Biennial Collaborative Agreement (BCA) 2018-2019
- Health situation analysis
- Priorities for collaboration
- Linkage of BCA with national and international strategic frameworks
- Programmatic priorities for collaboration
Health situation analysis
The average life expectancy at birth in Belarus remains below the European average and is 79,0 years for women and 68,9 years for men (2016). Noncommunicable diseases (NCDs) are estimated to account for 89% of all deaths in Belarus (cardiovascular diseases 55,2% and cancers 14,8%).
The STEPwise approach to surveillance (STEPS) survey, finalized in 2017, confirmed extensive presence of NCD risk factors in Belarus (62% of men and 50% of women of 45-69 years having three or more NCD risk factors). Smoking among men has shown a minimal decline in recent years (from 55% in 1998 to 48% in 2016) remaining one of the highest in the Region. Even more concerning is that smoking has increased more than threefold among women (3.6% in 1995 to 12% in 2016). Excessive alcohol consumption is also a significant public health issue though there are some signs of improvement with reduction of per capita adult consumption of pure alcohol. Of particular concern is the high prevalence of heavy episodic drinking among men 18-69 years amounting to 35%. According to the STEPS survey results, 61% of the adult population are overweight, 73% consume less than five portions of fruits and vegetables per day and 13% have sedentary lifestyle.
There is a need for health system strengthening interventions for appropriately addressing NCDs: 45% of the adult population have high blood pressure, however 53% of the population 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 with less than half of the surveyed population that received life-style advice from their primary-care providers within the last three years. Injuries are the second frequent cause of mortality among working-age population (24,2% in 2016) and the leading cause of death and disability among children. Although NCDs pose the greatest health burden, several communicable diseases, notably tuberculosis (TB), HIV and hepatitis present significant challenges to population health.
The HIV/AIDS epidemic in Belarus remains in a concentrated stage with an average prevalence of 0.2% and a high prevalence among key populations: injecting drug users (IDUs) - 25.1%, women involved in sex work (FSW) - 6.8% and men who have sex with men (MSM) - 5.7%, which remains relatively stable. National strategic goals and priority areas for combating the spread of HIV/AIDS are defined by the subprogram "Prevention of HIV infection" of the State Program "People's Health and Demographic Security of the Republic of Belarus" for 2016-2020. Antiretroviral (ARV) therapy coverage currently provides treatment for 53,5% of the number of people living with HIV detected and registered in health facilities. Since 2017 Belarus has aimed at achieving the UNAIDS strategic indicator for 90% coverage of ARV treatment for all identified HIV-positive patients. To achieve this, HIV treatment protocols have been updated in line with WHO recommendations and ARV medicines have been procured that provide treatment for all patients with HIV infection starting from 2018.
Belarus is a priority country for tuberculosis (TB) in Europe and is among the 27 high-burden multidrug resistant (MDR) TB countries in the world. Although Belarus is very close to reaching universal access to rapid diagnosis and treatment of MDR-TB and the absolute numbers of TB and MDR-TB cases have decreased in the last few years, latest WHO estimates (for 2015) are still indicating that 37% of newly-diagnosed TB cases and 69% of previously-treated TB cases have MDR-TB. There is a major challenge of enrolling into treatment all extensively drug-resistant TB (XDR-TB) patients using new and repurposed drugs, and support of the Global Fund through its project in Belarus is indispensable. The HIV and/or hepatitis and/or TB co-infection represents a serious public health problem in Belarus, especially among intravenous drug users.
Priorities for collaboration
The Health 2020 agenda has been supported in Belarus by the adoption of the new State Program “Healthy People and Demographic Security in the Republic of Belarus for 2016-2020” which was endorsed by the Government of Belarus in March 2016. The new State program consists of sub-sector action plans covering the areas of maternal and childhood health, noncommunicable diseases and major risk factors, communicable diseases (tuberculosis and HIV) and takes into account the need 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 the 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. A national coordination mechanism has been established in Belarus by appointment of the National SDG Coordinator and the establishment of the National Sustainable Development Council.
Belarus has already taken some important steps for the practical implementation of Agenda 2030 at the national level. The starting point for actions was the approval of the National Strategy of Sustainable Social and Economic Development (NSSD) by the Government in 2015. The NSSD is being aligned with the SDGs. In a short-term perspective, the Government will approve the updated NSSD based on the specific goals and objectives of Agenda 2030, taking into account the national system of indicators for sustainable development.
Linkage of BCA with national and international strategic frameworks
This Biennial Collaborative Agreement (BCA) for Belarus supports the realization of Belarus’s national health policies and plans that are included in the new State Program “Healthy People and Demographic Security in the Republic of Belarus for 2016-2020” which was endorsed by the Government of Belarus in 2016. This BCA has already identified the related key Sustainable Development Goals and supports the realization of the United Nations Development Assistance Framework (UNDAF) for 2016-2020.
Programmatic priorities for collaboration
The following collaboration programme for 2018–2019 as detailed in the 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 Belarus. It seeks to facilitate strategic collaboration enabling WHO to make a unique contribution.
Biennial Collaborative Agreement (BCA) deliverables in 2018-2019 reflect the key health challenges and include the following priorities:
- addressing inequities in health of the vulnerable groups of populations especially in the area of HIV, tuberculosis (TB) and hepatitis working in close collaboration with the partners in the framework of Global Fund projects on HIV and on multidrug resistant (MDR) TB control (WHO Category 1);
- development, implementation and monitoring of national health policies involving multisectoral approach in the areas of noncommunicable diseases; introduction of quality assured mass-screening in breast cancer; implementation of the National Action Plan for childhood injuries prevention (WHO Category 2);
- optimization of the health services for children by further improving the quality of paediatric hospital care; Environmental Health (WHO Category 3); and
- strengthening of primary health care and universal health coverage, improvement of the health information system; access and responsible use of antimicrobial medicines (WHO Category 4).
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 (SDG) target and Health 2020 targets is provided for every programme budget output, as described in Annex.
