Italy is divided into 20 regions, which constitute the first and highest level of local administration in the country's three-tier system. Regions hold significant autonomous powers, particularly in areas such as healthcare, education, transportation, economic development, and urban planning. Five of these regions—Sicily, Sardinia, Trentino-Alto Adige/Südtirol, Aosta Valley, and Friuli-Venezia Giulia—have special autonomous status with additional legislative powers due to historical, linguistic, or geographic considerations. Each region has its own elected council and president, allowing for substantial self-governance while operating within the framework of the Italian constitution. Regional governments manage considerable budgets and are responsible for delivering essential public services to their populations, making them critical intermediaries between the national government and local municipalities.