The Voluntary Sector’s Contribution to Integrated Care: The Case of Cyprus

Abstract

At a time when globalisation and the economic crisis have forced a reduction in public expenditure at all levels, social policy and social welfare systems’ efforts for sustainable development are focused on identifying alternative ways to provide integrated services and achieve balanced social development. Post-colonial Cyprus has experienced radical socio-political changes that have demanded rapid responses to address its needs. This paper aims to discuss the role of the Cypriot voluntary sector in the national integrated care. Within the spectrum of ensuring social rights and social justice, the voluntary sector has emerged as a key factor of social policy implementation. Through the exploration and analysis of this context, an in-depth insight is given into socio-political and economic factors, dimensions, relationships, processes, patterns, and critical junctures that, under the influence of history, have shaped the voluntary sector’s path, formed its major stages of transformation, and defined its relationship with structures and institutions.

1. Introduction

The shift towards welfare delivery by the voluntary sector is not a new alternative prospect in the field of social care and protection. The voluntary sector (non-profit organisations and religious, voluntary and community organisations) serves as a parallel alternative to welfare states which cannot assume more responsibility in welfare provision. Hence, the voluntary sector has undertaken a major role in welfare, acting as a key player, contributing to welfare strategies and safeguarding social rights and social justice, although not always with corresponding recognition and equal participation in decision-making for national social policy.

Since the mid-1990s, a noticeable shift has been observed in various welfare states and their respective governments, such as those in the United Kingdom, the United States of America, and New Zealand, as well as other Western European countries (Esping-Andersen 1994). This shift involved a withdrawal in the provision of public social services coupled with the promotion of a pluralistic social economy, which also led to increasingly inadequate access and polarisation (Cochliou and Vayas 2012; Christou et al. 2016; Nielsen and Hammerslev 2024). The active participation in providing social and welfare services has been an integral part of welfare systems and regimes. As highlighted in earlier but also recent studies, the voluntary sector and civil society at large play a significant role in creating a pluralistic social economy (EEAC 2017; Noya and Clarence 2007; Salamon and Anheier 1997). The “Third Way” was created in the mid-1990s, where the state and the market maintain the institutional legitimacy to provide social services, but simultaneously it is argued that the voluntary sector can and should play an important role in alleviating financial burdens from the former two (Giddens 1998). Etzioni (2001) also emphasised the “Third Way” as mobilising citizens themselves to actively participate in community development and social welfare.

This paper sets out to examine, in a systematic and critical manner, the contemporary landscape of voluntary organisations in Cyprus and their contribution to social welfare and integrated care. It follows a multidimensional approach that interweaves historical context, legislative evolution, and theoretical analysis, thereby offering readers a coherent account of how civic actors have both shaped and been shaped by changing political, economic, and social conditions on the island.

First, the study sketches the socio-political backdrop against which the voluntary sector emerged and expanded. Since the mid-1970s, Cyprus has experienced rapid economic growth, the challenge of post-conflict reconstruction, EU accession in 2004, and the financial crisis of 2012–2013. Each milestone generated new patterns of vulnerability—displacement, poverty, chronic disease burden and migration flows—that encouraged citizens to organise collectively. By tracing these successive “critical junctures,” this paper employs path-dependency theory to show how early choices about state–civil-society relations established institutional trajectories that still inform welfare provision today.

Second, the legislative framework governing voluntary organisations is analysed in depth. Particular attention is paid to the Law on Associations and Foundations of 2017 (CyLaw 2017), which introduced stricter reporting requirements, created a central registry, and formalised avenues for public funding. These measures sought to professionalise the sector and improve accountability, yet they also risked constraining the flexibility that once proved essential to rapid grassroots responses. The paper evaluates how legislative reforms have altered governance structures, resource flows, and the sector’s capacity to engage in policy co-design at national and European levels.

Third, the current configuration of welfare arrangements is mapped. Cyprus operates a mixed welfare regime in which public agencies, private providers, and voluntary organisations all deliver services but without a comprehensive integration strategy. Drawing on recent developments and secondary data from public authorities, the study assesses the sector’s tangible contributions to health promotion, long-term care, mental health support, disability services, and migrant inclusion.

Fourth, the analysis identifies systemic gaps that limit further progress toward integrated care. These include fragmented funding streams, uneven data sharing, insufficient participation of NGOs in strategic planning, and a lack of outcome-based commissioning mechanisms. Applying the path-dependency lens, the paper argues that previous policy choices—especially the reliance on voluntary actors in the delivery of welfare through project-based grants and informal cooperation—still lock stakeholders into sub-optimal patterns that perpetuate service delivery.

