Annexes to COM(2017)586 - Mid-term evaluation of the 3rd Health programme 2014-2020 under Regulation (EU) No 282/2014 - Main contents
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This page contains a limited version of this dossier in the EU Monitor.
| dossier | COM(2017)586 - Mid-term evaluation of the 3rd Health programme 2014-2020 under Regulation (EU) No 282/2014. |
|---|---|
| document | COM(2017)586  |
| date | October 11, 2017 |
The Programme demonstrated its capacities and flexibility when put to the test during the unprecedented high influx of refugees in 2015-2016. It provided a foundation for neighbouring countries and the International Office for Migration to work together to raise awareness and to strengthen their commitment to improve maternal health and healthcare for refugees and migrant women. The Programme was also instrumental in helping to develop and implement roadmaps and models for improving the access to healthcare for vulnerable immigrants and refugees in Europe and to deliver recommendations, technical guidance and training 21 to health professionals and to the law enforcement officers working at local level with migrants/refugees.
3. 1. 3. Innovation in health systems
The Programme works in synergy with other EU Programmes and different policies strands to increase the efficiency of the EU expenditure and maximise its impact:
The Joint Action supporting the eHealth Network 22 on interoperability and standardisation for cross-border health data exchange enables compatibility with Connecting Europe Facility 23 requirements and therefore promotes digital service infrastructures in public health.
Collaboration among EU Health Technology Assessment 24 bodies has delivered common tools and standards, offering potential for significant economies of scale. The sustainability of the network and improved national uptake are at the centre of the current Joint Action, which supports major policy aims such as accessibility, quality and sustainability of health care.
3. 1. 4. Access to better and safer health
24 European Reference Networks 25 for rare diseases have been established to unite the expertise of more than 300 healthcare providers and 900 centres of expertise across Europe and make it available to rare disease patients, who often find it difficult if not impossible to find specialised knowledge and care close to home. To review a patient’s diagnosis and treatment, coordinators will convene a ‘virtual’ advisory board of medical specialists across different disciplines, using a dedicated IT platform and telemedicine tools. Pooling together knowledge, expertise and resources across the EU helps make high quality healthcare accessible to all and helps reduce health inequalities both within and between EU Member States. In years to come, this concept could be expanded beyond rare diseases to other complex conditions.
The Programme also plays a crucial role in addressing Antimicrobial Resistance (AMR) by defining common approaches to fight AMR and to control healthcare-associated infections in line with ongoing EU and international policies, in particular the SDG 32.
3. 1. 5. Implementing EU health legislation
To reach its objectives and have its expected impact, EU legislation often requires support to consistently implement it across all Member States. Developing common standards and guidelines is at the heart of various actions funded by the Health Programme, whether for reporting purposes, carrying out audits and inspections, operating authorisation or for vigilance systems.
Several actions have supported implementing legislation on substances of human origin, through initiatives such as developing an IT platform to enable the exchange of organs between Member States; improving an information system and supra-national data sharing on living organ donation; optimising the process for post-mortem organ donation in hospitals by enabling the cooperation between critical care professionals and donor transplant coordinators; and improving inspection guidelines for blood and tissues establishments.
Several actions provided support to prepare delegated and implementing acts of the Tobacco Products Directive, including several studies 26 and an implementation analysis for the future EU system for traceability and security features in the field of tobacco products. The SCOPE Joint Action 27 has developed a curriculum and full set of capacity building and training material to support national regulators in the implementation of the 2012 pharmacovigilance legislation 28 .
3. 2. Lessons learned
➤ The Programme is highly relevant to Member States needs and the objectives set are clear, explicit and specific
The 23 thematic priorities help to better focus the Programme’s actions and avoid overlaps and potential duplications among the different objectives. At the same, these thematic priorities have the flexibility to allow for synergies that in some cases are clearly required. For example actions for migrants and refugees, an area in which the Programme’s design has proven to be flexible and sufficient. However, the Programme could benefit from more coherence and refinement in the future.
The actions financed under the first three years are also relevant to specific Programme objectives and priorities. They benefit from the Programme’s design through better alignment of their own objectives and outputs with the requirements of good Programme implementation. However, some actions under broader priorities which are not linked to EU legislation, and/or open-ended funding mechanisms such as operating grants, may lack focus and can risk deviating from their initial objectives. In these cases, particular attention should be paid during the planning stage, and the actions in question should be monitored and evaluated in good time to take any necessary corrective measures.
➤ Programme management has become increasingly effective
The Programme has been restructured following experience from the implementation of the two previous programmes (first programme in 2002-2007 and the second in 2008-2013). Its objectives were set in a very explicit and practical way, announcing the kind of outputs expected and providing indicators for measuring progress.
The Annual Work Programmes are established on the basis of a preliminary multi-annual planning exercise, meeting specific criteria set in the Programme Regulation (Annex II). The process for defining Annual Works Programmes works smoothly and the consultation with Member States takes place in a clear, transparent and equitable way. The multi-annual planning has proven to be a valuable tool for providing a more strategic view of the mid-term planning and allowing for the smoother adoption of annual Work Programmes and limiting the number of amendments. However, stakeholders want to have more opportunities to help determine annual priorities and the actions needed on a multi-annual and annual basis.
