Biennial Collaborative Agreement (BCA) 2020-2021

Description of the Biennial Collaborative Agreement

This document constitutes a practical framework for collaboration. It has been drawn up in a process of successive consultations between national health authorities and the Secretariat of the WHO Regional Office for Europe.

The collaboration programme for 2020–2021 has started with the bottom-up GPW 13 outcome prioritization process undertaken by the country in cooperation with the Regional Office. This work was carried out as part of WHO’s transformation in the overall context provided by GPW 13. The objective of the bottom-up planning exercise was to determine the priority health outcomes for WHO collaboration with the country during the period 2019–2023. This document further details the collaboration programme, including the prioritized outcomes, proposed outputs, and product and services deliverables.

The outcomes are the desired changes in the Member State’s capacities that result in increased access to services and that ultimately contribute to sustainable changes in the health of populations. These changes in the health of populations are those that the Member State aims to achieve on the basis of its uptake of the WHO Secretariat’s outputs, and hence they are a joint responsibility of the Member State and the Secretariat.

Achieving the prioritized outcomes as identified in this BCA is therefore the responsibility of both the WHO Secretariat and the Government of Belarus.

Different modes of delivery are foreseen in the implementation of this BCA, ranging from country-specific (for outputs that are highly specific to the needs and circumstances of individual countries), to intercountry (addressing countries’ common needs using Region-wide approaches) and multicountry (for subregional needs).

Annex 1: GPW 13 results framework

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Health situation analysis

Life expectancy at birth in Belaurs increased during the last decade by four years reaching 69 years for men and 79 for women in 2018. Yet for Belarusian men it is 9 years lower than in the EU countries with remaining 10 years gap in life expectancy to compare with women in Belarus.

Premature mortality, primarily among men of working age, has significant socioeconomic consequences and is a drain on the national economy amounting to 5.4% of GDP in 2015 in accordance with the recent WHO/UNDP report. Smoking among men has shown moderate decline in recent years reaching 48% in 2017. However smoking among women has increased nearly threefold in the last two decades reaching 12% in 2017. Alcohol consumption declined significantly during the last five years but remains a serious public health issue with per capita adult consumption estimates of 11.2 litres of pure alcohol per annum with high prevalence of binge drinking (27% among men). Unhealthy diet with high salt consumption on average 10 gram per day and physical inactivity are still major risk factors contributing to high mortality from noncommunicable diseases (NCDs).

NCDs are estimated to account for 80% of all deaths in Belarus (cardiovascular diseases 55% and cancers 15%). The prevalence of the main risk factors for NCDs in Belarus analysed within STEPS survey demonstrated that 13% of Belarusian 40-69 year-old adults have 30% or higher probability of fatal or non fatal cardiovascular event within 10 years.

45% of adult population have high blood pressure, however according to the STEPS survey results 53% of those with high blood pressure and 73% with high cholesterol levels do not take any medication for it. Counselling on risk factors at the primary care level is not sufficient, less than half of the surveyed population received life style advice from their primary care providers within the last three years. There is a need for health system strengthening interventions for proper NCDs prevention and control. Reform on introduction of general practicioners, electronic health, modern approaches to cancer screening programs, mental health and changes in finance system of health care initiated by Ministry of Health create opportunities to improve the quality of primary health care in Belarus.

Injuries are the second frequent cause of mortality among working age population (25% in 2017) and the leading cause of death among children.

HIV incidence in Belarus has been increasing for many years and was 25.9 per 100 000 in 2017 (increased by 100% since 2012). It is the third highest incidence rate in WHO European Region (after Russian Federation and Ukraine) and much higher than in EU/EEA (5.7 in 2016) and WHO European Region in general (7.7 in 2016). Data for 2018 show that the number of new cases started to decline (24.8 per 100 000 in 2018). WHO "Treat All" policy has been implemented since January 2018, ensuring universal access to anti-retrovirals for all people living with HIV in Belarus.