Integrated Care in the Welfare and Non-Profit Regime

If we could put integrated care into context as a system that brings together service providers, promotes more coordination, minimises defragmentation of service provision, for better outcomes in social policy implementation (Munday 2007; Nolte et al. 2016; Guagliardo and Dhéret 2019), then several factors need to be considered, most notably the welfare regime, the main welfare agents, their roles, and the circumstances that have shaped the system of services, as well as the distribution of welfare responsibilities (Irving 2009, 2011). Based on the definitions adopted by the WHO (2016), integrated, people-centred health services are managed and delivered so that individuals, carers, families and communities receive a seamless continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care, coordinated across all levels and sites of care both within and beyond the health sector and responsive to their needs throughout their life course. Hence, to understand existing welfare arrangements and the role of the voluntary sector in integrated care, we need to explore the welfare regime’s historical development, the processes that resulted in the division of welfare responsibilities, as well as relationships that guided welfare provision strategies over the years.

Current arrangements reflect the concept of path dependency (Guidi 2022; Casey 2016a; Wood and Gough 2006; Pierson 2000; Mahoney 2000). It reflects a path that has “reproduced” (Wood and Gough 2006, p. 1698) in the welfare state’s building process. The reproduction effect heavily rooted in Cyprus’ key historic events and interacting factors, have determined the voluntary sector’s trajectory, where voluntary associations have had a key role in welfare provision (Patsalidou 2014). The dominance of the voluntary sector in welfare can best be explained by Pierson’s (2000) argument that “particular courses of action, once introduced, can be almost impossible to reverse” (Pierson 2000, p. 251) and by the “increasing returns” feature (Mahoney 2000; Pierson 2000), considering that the voluntary sector has turned, throughout the years, into an “effective and efficient force in social service provision” (Patsalidou 2014, p. 166). This context, aligned with the path dependency logic, is rooted in history and the influence of a complex set of factors. This should not suggest that paths never divert; rather, as Guidi (Guidi 2022, p. 756) suggests, paths can be “malleable and manipulable”.

The state’s developmental process, marked by various turbulent phases, caused a delay in the introduction of a comprehensive welfare state. Patsalidou (2014) argues that colonialism’s poor socio-economic conditions, authoritarian administration, intense struggles, etc., enforced the development of voluntary networks to address the needs of society and resulted in organisations serving political and national interests towards the building of the anti-colonial struggle (1955–1959). When Cyprus gained its independence in 1960, following a long British colonial rule since 1878, democracy was challenged by political instability marked by bi-communal struggles and international intervention involving geopolitical interests. The state’s infancy and political instability facilitated the development of a larger landscape of associations, consolidating a “distinct sector” (Patsalidou 2014, p. 139) with features of isomorphic councils of social welfare provision but also diverse scope associations to meet different needs.

However, the tragic event of the Turkish invasion in 1974, which resulted to the military occupation of the northern part of Cyprus by Turkey until the present day along with the creation of severe political and social problems, has reorganised the voluntary sector, forced its geographical relocation, and marked the establishment of new networks to meet the needs of the aftermath of the war. As the state prioritised emergency relief, economic recovery, and political stability, its post-war social reconstruction strategy involved decisions aiming to empower communities and voluntary networks to meet emerging needs (Patsalidou 2014).

The post-war period (1974 onwards to the 1990s) and the political problem (division and continuing occupation of the island by the illegal regime, following the 1974 invasion by Turkey in violation of the UN Charter and all the principles of international law), which remains unresolved to the present day, have directed state decisions and strategies towards volunteer mobilisation and state funding to voluntary associations, with an increased context of associations.Themid-1980s and 1990s created new “dividing lines in the structure of the voluntary sector itself”, separating the philanthropic networks from the state-funded voluntary associations, which focused on specific social policy domains (Patsalidou 2014, p. 328).

These, as noted by Patsalidou (2014), have formed key critical junctures in the welfare history of Cyprus, affecting the trajectories of institutions, as well as negotiations in welfare, grounding the voluntary sector, the Church, the family, and communities as key welfare providers. The general instability created high levels of solidarity, social capital, and responsibility, facilitated by the island’s small size. Arrangements, therefore, in welfare have been marked by a complex set of interdependent relations among the voluntary-sector–religion–society spheres and the state, resulting in interconnected welfare trajectories. Governments, working in the shadow of critical events have been “reluctant to divert the voluntary sector’s or the state’s welfare trajectories” (Patsalidou 2014, p. 166) to different directions, and hence decisions on who should deliver welfare at community level “weighed towards existing voluntary and community-based welfare mechanisms” (Patsalidou 2014, p. 165).

These major processes forced the locking of organisations into what Mahoney (2001) describes as long-lasting “institutional patterns” that initiate cycles of “reactive sequences” (Mahoney 2001, p. 112). These developments established “a continuity of welfare arrangements” and “the voluntary sector’s dominance in service provision” (Patsalidou 2014, p. 337), locking welfare trajectories into specific directions.

Since 2000, Cyprus has witnessed a steady voluntary sector growth of diverse scope but also an emerging strategy of state funding to local authorities’ programmes in welfare, introducing criteria of collaboration with voluntary associations (PVCC 2000–2020). The economic crisis in 2012, which brought back philanthropic elements in the work of voluntary associations to address the consequences of the crisis, strengthened associations in the welfare domain and cooperation at different levels.

