Small countries of the WHO European Region exchange ideas and experiences of equity, sustainable development

Foto MW

A rich exchange of good practices and ideas for confronting health challenges took place at the Sixth High-level Meeting of Small Countries, hosted in San Marino on 31 March–1 April 2019. Under the theme “Equity and sustainable development – keeping people at the centre”, the 8 original members of the Small Countries Initiative (Andorra, Cyprus, Iceland, Luxembourg, Malta, Monaco, Montenegro and San Marino) once again convened for robust dialogue on key health issues. They were joined for the first time by Estonia, Latvia and Slovenia.

The event opened on a high note with the presence of WHO Director-General Dr Tedros Adhanom Ghebreyesus. Speaking to delegates at the opening session, he underlined the importance of bringing together similar countries to identify common problems and find common solutions.

“Small countries can set and implement policy quickly and effectively, and they can be agile and innovative in a way that is much more difficult for larger countries,” he said. “In this way, they can be health leaders, pioneering ideas that can then be adopted in larger countries.”

The pioneering role of small countries was on display throughout the meeting. Delegates presented numerous examples of the innovative ways in which their countries are implementing the Sustainable Development Goals (SDGs) and addressing complex health issues, such as building a sufficient and fit-for-purpose 21st-century health workforce.

Taking stock of progress, looking ahead to future collaboration

Many participants recognized San Marino’s role as host as well as its vital contribution to establishing the Small Countries Initiative in 2014. Speaking at the opening session, Dr Franco Santi, Minister of Health and Social Security, National Insurance, Family and Economic Planning for San Marino, said that the Initiative has naturally evolved from having the Health 2020 policy framework as its main point of reference to focusing on achieving the SDGs.

Dr Santi commended the countries of the Initiative for being “flexible, full of resilience and prompt in planning their policies and their decision-making, in line with the global values that can pave the way for a better, more equal, more sustainable tomorrow”.

The programme covering 2.5 days included sessions devoted to the economic and social impact of health systems; accelerating progress towards health equity, environmental sustainability and urban health; making the 2030 Agenda for Sustainable Development a reality; and addressing health workforce challenges.

During the session on health equity, Acting WHO Regional Director for Europe Dr Piroska Ӧstlin noted, “Our success in combating health inequalities depends very much on our ability to mobilize collaboration with other policy sectors and secure high-level political support. Accelerating progress towards healthy, prosperous lives for all is possible with systematic action, by scaling up and adapting approaches that work and generating new solutions and alliances that break down the barriers.”

World-renowned Italian architect and urban planner Mr Stefano Boeri, best known for his Vertical Forest in Milan, also joined this session to describe how the built environment can support efforts to improve equity.

The San Marino “Statement on equity: ensuring no one is left behind” was adopted at the final session of the meeting.

The delegates’ visit to San Marino was made even more memorable by the opportunity to attend the country’s Investiture Ceremony of the Captains Regent, where 2 new heads of state are installed in office every 6 months. Dr Tedros delivered a keynote address as part of the Ceremony, during which he called for the highly successful model of the Small Countries Initiative to be extended to small states around the world.

Highlighting SDG implementation in small countries

Above all, the meeting provided delegates with an opportunity to share best practices, success stories and lessons learned from their own experiences, thereby encouraging a fruitful exchange of ideas.

During the session focused on equity, delegates highlighted a number of positive examples, including:

  • San Marino’s creation of a master plan for sustainability, known as “San Marino for all”;
  • Estonia’s use of digital solutions to increase efficiency but also equity, with a focus on the electronic prescription programme implemented in January 2018;
  • Iceland’s introduction of a new payment participation system in 2017 aimed at improving transparency and reducing inequalities; and
  • Slovenia’s decade-long efforts to strengthen health equity, most recently resulting in tailored approaches to extend prevention and screening services to vulnerable populations.

In the session focused on the 2030 Agenda for Sustainable Development, countries shared examples illustrating their commitment to its implementation in an intersectoral and participatory manner. These included, among others:

  • San Marino’s establishment of an intersectoral, intergovernmental commission to align all policies with the SDGs; and
  • Malta’s successful introduction of a strategy for transgender health care developed by a multidisciplinary team and given a dedicated budget line within the Ministry of Health.

Good practices from all 11 participating countries were highlighted in a set of policy briefs on participatory approaches to reaching the SDGs, developed in advance of the event. Available online, they offer practical examples of the steps being taken by members of the Small Countries Initiative towards achieving the SDGs.

The meeting concluded with the fifth meeting of focal points of the Small Countries Health Information Network and a workshop on communicating the SDGs for communications officers and journalists.