The Commission encourages all EU-28 Member States and other third countries to take part in the Programme. The Programme gives them recourse to exceptional utility criteria and provides up to 80% EU co-funding to all actors involved. The co-funding is granted under particularly favourable conditions if a part of the overall budget is transferred for action in low GNI 29 countries. The exceptional utility criteria have not been effective so far. However, despite the difficult economic context and the significant barrier of assuring the remaining co-financing, the Programme is still attracting a similar level of participation from low GNI countries as in the previous Programme.
➤ The Programme demonstrated its responsiveness and flexibility in the face of emerging needs such as the refugees’ crisis in summer 2015, which made a significant contribution to the Commission’s migration policy.
In addition, the Programme also provides support for the first implementation phase of the newly established European Solidarity Corps, which reflects European values of solidarity and humanitarian action. Through the Solidarity Corps, European youth will not only provide assistance where it is needed, but will also broaden their experiences, deepen their cultural understanding, learn the value of service to others, and strengthen their sense of identity as Europeans.
➤ Efficiency is being improved
The Programme focused its limited budget on a strict selection of key objectives and priorities aligned with Commission’s main priorities. On this basis, most of the funding was allocated to outcome-oriented actions for modern health policies, stimulating innovation in health and healthcare and providing appropriate tools, methods and training for increased safety and security in the EU.
Objectives (2) for cross-border health threats and (4) for access to better and safer health received comparatively less financing. However they benefit from synergies with the European Centre on Disease Control for risk assessments, collection and analysis of epidemiological data and AMR. Broader thematic areas like health promotion and health systems were identified as priorities by Member States’ representatives in e-surveys and by a large number of health stakeholders in the public consultation and received the highest amount of funding. Health promotion includes actions in areas such as risk factors, chronic diseases and health information, health systems including Health Technology assessment.
The Programme has introduced programmatic indicators and action-level monitoring and invests into strategic dissemination activities. These are decisive steps responding to previous recommendations but there is still room for improvement and for speeding up progress.
Moreover, the Programme’s administration costs are low, compared to the administrative costs of other comparable Commission programmes. Administration costs represent just 9% of the overall budget.
➤ Simplification measures have been taken for rules and procedures including the use of electronic tools for the submission and evaluation of proposals, the management of grants, e-monitoring and e-reporting. While this development is resource intensive in the beginning for the design and testing of tools, the level of satisfaction from applicants and grant beneficiaries justifies these efforts, and financial gains are expected in the next years.
➤ A small Programme with big EU-added value
The cooperation at EU level and coordination of preparedness plans and responses to health threats is one of the strongest and best known aspects of the Programme’s EU-added value. Activities to support capacity building against health threats have helped to avoid duplication and improve capabilities, delivering added value for the EU and the wider international community. They have served to identify gaps in Member States’ capacities, prioritise actions and implement capacity building activities to fill in those gaps. They have also delivered toolkits and guidelines, training and testing of EU preparedness and response mechanisms and external quality assurance exercises and they have enabled the sharing of lessons learned from recent outbreaks and refugees’ crisis.
The Programme also helps Member States to increase their capacities in other areas: pooling knowledge, expertise and resources across the EU increases citizens' equitable access to high quality healthcare and contributes to the reduction of health inequalities both within and between EU Member States. For instance, through the 24 European Reference Networks on rare diseases where the possibility exists to expand the pooling of expertise to other complex diseases in the near future. Also through the collaboration between EU Health Technology Assessment bodies to deliver common tools and standards that support major policy aims such as accessibility, quality and sustainability of health care while offering potential for significant economies of scale. Another example is the support given to the eHealth Network for improving the interoperability and standardisation needed for the cross-border exchange of health data and to promote digital service infrastructures in public health.
Cooperating, using and sharing knowledge has high EU-added value: the collection and analysis of comparable data depicting the situation of Health in each of the EU-28 Member States (country-profiles) contributes to political dialogue and informed decision making for health policy. The exchange and implementation of best practice for promoting health and preventing diseases have also an EU-added value, which can help Member States in their health reforms to overcome threats to their health systems from demographic changes and the burden of non-communicable diseases and other chronic conditions.
➤ Working in coherence and developing synergies
The Programme is in alignment with the Commission’s main priorities under Article 168 TFEU and the SDG, and strives to maximise synergies with other EU policies and financial instruments such as Horizon 2020.
The Programme’s particularity remains its focus on health policy cooperation. It uses the results of research actions and tests their results in real settings in close cooperation with competent authorities in the Member States. The aim is to help Member States design and implement their own policies so as to build a strong social Europe while taking budgetary constraints and needs for system reforms into consideration.
To up-scale those effective actions and make them integral parts of Member States’ national health policies, the Programme should continue to encourage cooperation with the European Structural and Investment Funds 30 and other EU financial instruments. The effective use of such big financial instruments can have a greater impact than using the Programme alone, by building knowledge and capacities for monitoring and implementation and by supporting innovation and effectiveness for health investments.