Placing Cyprus’s voluntary sector in the traditional important work of the mapping of the non-profit regimes (Salamon and Anheier 1998), there should be a focus on more processes and a more complex set of dynamics to accommodate the peculiarities of specific contexts. The need for mapping and analysing the sector’s complexity is still important in the literature (Anheier 2023; Eikenberry and Nickel 2016; Casey 2016a, 2016b; Anheier et al. 2020; Benevolenski et al. 2023; Anheier et al. 2020; Mahon 2018; Maier et al. 2022). This is why it is important to shed new light on the role of the voluntary sector as a key welfare provider within the emerging concept of integrated care systems, but also its contribution to the wider welfare regime. Patsalidou (2014), for example, has argued for an extended theory of social origins factors beyond the classical work of social theory and the mapping of non-profit regime to understand the developmental path of the voluntary sector, its position, and its contribution. Cyprus’ voluntary sector’s development, as Patsalidou (2014) suggested, reflects factors of origin in Western (Salamon and Anheier 1998; Aspalter 2020; Maier et al. 2022; Casey 2016a, 2016b), underdeveloped (Salamon and Anheier 1997; Acet and Ahmed 2022; Casey 2016a), politically turbulent (Gidron et al. 2003; Kabalo 2009; Toepler et al. 2020; Ben-Porat et al. 2022; Mumtaz and Sumarto 2024), or Mediterranean regimes (Ferrera 1996; Gal 2010; Gunther et al. 2006; Karamessini 2007; Katrougalos 1996; Moreno 2006; Marí-Klose and Moreno-Fuentes 2013) or in regimes with an “interrupted” history of welfare state development (Rhodes 1997, p. 14), noting the significance of geographical location in shaping the paths of regimes (Steinberg and Young 1998), as well as the significance of “vulnerability” in small states (Irving 2009, 2011; Baldacchino 2011; Bertram 2011; Sarapuu and Jugl 2024). Key to this discussion is understanding the voluntary sector’s growth from different contexts of power relations and interests that move beyond class to include cross-border interests of nationalist, political, and geopolitical nature and involving more actors, including international powers and invading countries (Patsalidou 2014). Cyprus, located in the Mediterranean region, reflects how past choices under specific circumstances have built a strong voluntary sector. Positions in integrated care state that “IC weakness in Western European countries stem from arguable choices” of the past (Garattini et al. 2022, p. 146). As this paper aims to shed light on the context of integrated care in Cyprus and the contribution of the voluntary sector, it is argued that the past helps to understand the present (notably the roles of non-state actors) but also highlights the need to incorporate the influence of welfare and non-profit regimes’ path dependency, the role of welfare providers, and the choices/decisions of distribution of welfare in understanding voluntary sector’s contribution to integrated care.

If integrated care is about improving access to services, safeguarding the continuity of service provision in more effective and efficient ways (Guagliardo and Dhéret 2019), restructuring fragmented services (Garattini et al. 2022; Nielsen and Hammerslev 2024), building stronger relations (Blanken et al. 2023), etc., or new notions of engaging individuals and communities (Goodwin 2016), or even focusing on the links among welfare states, volunteering, and social integration (Ackermann et al. 2023), then the voluntary sector’s contribution should be understood through the lens of its development and past arrangements, especially if these persist to the present day. The state’s and the voluntary sector’s contribution to welfare and their capacity to safeguard access to services for all should also be evaluated through the lens of these factors’ responsibility towards international/European agreements. (See, for example, Leriou (2025) on the United Nations’ International Convention on the Rights of the Child.) Although it is beyond the scope of this paper to analyse international obligations in regards to access to services for all vulnerable groups, it is important to stress the need to link access to services as an institutional right and the impact on wellbeing. Leriou (2025), for example, has linked wellbeing in the Greek context in relation to measures on children’s unrestricted access to free healthcare services, under conditions of crises (economic, the COVID-19 pandemic, etc.). Mapping wellbeing when discussing the effectiveness of welfare states and policies is also stressed by Leriou (2022). The relation between a good quality of life and social wellbeing in regard to access to services and broader welfare policy has also been discussed by Michalos (1978, 2017), Heins and Deeming (2015), and Veenhoven (2000).

2. Legislative Framework

Introducing integration to social services at the local level, where voluntary organisations have a dominant role, depends on the determination of the legislative level to advance new legislation or incorporate the means towards integration in current laws. Hence, if we apply Leutz’s (1999, p. 77) reference of “laws of integration” and search for integration-related elements in current legislation, then we could suggest that the basic “ingredient” of cooperation among welfare actors is partially apparent in various welfare-related laws and procedures, noting cooperation (DMSW 2025). If the wider legal environment in social service provision, NGO regulation, etc., is examined, then we observe a context imposing mainly a regulatory framework rather than an enabling environment that builds a comprehensive integrated system in service provision across the whole spectrum of human services. Moreover, it is observed that most current legislation has built on the path of colonial laws, focusing in regulating specific areas, and has only introduced reforms with a rather slow mode/pace (Government Portal 2017; CyLaw 1959, 1930, 1972), suggesting that any attempts of reform in promoting integrated care will also follow a slow path of development.

