role on the measures to be taken in order to secure safety, health and well-being at work. At the same time and within the process of accession of Cyprus to the European Union, the relevant legislation has been reviewed and updated in order to be harmonised with the corresponding acquis. Within this context, 22 legislative pieces, which are fully harmonised with the provisions of the European Directives on Health and Safety at work, have been enacted. Examples of the harmonised legislation are the Regulations on Asbestos, Biological, Carcinogenic and Mutagenic Agents, work equipment, noise, etc. In addition, the Government, following the European and international trends on issues related to occupational safety and health, has promoted the active participation of employers and employees to the decision-making procedure for improving the working conditions and the work environment by introducing legislation for the establishment of safety committees at the workplaces22. Based on this legislation, safety committees have been elected in a large number of installations and it is expected that soon all sectors of economic activity will be covered. In the training sector, the Training Centre on Occupational Safety and Health of the Department of Labour Inspection organises special training programmes, seminars and workshops addressed to representatives of industries, members of safety committees, safety officers, secondary school teachers and trainers. These programmes intend to inform and train every participant on the control of occupational hazards at the work environment.

6. Protection of Maternity Law

Still on the guardianship laws of work, in 1987 the Protection of Maternity law, was passed, code numbered 54/87, and has been in force since then with various amendments23. The aim of this Law is to protect the working woman from possible dismissal during her pregnancy. The working woman, according to the Law, is entitled to 16 weeks maternity leave. During her maternity leave, she will receive a maternity allowance from the Social Insurance Fund, as set out in the Social Insurance Law. The maternity leave, where there is a collective agreement, is complemented by the employer to the level of the woman's salary, for as many weeks as the collective agreement provides for.

22http://www.pio.gov.cy/ministry_interior_eng/displaced_person/gen_info.htm 23http://www.sek.org.cy/english/labour/03.htm

The Law protects the working woman from the termination of her employment by her employer from the moment she notifies her employer of her pregnancy, with a certificate from a certified doctor, up to three months after her maternity leave expires. The Law gives working women the right to take one hour off work for six months after giving birth, without any income being held back, to take care of and breast-feed her child. The working woman may use this right in three different ways, in agreement with her employer: 1) To go to work one hour late; 2) To leave work one hour early; 3) To interrupt her work for one hour. According to the law, maternity leave does not in any way affect the seniority of the woman or her right to promotion or to return to work or the level of her salary. An innovation in this sector has been introduced by Law No. 100 (1) of 1997 on maternity protection24. It predicts that any employee who presents a medical certificate drawn up by a registered physician testifying that the bearer is to give birth in the week specified in the said certificate shall be entitled to maternity leave25. Besides, all female employees shall be entitled to maternity leave of a total duration of 16 consecutive weeks, nine of which must be taken during the period commencing in the second week before the week during which birth is expected to occur. It shall be prohibited to assign pregnant women to work that is classified, in regulations made by the Council of Ministers and published in the official journal of the Republic of Cyprus, as hazardous to the healthy development of pregnancy. This prohibition shall be valid for the duration specified in such regulations, but may not extend beyond six months following childbirth. A pregnant woman assigned to a post classified as dangerous in accordance with the law, shall have the right, once her pregnancy has been confirmed by a certificate drawn tip by a registered physician, to be transferred to another post that does not present a danger, without any reduction in salary." Recently, Cyprus took part in a Convention, the 88th Session, 30 May - 15 June 2000, whose object was the revision of the Maternity Protection Convention (Revised), 1952, and the proposed Recommendation concerning the revision of the Maternity Protection Recommendation, 1952. The most important provisions in it was: 1-The mother benefits: a) care given in a doctor’s office, at home or in a hospital or other medical establishment by a general practitioner or a specialist; b) care given by a qualified midwife or other maternity service at home or in a hospital or other medical establishment; c) maintenance in a hospital or other medical establishment; d) any necessary pharmaceutical and medical supplies,

24 Episêmê Ephêmerida tês Kypriakês Dêmokratias, 19 December 1997, N° 3207, supplement N° I(I). 25http://www.who.int/idhl-rils/frame.cfm?language=english

examinations and tests prescribed by a medical practitioner or other qualified person; e) dental and surgical care. 2-Financing of benefits: the cash and medical benefits should be provided through compulsory social insurance, public funds or in a manner determined by national law and practice. 3-Employment protection and non-discrimination: a woman should be entitled to return to her former position or an equivalent position paid at the same rate at the end of her leave referred to in Article 3 of the Convention. The period of such leave should be considered as a period of service for the determination of her rights. 4-Health protection: a woman who is pregnant or nursing should not be obliged to perform work where it has been determined by the competent authority to be prejudicial to the health of mother and child; or there is a recognized risk to the health of mother and child; or an assessment has established a significant risk to her own health or that of the child.

7. Latest forecasts: The United Cyprus Republic

On the 31 March 2004 “The Comprehensive Settlement of the Cyprus Problem” was published. It outlines the principles underpinning the “United Cyprus Republic”, an independent state, built in the form of an indissoluble partnership, with a federal government and two equal constituent States, the Greek Cypriot State and the Turkish Cypriot State26. So, the public administration system has to take into account the political reform in progress. On the basis of the document, the United Cyprus Republic is organised under its Constitution in accordance with the basic principles of the rule of law, democracy, representative republican government, political equality, bi- zonality, and the equal status of the constituent States. The federal Government sovereignly exercises the powers specified in the Constitution, which shall ensure that Cyprus can speak and act with one voice internationally and in the European Union, fulfil its obligations as a European Union member state, and protect its integrity, borders, resources and ancient heritage. The constituent States are of equal status. Within the limits of the Constitution, they sovereignly exercise all powers not vested by the Constitution in the federal Government, organising themselves freely under their own Constitutions.

26 The Comprehensive Settlement of the Cyprus Problem, of the 31 March 2004, in http://www.state.gov/r/pa/rmo/hglt/31329.htm

The constituent States shall cooperate and co-ordinate with each other and with the federal Government, including through Cooperation Agreements, as well as through Constitutional Laws approved by the federal Parliament and both constituent state legislatures. In particular, the constituent states shall participate in the formulation and implementation of policy in external relations and European Union affairs on matters within their sphere of competence, in accordance with Cooperation Agreements. The health question is considered in the project of the Constitution of the United Cyprus Republic. In fact, the constituent States shall strive to coordinate or harmonise their policy and legislation, through agreements, common standards and consultations wherever appropriate, in particular on the following matters: a. Tourism; b. Protection of the environment and use and conservation of energy; c. Fisheries and agriculture; d. Industry and commerce, including insurance, consumer protection, professions and professional associations; e. Zoning and planning, including for overland transport; f. Sports and education; g. Health, including regulation of tobacco, alcohol and drugs, and veterinary matters; h. Social security and labour; i. Family, company and criminal law; j. Acceptance of validity of documents.