EC-WHO agreements on global health

The relations between WHO and EC are governed by an exchange of letters (dated 14 December 2001), which outlines the objectives for the priority areas of cooperation, as well as the procedures and practical arrangements for implementation of activities. Since the signing of this exchange of letters, WHO and EC have formulated operational working arrangements between their offices at the global, regional and country levels. In this framework, the two organizations’ high-level and senior officials meet regularly to discuss health issues related to EC–WHO cooperation. On 24–25 March 2001, senior officials and experts from WHO and EC met in Brussels, Belgium, for the 9th EC–WHO Senior Officials’ Meeting (SOM). (The previous meeting was held in Brussels in November 2008.)

Discussions at this year’s senior officials’ meeting covered a wide range of issues. At the introduction, senior officials of the two organizations exchanged views on humanitarian assistance and recent events (the situation in the Arab world), ongoing processes (update on The Lisbon Treaty and its impact on health, the reform of WHO, the revision of the EU development policy, changes in the global health architecture) as well as on the status of their cooperation at the global, regional and country levels. They acknowledged the good progress achieved in the past years in strengthening exchanges and cooperation. They also identified opportunities for making their collaboration more strategic and ensuring greater synergies and complementarities.

This year, special attention was paid to six main areas for collaboration.

1. Innovation and health:

The importance of innovation in health is recognized by both the EC and WHO. As a result of discussions between their senior officials,, there has been a mutual agreement to continue collaboration and further develop the existing discussions and projects. A synthesis of initial discussion has resulted in the following possible areas of collaboration.

  • Collaboration on ongoing projects will continue and additional synergies will be developed in support of the global strategy and plan of action on public health, innovation and intellectual property, and relevant EU initiatives, such as the European and Developing Countries Clinical Trials Partnership (EDCTP);
  • Prioritization of research and development must go beyond type II and type III diseases and  and include non communicable diseases (NCD) and public health.
  • Collaboration to develop/improve classification systems for health research.
  • Collaboration to develop support mechanisms for health-innovation policies and programmes in developing countries, including the management of intellectual property in a manner that promotes public health and supports health innovation.
  • Collaboration to develop a monitoring and evaluation framework for the global strategy and plan of action on public Health, innovation and intellectual property.

2. Health security

The EC and WHO agree that the many different health-security challenges, for instance those presented by communicable diseases, the animal−human interface, antimicrobial drug resistance, and better preparedness and response are of high priority, and that collaboration and coordination between the organizations will provide global and regional benefits.

The organizations recognize that there are already highly useful and successful areas of ongoing collaboration (such as the fight against tuberculosis) and of planned collaboration (such as those related to information and communications technology (ICT)), and that additional areas of collaboration should be established and implemented.

Priority concerns for both organizations include:

  • strengthening the implementation of IHR, including national core capacities;
  • improving preparedness for and response to pandemics, including those caused by new influenza viruses and other emerging infectious diseases;
  • decreasing antimicrobial drug resistance and addressing hospital-acquired infections;
  • more effectively preventing or reducing the public health impact of infectious diseases;
  • improving the public's understanding, acceptance and use of vaccines;
  • strengthening global and regional alert and response mechanisms, including better coordinated surveillance, and ensuring synergy in the use of new or existing electronic tools.

3. Health information

The organizations emphasize that health information systems (HIS) represent a key element of health systems for action, policy and research, and that:

  • HIS are essential for enhancing accountability for resources and results;
  • HIS are essential for monitoring and evaluation;

The organizations agree on:

  • supporting comprehensive HIS (not disease-specific or vertical systems);
  • collaborating on country health assessments (together with other partners)
  • developing a joint programme to increase institutional capacity in countries to support regular monitoring and evaluation of national health strategy;
  • developing a core set of health indicators (definition and collection) and supporting implementation in countries.

Regarding e-health, the two organizations:

  • support the strategic use of ICT to strengthen HIS and the monitoring of health-system performance;
  • develop global e-health approaches to support developing countries in their national e-health plans;
  • collaborate on the development of approaches for measuring the impact and economic value of e-health/telemedicine implementation;
  • support global approaches towards the interoperability and integration of e-health systems.

4. Health inequities

The collaboration between the EC and WHO on health inequalities has been strong and is growing. The partners work at all levels to build a common evidence base and define its policy implications.