For example, the Law on Associations, Foundations and Other Related Issues (L.104(I)/2017) (Government Portal 2017), which regulates the registration of associations, foundations, federations and/or unions of organisations, forms a more modern legal context but has developed rather late considering its respective “predecessors” and other related legislation on charities (the Associations and Institutions Law (57/1972) (CyLaw 1972) and Clubs (Registration) Law—Cap. 112 (1930) (CyLaw 1930). Also, the current Children’s Law, introduced in 1956 (Cap 352/1956), did not undergone form until 1999 (CyLaw 1959).

A key legal context that grasps some of the foundations of integrated care is the Pancyprian Volunteerism Coordinating Council Law (PVCC) (61(I)/2006) (CyLaw 2006), replacing the former context (the Pancyprian Welfare Council Law (PWC) (152/1989) (CyLaw 1989). The PVCC law supports local non-profit welfare providers to coordinate the increasing scale of voluntary sector bodies in welfare to engage in policy making and collaborate with the state in social policy and voluntary sector issues.

The law provides a comprehensive legal context for the establishment and functioning of coordinating volunteering councils at the district level, as well as volunteering councils which act as key welfare providers at the local level. Beyond the strong element of the coordination of the activities and planning of its member organisations, the PVCC law incorporates the coordination of these actors’ activities with the state. All these features, as well as the PVCC’s recognition as a key partner of the state in social policy formulation and a key player in the coordination of affairs, lay the foundations for advancing a strategy towards integrated care between non-profit welfare providers and the state.

Despite these favourable elements, the wider legal environment can be characterised as a context imposing mainly a regulatory framework rather than an enabling context for advancing the full potential of organisations or the matter under discussion, namely integration. Although transparency and good governance are pursued by most stakeholders, the current situation does not balance the need or requirements between regulation on the one hand and towards the development of organisations on the other. Despite recent positive reforms in important pieces of legislation, some still have a strong link with colonial legislation, and others have demanding requirements that impose obstacles rather than provide essential support to organisations. The legal context is in need of further reform to accommodate the dynamic changing environment of non-profit welfare providers and define relations among different welfare actors. Another obstacle is the risk-based approach that has been recently employed in the broader non-profit sector. At this infant stage, the aim has been to categorise entities that have a higher degree of vulnerability to money laundering and terrorism financing. Although compliance safeguards transparency and control, it should, however, employ a more balanced approach, accommodating proportional and more objective criteria, based, for example, on the type and scale of activities and/or the financial and activity records of organisations. (See Gibson and Crutcher (2020) for more analysis.) In fact, it has been stressed that states should “identify the risk of anti-money laundering and terrorism financing before they impose further measures for the sector” (Hadzi-Miceva Evans 2021, p. 23).

A burdensome rather than an enabling legal environment cannot contribute towards meeting the goals of pressing social policy issues nor promote a strong voluntary sector to achieve more integration in welfare and health care. Although many other factors need to be in place to meet this objective, how associations are treated is a key challenge that the policy-making level, in collaboration with voluntary associations, needs to address. The aim should be to set a regulatory framework that safeguards control, creates beneficial conditions, and eliminates obstacles to the everyday functioning of organisations. Finally, the legal framework should always safeguard that voices are heard and that participation is strong so that organisations can, in collaboration with the state, build a stronger welfare regime meeting the goals towards integrated care.

3. The Current Landscape of Voluntary Organisations in Cyprus

Volunteering and associational life have developed under various forms and cultural norms and have been driven by path-dependent choices to define the boundaries of welfare provision as well as the division of welfare responsibility (Patsalidou 2014, 2020). Structurally, the non-governmental and non-profit context includes coordinative councils, associations, organisations, foundations, networks, federations, confederations, community councils/committees, etc., addressing diverse policy domains (Ministry of Interior 2025). Although charity and philanthropy are still apparent in the work of some organisations, most have a more policy-oriented scope (PVCC 2024a; Patsalidou 2020).

This sector relies on the self-organisation of citizens and voluntary service provision, based on solidarity and cooperation. In the field of social services, it seeks to fill “gaps” in the demand for services, whose provision by free market mechanisms is deemed unprofitable and by the state is often unfeasible. Particularly in recent years, entities in this sector are increasingly incorporating business methods in their practices, as well as approaches that relate to efficiency, effectiveness, and transparency. Of course, what distinguishes the work of these entities is their ability to encourage interpersonal bonds and strengthen local solidarity, thus contributing to the strengthening of the social fabric and social cohesion (PVCC 2024b; Patsalidou 2020).

The voluntary sector today is recognised as a key partner of the state in implementing social and health care programmes (PVCC 2024a, 2024b; CNA 2025). However, its role and contribution in welfare have not been measured, and the extent of “equal” participation in decision-making is not documented. Furthermore, its achievement levels towards meeting the goals for more coordination and effectiveness in the field of social care and integrated care are equally blurred. Generally, it can be argued that the voluntary sector has not been substantially explored in Cyprus so far, although it provides a multitude of services within the territory of the Republic of Cyprus.