4. HOW CAN THE IMPLEMENTATION OF PROGRAMME BE IMPROVED
Following the ex-post evaluation of the second Health Programme, the Commission undertook to work on three main aspects of the third Health Programme, as stated in its report to the European Parliament and the Council in May 2016 31 : These commitments were to:
(a) improve monitoring, reporting and dissemination efforts
(b) encourage participation of all Member States and other participating countries, and to work with all Member States, particularly those with greater public health needs; and
(c) develop synergies with the Commission’s main priorities and other programmes.
These points are still valid and the Programme will continue to work on these areas. In particular for the dissemination of results which is an area where work must be speeded up as much as possible.
Moreover, and as suggested in the mid-term evaluation, the Programme should remain focused on issues where EU added value can be achieved. These areas fall mainly under the objectives of protecting against cross-border health threats and the access to better and safer healthcare. For the priorities under the objective of health promotion and prevention of diseases, the Commission is currently working on defining concrete needs in Member States 32 where integrating best practices into national policies could bring the expected results and impact on the population’s health and the sustainability of the health systems.
Links to SDG and the wider Commission and EU policy agenda will be improved so as to better prioritise actions and increase impact. This approach could also increase the Programme’s visibility and boost its role in the international arena despite its modest budget.
The EU-added value criteria could be further simplified for potential applicants and made easier to understand by using concrete examples.
5. CONCLUSION
The mid-term evaluation was positive and found that implementation of the Programme is on track. All thematic priorities remain valid and most actions deliver useful outcomes with high EU-added value, in particular for crisis management and for the safety and security in Europe.
The open public consultation attracted the attention of a broad selection of interested parties and provided strong support for continued cooperation through the Programme, particularly in areas such as health promotion, disease prevention and eHealth.
(1)
http://eur-lex.europa.eu/legal-content/EN/TXT/;jsessionid=5Qj3TvyCyBqbhfLZzzBttjDGh3gyXkQWYrjhrt36mChMJJlp02XX!2060916514?uri=uriserv:OJ.L_.2014.086.01.0001.01.ENG
(2)
COM (2016) 739 final
(3)
The 1st prize was attributed to The Alliance for International Medical Action (ALIMA), the 2nd prize to Concern Worldwide and the 3rd prize to the Spanish Red Cross.
(4)
The 1st prize was attributed to BEUC/The European Consumer Organisation, the 2nd prize to Alliance to Save our Antibiotics – Compassion in world Farming – Soil Association, and the 3rd prize: World Alliance Against Antibiotic Resistance WAAAR
(5)
Deadline for submission of applications: 30 June 2017.
(6)
This participation is out of the scope of the mid-term evaluation.
(7)
Article 13(3)(c) of Regulation (EU) No 282/2014 for a mid-term evaluation by 30 June 2017.
(8)
Most of the actions have a life span of three years with the exception of operating grants, procurement contracts and some projects for migrants at the end of 2015, which had duration of one year.
(9)
http://ec.europa.eu/health/state/glance_en
(10)
http://www.bridge-health.eu/
(11)
https://e-detecttb.eu/
(12)
http://www.rarha.eu/Pages/default.aspx
(13)
http://ec.europa.eu/health/sites/health/files/mental_health/docs/ev_20161006_co05_en.pdf
(14)
https://ec.europa.eu/jrc/en/event/workshop/european-quality-assurance-scheme-breast-cancer-services
(15)
http://ecibc.jrc.ec.europa.eu/european-guidelines
(16)
http://www.encr.eu/
(17)
https://ec.europa.eu/health/sites/health/files/major_chronic_diseases/docs/2017_cancerscreening_2ndreportimplementation_en.pdf
(18)
http://ec.europa.eu/health/sites/health/files/preparedness_response/docs/jpa_agreement_medicalcountermeasures_en.pdf
(19)
https://ec.europa.eu/health/preparedness_response/key_documents_en#anchor0
(20)
http://www.emerge.rki.eu/Emerge/EN/Home/Homepage_node.html
(21)
The material for trainings and other relative information is published on the Health Policy Platform at: https://webgate.ec.europa.eu/hpf/
(22)
http://jasehn.eu/index.php/about-jasehn/background/
(23)
https://ec.europa.eu/digital-single-market/en/connecting-europe-facility
(24)
http://www.eunethta.eu/
(25)
http://ec.europa.eu/health/ern/networks_en
(26)
https://ec.europa.eu/health/tobacco/key_documents_en#anchor0
(27)
http://www.scopejointaction.eu/
(28)
https://ec.europa.eu/health/sites/health/files/files/eudralex/vol-1/reg_2010_1235/reg_2010_1235_en.pdf
(29)
Gross national income
(30)
https://ec.europa.eu/health/health_structural_funds/used_for_health_en
(31)
COM(2016) 243 final at http://ec.europa.eu/health/programme/policy/2008-2013/evaluation_en
(32)
http://ec.europa.eu/newsroom/sante/newsletter-specific-archive-issue.cfm?newsletter_service_id=327&newsletter_issue_id=2820&page=1&fullDate=Fri%2017%20Mar%202017&lang=default