Day 2 highlights: strengthening health systems to advance the 2030 Agenda for Sustainable Development

“For us, the goal of universal health coverage is the lodestar of our health policy,” said His Excellency Prime Minister Edi Rama of Albania. From improving vaccine coverage to ensuring financial protection, strengthening health systems was a key theme on Day 2 of the 68th session of the WHO Regional Committee for Europe (RC68).

WHO programme budget for 2020–2021 and GPW13 prioritization

The prioritization exercise for WHO’s 13th General Programme of Work (GPW13) for 2019–2023 continued from Day 1, together with discussions of the proposed high-level programme budget for 2020–2021.

Delegates noted that there was insufficient time for the prioritization exercise. They also requested that a more comprehensive programme budget be presented to the Executive Board in January 2019.

Delegates raised several concerns over issues including: the reflection of thematic areas such as antimicrobial resistance; the share of the proposed budget for 2020–2021 allocated to WHO/Europe; and the requested budget increase, which some pointed out was not realistic.

Additionally, delegates requested further information on the functions to be carried out at the 3 levels of the Organization. They stressed that the emphasis should be on increasing investment at the country level and not in country offices, and noted that, in this context, different regions will need different business models.

In future sessions of its governing bodies, WHO/Europe will provide Member States with further details on the outcome of the prioritization exercise.

Implementation of the roadmap for the 2030 Agenda and review of the joint monitoring framework

It has been 2.5 years since the 2030 Agenda came into force. All countries, sectors and stakeholders must collaborate to achieve its 17 Sustainable Development Goals (SDGs). Last year, European Member States adopted a strategic roadmap to guide the implementation process. During this session, Member States discussed progress on the SDGs and the adoption of a joint monitoring framework (JMF) to track progress.

Dr Piroska Östlin, Director of WHO/Europe’s Division of Policy and Governance for Health and Well-being, noted that 35 countries from the WHO European Region have already reported their progress on SDG implementation to the United Nations High-level Political Forum on Sustainable Development. She explained that the importance of health is increasingly recognized at the highest level of government, and that countries mention universal health coverage and equity most frequently in reporting. Unfortunately, less is reported on activities related to health determinants, health literacy, health financing and investment for health.

Introducing the JMF for Health 2020, the 2030 Agenda and the Global action plan for the prevention and control of noncommunicable diseases 2013–2020, Dr Claudia Stein, Director of WHO/Europe’s Division of Information, Evidence, Research and Innovation, explained that it was developed with guidance from an expert group and in consultation with Member States. The JMF aims at reducing the reporting burden in these 3 areas, promoting linkages and removing overlaps.

Keynote address by the Prime Minister of Albania

“I strongly believe that the fight for human health and human dignity is the most important struggle of all,” said Prime Minister Rama in his keynote address. Referring to the findings of the recently published “European health report 2018”, he noted that although rising life expectancy and reductions in premature mortality are positive developments, high levels of smoking, alcohol consumption, obesity and social inequalities, as well as suboptimal vaccination rates, hinder progress and reveal uneven health improvements in countries.

Prime Minister Rama called on WHO to show the way and increase its impact in countries by expanding work in public health areas such as health technology assessments, big data, digital health and human resources.

Illustrating Albania’s strong political commitment to implementing the SDGs, Prime Minister Rama explained that in 2017 the country established the multistakeholder, high-level Interministerial Committee on the SDGs, chaired by the Deputy Prime Minister, to oversee the process. The Committee comprises key governmental institutions as well as other stakeholders from the business community, civil society, academia and international organizations.

Specifically, Albania is taking steps towards universal health coverage. It is now providing health services to the 1 in 5 (600 000) citizens who were previously uninsured. Free annual health check-ups are available for people aged 35–70 years, visits to the family doctor are free of charge for anyone, and value-added tax on medicines has been removed. In addition, 80 new primary health care clinics are being built or refurbished this year, and the completion of 300 new health clinics by 2021 is planned.

Voices of the Region

This address was followed by the first of this year’s Voices of the Region – a series of short films bringing people’s personal experiences and insights on key health topics to the Regional Committee. Her Excellency Prime Minister Katrín Jakobsdóttir of Iceland explained, “The SDGs are really all about daily life. They are about the things you do – education, health – but also about how you consume, how you live, where you work, your environment … The role of the Government and the Prime Ministry here in Iceland is to make these Goals relevant for the daily life of the normal Icelandic person.”