Voluntary organisations and volunteering have a key role in the modern social policy system. Key drivers of most organisations are individual selfless actions or the altruistic dispositions of individuals, as well as active citizenship (Nielsen and Hammerslev 2024). More specifically in Cyprus, voluntary organisations are active in a wide range of policy areas (environment, culture, sports, education, peace, democracy, sustainable and sustainable development in various sectors of the economy and society, development of corporate sustainability and responsibility, and human rights, etc.) (Ministry of Interior 2025). There is, however, a long tradition of engagement in the provision of social and health care services (Patsalidou 2014). It is also noteworthy that voluntary organisations’ strong links with communities, expertise, and knowledge have developed their capacity to be proactive in the identification of emerging and complex social needs and tackling problems. Their diverse work in social care, rehabilitation, counselling, palliative care, prevention and therapy programmes, etc., either substitutes or complements the public state services (Cochliou and Vayas 2012; Christou et al. 2016; Kalweit and Grech 2023).

Discussing the voluntary sector’s contribution to integrated care, a special mention should be made to an important sub-sector introduced in the 1960s, namely the Community/Committees Welfare Councils, which is still acting today. This isomorphic structure has served to meet local social needs, delivering a common core of social services like infant/toddler care centres, child protection and pastime centres, homes for the elderly and the disabled, adult centres, etc., at the community level (PVCC 2024a; SWS 2024). This chain of social programmes has shared a common form of structure (CyLaw 1989, 2006), is governed by respective legislative frameworks in their policy domain (SWS 2025b), is inspected to safeguard a set of minimum standards, etc., by the Social Welfare Services of the Republic of Cyprus. All these structures have been organised and governed by articles of the PVCC legislation. Strategic planning could evaluate the dynamics stemming from this sub-sector to meet the goals of integrated care. Furthermore, integrated planning in care should acknowledge the assets stemming from the work of volunteer centres (see Patsalidou and Kyriakou 2009) and incorporate individual and group volunteers in the planning of integrated care.

4. The Organisation of Welfare

A considerable amount of discussion in the literature revolves around integrated and social care (WHO 2008, 2015; Nolte et al. 2016; Goodwin 2016). In Cyprus, this has not been adequately discussed or researched, even today, when the need for improving the healthcare and welfare services is not only evident but also urgent. Healthcare is a mixed system that integrates elements of a national health system and health social insurance, providing universal coverage to the population based on legal residence, while there also is a large private healthcare market involved, both in service provision and in system financing (Petrou 2021; OECD 2023).

Before 2019, the old system covered only about three-quarters of the population (OECD/EU 2018). According to a study (Kringos et al. 2013) conducted in the context of evaluating health care systems, it was found that in the case of Cyprus, the system was characterised as “weak” in terms of both the structure and the process of service delivery (degree of access, continuous services). However, within the framework of the new general health system, the Health Insurance Organisation serves as the sole purchaser of services from both public and private providers. The State Health Services Organisation is responsible for the development, management, control, and supervision of healthcare providers in the public sector (Petrou 2021; OECD 2023). The efficient and integrated functioning of health care is a crucial factor for public health systems and the quality of life of citizens, as it serves the first level of care provision.

Integrated care has become the focus of attention for governmental agencies globally in recent years (Nolte et al. 2016; Garattini et al. 2022). However, this sector has remained mainly underdeveloped in Cyprus due to factors such as the allocation of financial resources and the procrastination of the modernisation and restructuring of Social Welfare Services and the general health system (Petrou 2021). Furthermore, low economic growth and rising healthcare costs have already been on the agenda (Petrou 2021).

In welfare, new reforms are expected to introduce more targeted objectives and rational planning towards modernising the social welfare system in Cyprus. The new objective to strengthen the Social Welfare Services (SWS) under the SWS Restructuring Project (Directorate General Growth 2024) aims to remedy the weaknesses, overlaps, and fragmented coverage of the welfare system and the marginalisation and exclusion of social groups. The restructuring of social welfare aims to improve the coordination among service-providing agencies, as well as to adapt welfare structures to the new conditions that have emerged in recent years. It furthermore seeks to terminate outdated practices but more importantly establish a modernised institutional approach of care to meet the needs of vulnerable groups. It is documented that reforms will overcome the limitations in welfare provision. To address delinquency, social exclusion, and limited access to social services, the newly established Social Neighbourhood Worker programme, aiming to address social issues at the community level, is expected to support communities in accessing the social welfare state and services provided by other welfare actors (European Commission 2024). The outcomes of this new strategic planning will reflect, soon, its capacity to lift the substantial responsibility in care provision undertaken by families.

Social welfare has been radically transformed over the last twenty years in modern Western societies, in terms of philosophy and orientation, ideologies in the division of welfare responsibility among welfare providers, and the quality characteristics of service provision (Nielsen and Hammerslev 2024). From the care of the “weak,” the institutionalisation, and reproduction of their dependency on traditional state policies, a new perception has emerged towards the provision of qualitative integrated services, respecting the diversity of needs and tailored to meet individual needs. Socially inclusive, multidimensional support services and deinstitutionalisation are some of the new concepts forming a new culture in providing welfare services (Carpenter et al. 2022).

