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 Croatia.

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

Noncommunicable diseases - NCDs account for 90% of overall mortality in Croatia. The leading causes of death were circulatory diseases - most commonly ischemic heart and cerebrovascular diseases, followed by neoplasms accounting for three quarters of overall causes of mortality. The remaining deaths were caused by injuries and poisonings, diseases of the respiratory system, diseases of digestive system and other less common causes. From a long-term perspective, cancer incidence and mortality in Croatia are on the rise. Preventive programmes targeting main public health problems such as overweight and obesity, hypertension, diabetes, certain sites of cancer and amblyopia in children are implemented according to the national action plans. Mental health related disorders also represent significant public health burden.

Communicable diseases - Constitutional Court on 30 January 2014 issued a decision that the right of Child's health is above the right of parents' choice not to vaccinate child. The national surveillance system for communicable diseases in Croatia is well established and gives a solid and accurate insight into epidemiological situation in the country. Immunization coverage rates have slightly declined showing downward trend however still maintaining favourable epidemiological situation. The vaccination against human papilloma virus (HPV) for both male and female primary school students is voluntary and recommended, provided free of charge and it has been administered in the last 10 years. Due to systematic implementation of prevention measures against HIV infection and AIDS the number of HIV/AIDS cases over the 30 years period remained on a low level, one of the lowest in Europe.

Life style risk factors - Due to sedentary lifestyle and unhealthy diet the prevalence of overweight and obesity among adults as well as among children population has become significant public health concern. The aim of ongoing “Healthy Living" national programme 2016–2022 is to reduce modifiable behavioural risk factors such as smoking, unhealthy diet, sedentary life style, and the harmful use of alcohol.

Croatian Government established the National Council for Sustainable Development in January 2018. In the recent Sustainable Development Report 2019, according to the SDG Index, Croatia ranks 22nd of 162 countries. The review was prepared in parallel to the 2030 National Development Strategy, which will be adopted in the first half of 2020.

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

Selected country priority areas listed below are aligned with the GPW 13 strategic priorities (SPs) and outcomes to be achieved in collaboration with all three levels of WHO (headquarters, regional and country level):

  • SP1. One Billion More People Benefiting from Universal Health Coverage addressing the following outcomes:
    • 1.1 Improved access to quality essential health services (outputs: 1.1.1 Countries enabled to provide high-quality, people-centred health services, based on primary health care strategies and comprehensive essential service packages; 1.1.2 Countries enabled to strengthen their health systems to deliver on condition- and disease-specific service coverage results; 1.1.3 Countries enabled to strengthen their health systems to address population-specific health needs and barriers to equity across the life course);
    • 1.2 Reduced number of people suffering financial hardship (output: 1.2.1 Countries enabled to develop and implement more equitable health financing strategies and reforms to sustain progress towards universal health coverage);
    • 1.3 Improved access to essential medicines, vaccines, diagnostics and devices for primary health care (output: 1.3.5 Countries enabled to address antimicrobial resistance through strengthened surveillance systems, laboratory capacity, infection prevention and control, awareness-raising and evidence-based policies and practices).
  • SP2. One Billion More People Better Protected from Health Emergencies addressed through the following outcome:
    • 2.1 Countries prepared for health emergencies (output: 2.1.1 All-hazards emergency preparedness capacities in countries assessed and reported).

In addressing environment and health issues, Croatia has decided to strengthen activities related to achieving health related SDG goals which also include establishment of sustainable, safe and climate change resilient cities, an area of interest addressed by the National portfolio of environment and health activities. According to the European Environment Agency (EEA) report, Croatia belongs to a group of countries with the highest cumulative share of the damage from extreme weather and climate events in relation to GDP. As a result, Croatia recognised the need to strategically approach the climate change adaptation process and developed the Climate Change Adaptation Strategy in the Republic of Croatia by 2040 with a view to 2070, to be adopted by the end of 2019.

  • SP3. One Billion More People Enjoying Better Health and Well-Being addressed through the following outcomes:
    • 3.1 Determinants of health addressed (output: 3.1.2 Countries enabled to address environmental determinants of health, including climate change);
    • 3.2 Risk factors reduced through multisectoral action (outputs: 3.2.1 Countries enabled to develop and implement technical packages to address risk factors through multisectoral action; 3.2.2 Multisectoral determinants and risk factors addressed through engagement with public and private sectors, as well as civil society);
    • 3.3 Healthy settings and Health in All Policies promoted (output: 3.3.1 Countries enabled to adopt, review and revise laws, regulations and policies to create an enabling environment for healthy cities and villages, housing, schools and workplaces).
  • SP4. More Effective and Efficient WHO Providing Better Support to Countries 
    • Strengthened country capacity in data and innovation (output: 4.1.1 Countries enabled to strengthen data, analytics and health information systems to inform policy and deliver impacts).

Defined priorities also address the four priority areas defined by the European policy framework 2020 and are supporting the 2030 Agenda in Croatia. With the aim to further improve the health of the nation and the quality of health care, Croatia is in the process of adopting the National Plan against Cancer 2020 –2030 and the National Strategy to Control Viral Hepatitis. The National Sports Programme for the period 2019–2026 has been recently adopted.

The key strategic goals according to the Croatian National Review of the UN2030 Agenda for Sustainable Development Implementation 2030 include “Improving the health of citizens throughout their lives” and “Improving the access to and quality of healthcare services and creating an efficient healthcare system”.

In order to achieve the goals it requires comprehensive, integrative and multisectoral approach investing in health through a life-course approach, addressing the major disease burdens of noncommunicable and communicable diseases; strengthening people-centred health systems and public health capacity including strenghtening preparedness and response capacity for dealing with emergencies and creating resilient communities.

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

This BCA for Croatia supports the realization of Croatia’s national health policies and plans:

  • National Health Care Strategy 2012-2020
  • National programme “Healthy Living"
  • National programme for AMR resistance on antibiotics 2017-2021
  • National programme for prevention of HIV/AIDS
  • Strategic NAP for reduction of excessive intake of salt
  • National programme for protection and promotion of breastfeeding for the period 2018-2020.

This BCA derives from the Croatia United Nations Sustainable Development Cooperation Framework.

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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 Croatia. It seeks to facilitate strategic collaboration and enable WHO to make a unique contribution.

Annex 2

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