The scale, severity and increase of health inequalities are a challenge both globally and in Europe: this is one of the most challenging issues in public health and an indication that global health may be failing. The partners agree that all aspects of dealing with health inequalities on the European dimension are highly relevant to the global level, too, in terms of gaps between countries and increasing disparities within countries.

While health inequalities are closely connected to the agenda of social determinants of health – with a view to social protection and social cohesion – special focus should be on access to health services. This relates to the equitable availability of financial resources for health across regions and within countries. Equity is a gradient for moving toward universal coverage and, as such, it should guide all components of the health system (from the definition of health-services packages and their distribution to all levels of care and – geographically – to the selection, analysis and use of indicators).

  • ­ Health inequalities should be addressed with the human-rights approach: besides helping countries to increase their financial and management capacities, communities also need support to empower them to know, use and demand their rights, including the right of access to equitable health services.
  • ­ Specific action points for 2011 include collaboration on:
    • reviewing the European social determinants of health (SDH) divide and preparation for the Rio Conference;
    • developing tools for policy-making and guidance for equity-based approaches;
    • inequalities in NCD in the context of the forthcoming Moscow consultation and beyond;
    • the inequalities' dimension of joint work on healthy and active ageing.

5. Health systems

Based on a joint vision on and common ground with respect to the essentials of health systems, the EC and WHO will work to align their approach to health-system strengthening (HSS), defined as support to comprehensive changes in policy and practice in a country’s health system to enable the country to respond better to its health and health-system challenges. In this context, international health aid should be designed and implemented in a way that strengthens health systems.

EC and WHO recognize that HSS efforts must, of necessity, be tailored to and embedded in the reality of the health-sector policy dialogue of each country. EC and WHO acknowledge that country experience needs to inform normative work (e.g. on financing, human resources, medicines, technologies, infrastructure or disease and life-cycle programmes), which in turn can inform countries as they strive towards universal coverage, primary care and health-in-all policies.

The 2011 WHO Executive Board (EB) resolution, “strengthening national policy dialogue to build more robust health policies, strategies and plans”, marks a new orientation of WHO’s work on strengthening health systems at country level and is considered by both sides – WHO and EC – as an important step forward and a promising basis for increased cooperation.

The joint EC−WHO programme under preparation, “Supporting policy dialogue on national health policies, strategies and plans in selected countries”, will be specifically designed to support the implementation of their policy intentions regarding improved HSS, aligned with country priorities and country ownership.

EC and WHO will intensify and systematize exchange, at the regional and global levels, on the technical challenges, process aspects and strategic information gained from HSS experiences across the world, with a view to identifying and sharing lessons learnt.

EC and WHO will collaborate on the documentation of return on investment of HSS efforts (reporting on results and outcomes).

EC and WHO will intensify their dialogue and common understanding with a view to improving the design and management of global health aid and its contribution to HSS.

6. In-country collaboration

EC and WHO will collaborate at the country level to facilitate sector dialogue, national health policy, strategy and plans, and sector-performance monitoring. This includes work on situation analysis and needs assessments with the view to moving towards universal coverage with the comprehensive quality services required to reach the millennium development goals (MDGs). EC and WHO will take measures to ensure smooth collaboration between themselves and the governments.

EC and WHO will enhance their exchange of evidence information and advocacy material on international health conventions, including the potential impact of non-health policies.

The 2011 WHO EB resolution, “Strengthening national policy dialogue to build more robust health policies strategies and plans‟, together with the principles of the international health partnership, provide the framework for improved support by both organizations.

WHO and EC will increase their mutual understanding of their respective programming processes and specific needs for a more appropriate timing of the input they can provide to country processes.
Where European neighbourhood policy (ENP) and EU instrument for pre-accession assistance (IPA) countries consider it important, WHO will collaborate with EU to facilitate the integration of EU-sector policy elements with health implications.

Next steps:

  • EC and WHO will seek areas of joint technical or policy interest that may be addressed via round-table or other exchanges at the country, regional or national levels.
  • EC and WHO will assess the lessons learnt through a survey on EC–WHO collaboration in the non-EU countries of the WHO European Region to better shape collaboration.
  • Development of three subregional road maps within the WHO European Region, which may also include specific national issues where relevant.
  • EC and WHO will contribute to the development of the international health partnership workplan 2012–2013 with a view to the further roll out and uptake of joint assessment of national strategies (JANS) approach and country compacts.
  • In addition, six roadmaps were developed for the implementation of the joint EC–WHO Moscow declaration, “A shared vision for joint action".