In the era of late modernity, with the weakening of family and kin networks as the primary cell for care provision (Schubert et al. 2016; Nielsen and Hammerslev 2024), as well as the challenging demands on states for more efficiency and adequacy in service provision rather than mere “effort,” voluntary organisations have evolved from amateur charitable networks to flexible and effective bodies in the provision of welfare services. The market, on the other hand, has strengthened its social profile through its increasing contribution to social care as well as other policy areas. In the era of efficiency and effective resource management, the goal is the effective mobilisation of human and material resources through flexible and efficient care services. The question “what can the state do” has transformed into “what can the entire society do” in social welfare (Aravacik 2018), and what the role and responsibility of each entity is in a process of synergy and coordination to achieve the desired outcome. Within this framework, the voluntary sector tends to be, or in several countries has evolved into, the main sector for providing social and health care services (Kalweit and Grech 2023).

5. Collaboration in Welfare

A key driver of collaboration is state funding. In social service provision, the main State-Aid Scheme of the Deputy Ministry of Social Welfare, for example, implemented by the Social Welfare Services (SWS 2025b), supports institutions that provide social care services of general economic interest (including associations, foundations, organisations, and local government authorities). The scheme itself defines a solid strategy of collaboration between the state and voluntary associations to deliver social services. A key element is that partnerships of organisations and/or local authorities are included in the list of beneficiaries of the Scheme, suggesting that building partnerships in social service provision is among the priorities in social care. The scheme sets priorities in the areas of social care to be subsidised; therefore, not all social programmes are supported. The scheme’s criteria promote several other integration parameters through its financial regulatory framework, which monitors the effective allocation of funding (SWS 2025a). So, for example, through monitoring mechanisms, the Scheme safeguards that there is no overlap among programmes serving the same need or target group in the same area.

Analysing the scheme is important because it reflects ideologies and practices in the division of welfare responsibilities and provides insight into the integration of care under discussion. It establishes a strategy to address welfare issues through collaborations, based on the mixed economy concept in social care involving non-state community actors (CNA 2025). The idea of state sector collaboration reflects not only ideologies in welfare provision between the state and NGOs and a scarcity of the state’s resources to address all needs (PVCC 2024b), but also path-dependence forces already discussed in previous sections. This relationship and exchange context in the delivery of welfare through state funding can be characterised as a positive element towards more collaboration and integration of services, provided, though, that the funding of schemes or other income generated by the organisations can cover their expenses as welfare providers or produce such outcomes that benefit the end users or vulnerable groups in society (PVCC 2024b).

As is the case in developed Western countries, the Cypriot state increasingly contributes to the funding of programmes implemented by the voluntary sector in order to improve services and address social needs in a holistic way (CNA 2025; PVCC 2024b). Moreover, it is inefficient for the state to maintain small service units in different geographical locations to meet diverse social welfare objectives (PVCC 2024b). As a result, the funding of voluntary organisations by the Deputy Ministry of Social Welfare and the Ministry of Health, which also implements a parallel funding Scheme (Ministry of Health 2025), aims to direct the activities of voluntary organisations towards the implementation of social policies deemed necessary to address respective needs in the welfare and health domain (PVCC 2024b).

The notion of integration in social care and strengthening collaborations is also reflected in the new action plan of the Deputy Ministry of Social Welfare for 2025, which incorporates the basic elements of an integrated care system, such as a mission to upgrade the structures and operation of the state’s social services, a vision of the holistic support of the individual and the family in a human-centred, multidisciplinary, and effective way (Annual Action Plan 2025, pp. 3, 18); the support, mobilisation, and funding of non-governmental organisations (NGOs) and local authorities for the operation of social programmes (Annual Action Plan 2025, p. 5); the coordination of action plans for specific social groups (Annual Action Plan 2025, p. 8); and a number of planned initiatives that promote efficiency and effectiveness in Social Welfare Services (Directorate General Growth 2024).

Other initiatives that facilitate collaboration between state and non-state actors include annual dialogues organised by the PVCC between ministries/deputy ministries and voluntary associations (PVCC 2025; European Commission 2024) and national forums held between state authorities and voluntary associations to discuss the needs of specific social groups (PVCC 2024b). The scarcity of resources at all levels, though a burdensome factor to achieving more qualitative and effective social service provision, strengthens collaborations and exchange relations at different levels. Although a culture of collaboration exists, practically facilitated by the small size of the island and strong cooperation among non-state actors (Patsalidou 2014), this does not imply that voluntary organisations are equal partners with public authorities in decision-making in the delivery of welfare. Depending on various circumstances, hierarchies are strong, and the vertical line of exchange relations (from the policymakers to grassroots organisations) does not always entail an equal partnership in policy-making/implementation, or sharing the same goals, or that the needs of service providers are met. Although there is therefore a shared vision towards improving social care, diverse opinions and scarce resources do not always lead to consensus (PVCC 2024b).