Panel discussion on the SDGs

A panel of ministers and state secretaries from Armenia, Belarus, Georgia, Germany, Hungary, Malta and Romania explored different aspects of achieving the SDGs. Panellists welcomed the JMF, and underlined that universal health coverage is key to achieving the SDGs. They also described the actions they are taking to promote primary health care at the national level.

Dr Arsen Torosyan, Minister of Health of Armenia, explained that strong, people-centred primary health care is the “golden pathway” to reaching the SDGs. Ms Sabine Weiss, Parliamentary State Secretary to the Federal Minister of Health of Germany, noted that at the request of Germany, Ghana and Norway, WHO will introduce a draft action plan for SDG 3 at the World Health Summit in Berlin in October.

Interventions from Member States reflected widespread support for the JMF, and delegates thanked the expert group and WHO for this development. The draft decision to implement a common set of indicators was adopted.

Report of the Twenty-fifth Standing Committee of the Regional Committee (SCRC)

Since RC67, the SCRC has had 4 regular sessions in Denmark, Georgia, Hungary and Switzerland. The SCRC also benefits from the work of subgroups on governance, vector control and countries at the centre. The SCRC considered and reviewed the RC68 agenda at all 4 of its meetings; adopted the provisional agenda and programme; and reviewed and noted all action plans, reports and meeting outcomes to be considered during RC68.

A representative of WHO/Europe’s Staff Association addressed the SCRC and noted concerns regarding the introduction of global mobility.

Realizing the full potential of the European Vaccine Action Plan 2015–2020 (EVAP)

Dr Nedret Emiroglu, Director of WHO/Europe’s Division of Health Emergencies and Communicable Diseases and Acting Director of Programme Management, presented the mixed outcomes of a midterm review of progress towards EVAP goals.

The review indicated that the Region is on track with respect to retaining its polio-free status; developing evidence-based recommendations through national independent advisory committees; and financing routine vaccines using domestic funds. The validation of progress towards hepatitis B control targets is pending. However, the Region as a whole will not achieve measles and rubella elimination by 2020, and is at risk of falling short of immunization coverage targets.

The Chair of the European Technical Advisory Group of Experts on Immunization reminded delegates of the historic health gains achieved by vaccines, and of the need for all to stay committed to further progress. Several Member States expressed gratitude for WHO/Europe’s leadership and technical support in this area, and outlined national plans and initiatives to speed up progress. Further discussion on this topic was postponed to Wednesday morning.

Health Systems Respond to NCDs: report on the high-level meeting

People-centred health systems were the main topic of the afternoon session, which focused on critical milestones on the journey towards universal health coverage. As Dr Hans Kluge, Director of WHO/Europe’s Division of Health Systems and Public Health, said in his introduction, all share a common aim to “turn on the heat under the burning platform of people-centred health systems”.

Dr Melitta Jakab, Senior Health Economist at the WHO Barcelona Office for Health Systems Strengthening, summarized the outcomes of the high-level meeting Health Systems Respond to NCDs, held in April 2018 in Sitges, Spain. She described NCDs as “a wicked problem” due to their complex web of risk factors and the lack of “magic bullet”, pointing to the need to address them through systems thinking and careful alignment. This involves empowering people, transforming public health education, rethinking priority-setting, and increasing the use of best buys – all of which require sustainable governance structures.

Regarding NCD outcomes, the Region is a success story. Experts pointed to countries that have accelerated health systems transformation – known as leapfrogging – as examples of how to address health inequalities. WHO’s role in this process involves providing leadership and supporting implementation at the country level, as well as promoting the need to tackle risk factors and to work beyond the health sector.

In interventions that followed the presentations, Member States and non-State actors expressed strong support for the meeting’s outcome document.

Health Systems for Prosperity and Solidarity: report on the high-level meeting

European health policy expert Dr Elke Jakubowski summarized the outcomes of the high-level meeting Health Systems for Prosperity and Solidarity, held in June 2018 in Tallinn, Estonia, to celebrate the 10th anniversary of the signing of the Tallinn Charter.

The meeting was designed around 3 themes: inclusion, which deals with access to services, coverage and financial protection; investment, which focuses on sustained investment in health systems as a prerequisite for making them more inclusive and innovative; and innovation, which involves harnessing innovations to create stronger and more equitable health systems.

Member States voiced support for policy makers to invest more in health systems to move towards universal health coverage, and several underlined the pivotal role of primary care in advancing universal health care. The proposed draft resolution on 'Reaffirming commitment to health systems strengthening for universal health coverage, better outcomes and reduced health inequalities' was adopted with amendments.

