Biennial Collaborative Agreement (BCA) 2018-2019

Health situation analysis

According to health indicators, mortality and morbidity in Croatia are dominated by chronic noncommunicable diseases (NCDs), primarily cardiovascular, followed by malignant diseases, diabetes, mental disorders, chronic respiratory diseases, and injuries. It is estimated that up to 93% of mortality in Croatia is related to NCDs. Compared with other European countries, Croatia is a country with a high incidence and high mortality rate of malignant diseases, cancer alone accounts for 25% of all deaths in the country. Sedentary lifestyle and poor dietary habits lead to public health problem of overweight and obesity, over 60% of men and 50% of women in Croatia are overweight. Croatia has drafted a national NCD strategy but does not have a National Cancer Control Plan. The rate of hospitalization for mental disorders is increasing, while the average length of stay is decreasing. Almost 70% of all hospitalizations due to mental disorders are in the age group 0-59 years.

After the disappearance of “classic” sexually transmitted diseases (STDs), attention has been shifted towards diseases such as non-gonococcal cervicitis and urethritis, hepatitis C, HIV infection and AIDS, genital herpes and Human Papillomavirus (HPV) infection. The Ministry of Health supports the principle of integrated care, providing acute and chronic health care in local community through significant strengthening of the primary health care with the aim to establish efficient control over the use of secondary and tertiary capacities and general health care system expenditure.

Health system is challenged with increase of health expenditures required to cover for access of publicly provided medical services under circumstances of continued accumulated operating deficit, where only 35% out of the total number of insured persons contributed to the mandatory health insurance fund. Furthermore the health system is confronted with insufficient number and unfavourable age structure of health care workers and their outflow after Croatia’s accession into the European Union (EU).

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Priorities for collaboration

Croatian Parliament in 2012 adopted the National Health Care Strategy 2012-2020. This strategy is aligned with Europe 2020, Common Strategic Framework 2014-2020, Health 2020 and the 2030 Agenda. It serves as the basis for planning and decisions, evaluation and revisions of national action plans in all health care segments, primarily addressing defined eight priorities areas. Cooperation with other sectors and the society in general is one of the eight selected priorities stressing the significance of intersectoral collaboration, partnerships and joint effort of all participants in achieving better health, well-being of people, reducing inequalities in health, and ensuring universal health coverage. Intersectoral approach in the “health in all policies” approach, “whole-of-government” approach and “whole-of-society” approach are among the priorities of the strategic development of Croatian health care and will involve different sectors such as Ministry of Science and Education, Ministry of Environment and Energy, Ministry of Internal Affairs, Minister of Labor and Pension System, Ministry for Demography, Family, Youth and Social Policy etc.

Furthermore the document Strategy for Sustainable Development of the Republic of Croatia gives directions and lists measures to achieve overall and specific objectives related to improving health of the population. In the document “Croatia in the 21st Century – Macroeconomics” health is addressed within different aspects such as macroeconomic policies, infrastructure and development policies, fiscal policy, financial instruments and markets, health reform process, health insurance reform, workforce – all aligned with National Health Strategy.

In June 2017, as multisectoral mechanism addressing health in SDGs implementation, Croatia adopted the Regional Development Strategy of the Republic of Croatia for the period by the end of 2020. The strategy defines three strategic goals of regional development policy: enhancing the quality of life by promoting sustainable territorial development, increasing regional competitiveness and employment, and systematically managing regional development. By close collaboration, WHO will continuously provide support to the Ministry of Health through advocacy, raising awareness and representation of health sector with the Ministry of Foreign and European Affairs. WHO Country Office (CO) will continue with assisting country particularly in the area of translation, implementation and evaluation of global goals into national country-specific goals and targets.

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Linkage of BCA with national and international strategic frameworks

This Biennial Collaborative Agreement (BCA) for Croatia supports the realization of Croatia’s National Health Care Strategy 2012-2020, Strategic Human Resources Development Plan 2015-2020, Strategic plan for reduction of excessive salt intake, National Diabetes Programme, National Cancer Prevention and Control Programmes, National Programme on Occupational Health and Safety for Persons employed in Health Care for the period 2015-2020, National Control Programme on Antimicrobial Resistance and National programme – Healthy living. This BCA has already identified the related key Sustainable Development Goals (SDGs) targets and indicators and supports the realization of the Croatia’s national health priorities.

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Programmatic priorities for collaboration

The collaboration programme for 2018-2019 as detailed in Annex is based on the country-specific needs and WHO regional and global initiatives and perspectives and was mutually agreed and selected in response to public health concerns and ongoing efforts to improve the health status of the population of Croatia. It seeks to facilitate strategic collaboration enabling WHO to make a unique contribution. The programme budget outputs and deliverables are subject to further amendments as stipulated in the Terms of Collaboration of the BCA. A linkage to the related Sustainable Development Goals targets and Health 2020 is provided for every programme budget output, as described in Annex.

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