6. Main Challenges and Lessons Learned

Social service provision is a fundamental aspect of contemporary Cypriot voluntary organisations’ work. This role should neither be taken for granted, nor should it absolve the state of its own responsibility to mitigate the causes or effects of social exclusion and welfare challenges at large. Voluntary organisations form an effective mechanism for detecting new needs in social protection and developing programmes to address them, especially in cases when these cannot be delivered by the state. From such a perspective, voluntary organisations play a vital role in social policy and in strengthening human relationships of reciprocity with end users and other welfare providers. A challenge for policymakers is to provide the maximum support to organisations so that they can deliver effective outcomes.

At the same time, legislative frameworks in health and social welfare for the protection of different vulnerable groups do not adequately represent contemporary needs and challenges or address inequalities (AIDA 2024). This demonstrates a stagnation of the policymaking arena in understanding the complexity of modern social phenomena and their impact on the everyday lives of vulnerable groups. Although social policy legislation has improved over the years, legislative impediments remain in resolving key issues concerning these groups.

Furthermore, some of the key challenges towards achieving the maximum potential of integrated care mainly include the effective integration and interoperability of different levels of healthcare and social care service delivery structures. Integration among health care structures (horizontally and vertically), as well as with social care organisations in the community, and needs to be prioritised to achieve a robust provision of services. However, such an initiative demands the promotion of a bottom-up approach of effective participation of voluntary organisations in the early stages of designing and developing policies and priorities with authorities, rather than restricting their mobilisation during the implementation phase. Additionally, creating a more favourable and supportive legal and socio-economic framework for NGOs to realise their full potential in social welfare can strengthen their participation in decision-making but more specifically in social welfare areas that dominate as service providers. In that respect, addressing the imbalance of power between the state and the sector is also important. Unless the sector is recognised as an equal partner, a balance cannot be achieved in the hierarchies of power relations or the strengthening of the culture of partnerships in welfare provision.

Furthermore, collaboration in contexts of scarce funding is challenging, considering that funding is short-term and competitive. In most cases, competition to secure funds does not favour collaborative efforts. The limited and “unstable” financial resources and the limited use of European Union funds call, therefore, for more user-friendly, enhanced, and expanded funding mechanisms from both the state and donors/sponsors to cover the subsidisation of diverse social programmes and to enable small voluntary organisations’ access to funds. For example, there is no state funding for NGOs that fall outside the predetermined policy areas and priorities set by the state’s schemes. Specifically, the funding criteria do not cover all vulnerable groups or types of social services implemented by voluntary organisations, although public services in some areas are insufficient or non-existent. Therefore, funding schemes should expand their criteria so that they subsidise voluntary organisations that fill such gaps.

Regardless of which holds true, the responsibility cannot and should not rest solely or to such a large extent on voluntary organisations. Changing perceptions on social priorities to accommodate emerging social needs, including the targets of the Sustainable Development Goals (SDGs) arising in a globalised society, is primarily the obligation of the state at all three levels of administration (central—municipal/community). Collaboration with the sector is vital to safeguard a connected approach to care, health, and welfare at large.

Strengthening local government and voluntary organisations in tackling social issues should be the steady-course indicator. The state’s responsibility in social policy should seek new directions and perspectives, as well as models of collaboration for strengthening participation and networking to orient the volunteer sector’s path or role accordingly.

Additionally, the voluntary sector holds a key place in welfare provision in a challenging environment, which poses significant obstacles that threaten its sustainability. Looking forward, “there is not one future, but multiple possible possibilities, depending on how the voluntary sector will choose to respond to the challenges and adapting and changing to meet the changing needs of society” (Patsalidou 2020, p. 13). A key question to answer in future research is whether the current situation of welfare service providers reflects “parallel” systems of welfare delivery or a truly integrated welfare/care system. The Cypriot welfare regime works under the shadow of path dependence on who delivers welfare and how welfare is to be delivered. Choices of “whether to rely on market, non-profit, or state provision of key services are heavily constrained by prior patterns of historical development that significantly shape the range of options available at a given time and place” (Salamon and Anheier 1998, p. 226).Furthermore, if the well-being parameter is placed into the discussion, other challenges are noted. For example, although it ranks 30th in the world on the Social Progress Index (measuring social progress on dimensions such as Basic Human Needs, Wellbeing and Opportunity (Global Relocate 2025)) and its social protection expenditure as a percentage of the GDP reached 21.0% in 2022 (Statistical Service and Press and Information Office 2024), more analysis and data are needed to address the linkage between social wellbeing and welfare outcomes on recipients, the extent of access to services, quality outcomes, etc. In the absence of comparative data on the quality of services (ESN 2024), safeguarding consistent quality standards in social services remains a challenge not only for Cyprus but also in Europe (ESN 2025). In achieving a holistic system of integrated care, other challenges include the need to introduce measures that truly engage voluntary associations in an integrated care system, to apply new strategic and working methods for effective collaboration, connect all welfare actors to improve outcomes, and to develop a system that links all sub-systems into a whole.