Belarus is among the 18 high-priority countries for tuberculosis (TB) in Europe and among the 27 high-burden multi-drug resistant (MDR) TB countries in the world. Although both TB incidence and mortality rates have been steadily decreasing during the last 10 years (minus 43% and minus 62% respectively), 37% of the newly-diagnosed TB patients and 69% of those returning for treatment have MDR-TB. Since 2013 Belarus managed to curb the rise of MDR-TB cases in absolute numbers. National TB program has the global leadership in introducing new anti-TB drugs (bedaquilline and delamanid) complying with WHO recommended active pharmacovigilance procedures.

The Government of Belarus is demonstrating regional leadership in promoting Sustainable Development Goals (SDGs) by adopting SDGs target indicators including health related targets into the national statistics and incorporating them in the strategic national programmes. National coordination mechanism was created by appointment of the National SDG Coordinator and the establishment of the National Sustainable Development Council in Belarus.

Belarus is making progress in intersectorial collaboration on health including recently implemented smoke-free legislation, adopting new standards on lowering transfats in food products, more active engagement of NGOs in harm reduction and support programmes for patients with HIV and TB. However there are additional opportunities for intersectoral collaboration to reduce the burden of NCDs including optimizing taxation policies on tobacco and alcohol, implementing restrictions on physical availability of alcohol, promoting reformulation of foods and meals to contain less salt, lowering speed limit in cities to reduce road injuries and promoting cycling movement in cities.

WHO will provide support to the Ministry of Health on communicable diseases (TB and HIV), intersectorial collaboration and public health interventions for NCDs including strengthening surveillance through conducting a follow-up STEPS survey, breast cancer screening programme, mental health, health system strengthening with particular focus on introduction of e-health, GP-oriented primary health care, mental health and quality of care. Support will be provided in development of the next State Programme “Health of People and Demographic Security of the Republic of Belarus” for 2021-2025 and implementing new approaches in health care financing.

The following collaboration programme for 2020–2021 as detailed in Annex 2 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 Belarus. It seeks to facilitate strategic collaboration enabling WHO to make a unique contribution.

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GPW 13 prioritized outcomes and links to Health 2020 and the 2030 Agenda in Belarus

The following high and medium priorities within framework of GPW13 have been chosen for collaboration:

  • Improved access to quality essential health services
  • Reduced number of people suffering financial hardship
  • Improved access to essential medicines, vaccines, diagnostics and devices for primary health care
  • Epidemics and pandemics prevented
  • Health emergencies rapidly detected and responded to
  • Determinants of health addressed
  • Risk factors reduced through multisectoral action
  • Healthy settings and Health-in-All Policies promoted
  • Strengthened country capacity in data and innovation.

The Health 2020 agenda was supported in Belarus by adoption of the State Programme “Health of People and Demographic Security in the Republic of Belarus” for 2016-2020 endorsed by the Government of Belarus in March 2016. The State Programme consists of sub-sector action plans covering the areas of maternal and childhood health, noncommunicable diseases and major risk factors, communicable diseases (TB and HIV) and taking into account the needs for multi-sectoral collaboration and addressing social determinants of health.

Belarus is committed to the implementation of the 2030 Agenda for Sustainable Development and assumes that Sustainable Development Goals (SDGs) can be achieved through coordinated efforts of all national partners in the economic, social and environmental dimensions in the context of political stability and sustained economic growth.

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Linkage of the BCA with national and international strategic frameworks for Belarus

This BCA for Belarus supports the realization of Belarus national health policies and plans that are included in the State Programme “Health of People and Demographic Security of the Republic of Belarus” for 2016-2020 endorsed by the Government of Belarus in 2016. This BCA has already identified related key Sustainable Development Goals and supports the realization of the United Nations Development Assistance Framework (UNDAF) for 2016-2020. This approach will be continued in the process of development and implementation of the United Nations Sustainable Development Cooperation Framework (UNSDCF) 2021-2025 for Belarus.

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Programmatic priorities for collaboration

The collaboration programme for 2020–2021, as detailed in Annex 2, is grounded in the above analysis and was mutually agreed on and selected in response to public health concerns and ongoing efforts to improve the health status of the population of Belarus. It seeks to facilitate strategic collaboration and enable WHO to make a unique contribution.

Annex 2

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