Can people afford to pay for health care? New evidence on financial protection in Europe

Dr Tamas Evetovits and Dr Sarah Thomson of the WHO Barcelona Office for Health Systems Strengthening presented new evidence on financial protection in the Region. The analysis, carried out over 5 years in 25 countries using an advanced methodology, has resulted in a better understanding of the number of households that are impoverished by out-of-pocket payments for health care; the type of health services that drive financial hardship; and the coverage policies that protect people from financial hardship.

The evidence suggests that far too many people in the Region – even in high-income countries – are insufficiently protected against the cost of using health care. In all 25 countries in the study, catastrophic out-of-pocket payments were heavily concentrated among the poorest consumption quintile. Within countries, catastrophic payments are mainly for outpatient medicines in poorer households and dental care in richer households.

The evidence confirms that financial protection is stronger where public spending on health is high. It also suggests that it is important to put in place coverage policies that are carefully designed to minimize out-of-pocket payments and protect poor people and other vulnerable groups from co-payments.

Member States and non-State actors welcomed this groundbreaking work, and thanked WHO for the conceptually clear and rigorous study that includes actionable outcomes. In wrapping up the session, Dr Hans Kluge announced that the next stage of the work is to help countries design and implement policies that provide financial protection to their people.

Ministerial lunch: innovations in health information systems

Health information and evidence are the backbone of solid public health practices and policies. While Member States in the Region have access to some of the best-quality evidence globally, significant challenges remain in some areas. Innovation is required to address these challenges.

At the ministerial lunch, ministers were taken through the cycle of production, analysis and reporting of information all the way to the use of evidence for policy-making. Pitches related to each stage of the evidence-to-policy cycle were made to feature the experience of Member States and to showcase examples of innovation, including through digital health.

Member States proposed concrete next steps to strengthen health information systems in the Region. Among other things, they suggested the development of a position paper on innovations covering all elements of the evidence-to-policy cycle, including the role of the private sector, and providing specific guidance on data protection and the ethical use of data.

Technical briefing: healthy people through environmentally sustainable urban transport

Dr Vadim Donchenko, Chair of the Transport, Health and Environment Pan European Programme (THE PEP) introduced this briefing by referring to a figure from the Organisation for Economic Co-operation and Development: half of air pollution is from road transport.

Presenting the Healthy Streets Approach, Ms Lucy Saunders from Transport for London underlined how motorized transport negatively affects health: it reduces levels of physical activity by making walking and cycling difficult and unsafe; it causes injuries; it lowers air quality; it creates noise; and it causes severance – the disconnection of where people are from where they want to be. “We want streets to be public fora, community meeting places, not corridors for motorized vehicles to move from A to B,” she commented.

Mr Martin Eder, National Cycling Officer in Austria’s Ministry of Environment, explained some of the economic benefits of promoting cycling and outlined the process for developing a pan-European master plan for cycling. This plan is expected to be adopted at the Fifth High-level Meeting on Transport, Health and Environment, set to take place in Vienna next year.

Breakfast briefing: Tuberculosis Regional Eastern European and Central Asian Project (TB-REP) – health systems for effective TB prevention and care

Eleven national delegations, including 6 ministers from Armenia, Belarus, Georgia, Kyrgyzstan Uzbekistan and Ukraine, joined the third annual ministerial breakfast meeting on TB-REP, a project to strengthen health systems for effective TB and drug-resistant TB prevention and care.

The delegations expressed strong support for the approaches promoted by TB-REP for implementing a people-centred model of TB care. They underlined that strengthened health financing mechanisms and a new model of delivering TB services through more active engagement of primary health care will help to tackle TB in the Region.

Delegations also noted that improving access to medicines through effective national regulations and efficient procurement practices is one of the key issues that countries would like to explore in the next phase of TB-REP, which will span 2019–2021.

Breakfast briefing: the need for tobacco product regulation

In this briefing organized by the Ministry of Health, Welfare and Sport of the Netherlands, Dr Reinskje Talhout, Senior Scientific Adviser involved in tobacco product regulatory science at the Netherlands National Institute for Public Health and the Environment (RIVM), delivered a presentation on the need for tobacco product regulation using relevant methods developed by independent bodies.

Highlights for Day 3

  • Continuation of discussions on realizing the full potential of EVAP
  • An action plan to improve public health preparedness and response
  • Launch of the “European health report 2018”
  • Advancing public health in the Region for sustainable development