7. Conclusions

In Cyprus, the voluntary sector is recognised as a key partner of the state in implementing social programmes in almost all areas of social welfare and health, thus forming a basis for designing integrated care. However, it has been discussed that its role needs to be redefined and evaluated, particularly in its capacity to participate “equally” in decision-making concerning the broader social policy of the state. Furthermore, it should be evaluated whether it achieves a coordinated and effective approach with other services in the field of social and health care. In this respect, it is considered important to enhance research initiatives that will produce empirical evidence to assist evidence-based policy-making and implementation.

The future of the voluntary sector in Cyprus is not likely to be determined solely by the adequacy of institutional frameworks, coordinating mechanisms, or funding resources but by the ability of all stakeholders to respond to the emergence of new forms of needs in the field of social welfare and health to meet the goals of integrated care. The voluntary sector should preserve its more prominent characteristics of building trust with local communities and relationships of reciprocity with end users of services, and in any case, maintain the core of its creative energy and flexibility to address society’s needs. Rationalisation, organisational upgrading, and alignment with state policies are key factors for its development and substantial growth. Networking and coordination with other entities based on more modern institutional approaches are considered prerequisites for the development of the voluntary sector.

Volunteering, an essential element and key driving force of organised structures, currently represents a great force that can contribute to effective synergies to meet goals in integrated care strategies. The phenomenon of organised volunteering is acquiring increasingly new and innovative qualitative and quantitative dimensions that surpass outdated practices of traditional philanthropy and instil a consciousness of social responsibility among citizens. Volunteering is a significant component of civil society through which parameters are created to address multiple deadlocks in Cypriot society. Voluntary organisations’ work at grassroots levels enables them to identify new social needs and intervene with programs to address them, often before the state itself. From this perspective, voluntary organisations should be co-creators and main stakeholders in shaping a social policy and contributing to the development of an integrated welfare system.

However, the voluntary sector, like the state, is also influenced by economic and social policy developments at the European Union level. The relationship between NGOs, the European Union and other bodies, the state, and the profit-driven business sector largely remains undefined, with responsibility falling on all parties. Unless the role of voluntary organisations is clearly defined, there is a risk that their resources and services are not connected with policies or are underutilised by the state.

Also, most voluntary organisations do not perceive the benefit from aligning their work with European Union objectives in social policy and health or from actively participating as an official partner and an equal interlocutor in social dialogue and in the formulation of the social policy. As long as these issues remain unresolved and possibly become more complicated due to the current economic crisis in the Eurozone, the need to invest in voluntary sectors will become increasingly apparent due to EU member states’ weakening capacity to design comprehensive, effective, and integrated social policy systems with and for the citizens. A significant challenge remains in fully utilising the mechanisms and funding streams that could secure longer-term sustainability and foster transnational learning in order to remedy the fragmented, short-term, and project-based funding inhibiting comprehensive strategic planning towards integrated care. Comparable gaps exist in other EU member states and in low- and middle-income countries, suggesting that capacity-building in grant-writing, governance, and data management should be an international priority.

Effective integration strategies should involve addressing the needs and rights of social groups by engaging all stakeholders both in the design and implementation of social services, as well as safeguarding coordination and cooperation among service providers to achieve the best outcomes for service users. Although the advantages of integrated care are documented, achieving the desired outcomes entails challenges. Notably, a shared vision should be pursued by all stakeholders, balancing power relations, securing financial resources, and redefining the roles and responsibilities of welfare providers, so as to secure the best approach that suits the need. In that respect, and to start with integration care planning, the challenge is choosing between structural changes versus promoting collaborative relationships or perhaps combining both approaches, aligning the priorities of different programmes of care across organisations and institutions. The key in this process is to identify the assets in the welfare provision system, including the skills, expertise, and resources of the welfare actors and how organisations can contribute towards shared goals to achieve certain outcomes.

In summary, Cyprus demonstrates that the voluntary sector can serve as both innovator and stabiliser within an integrated, people-centred welfare system. Its ability to build trust, identify emerging needs, and iterate rapidly on programme design offers a practical blueprint for other countries, irrespective of size or income level. Realising the sector’s full potential, however, demands clearer policy frameworks, sustainable financing, and rigorous evaluation. International stakeholders stand to gain by engaging with the Cypriot experience, adapting its successful practices, and collaborating on the shared challenge of delivering coordinated, effective care for all. By combining historical insight, legislative analysis, and empirical evidence, the paper demonstrates that the voluntary sector is indispensable to Cyprus’s quest for integrated, people-centred care. Yet its future effectiveness will depend on recalibrating state–civil-society relations, modernising governance tools, and embracing a genuinely collaborative planning culture. These findings hold relevance not only for policymakers and practitioners in Cyprus but also for international observers seeking transferable lessons on harnessing civic energy within mixed welfare regimes, especially regimes which share common paths and welfare trajectories like Cyprus.