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 the country. 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 Malta.

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

According to the National Statistics Office (NSO) figures, life expectancy at birth in 2018 was 80.5 years, 78.1 years for men and 83 years for women. World Bank data for 2016 show that the probability of dying in the younger age groups (15–60) has been decreasing steadily with a wide gap between males and females. This is partly attributable to ischaemic heart disease and external causes of death, such as traffic accidents and suicides. The total crude death rate in 2017 was 8 per 1,000 population.

Noncommunicable diseases (NCDs)  are a major challenge. Despite health gains, there are increased risk factors associated with NCDs. One preventable contributing factor is obesity, which is increasingly prevalent among both adults and children. Diseases of the circulatory system are the leading cause of death, accounting for 38% of all deaths in 2016, according to the WHO – Noncommunicable diseases (NCD) Country Profiles, 2018. Despite a generally downward trend, ischaemic heart disease mortality rates are higher than the EU15 average. Diabetes mellitus as an underlying cause of death accounts for 4% of all deaths, which is also higher than the EU15 average. Neoplasms are the second major cause of deaths, accounting for 27% of all deaths, while the rest of deaths are largely attributable to other causes (15%), diseases of the respiratory system (6%) and external causes of morbidity and mortality (3%), according to the 2013 Annual Mortality Report. As the population survives to older age, deaths due to dementia become more important. Dementia accounted for 4.2% of all deaths in 2015 (DHIR, 2015).

Mental illness is the leading cause of disability effecting the individuals, families and communities and also has a significant impact on the economy. OECD estimates that the direct and indirect costs amount to 4% of the national GDP, which in monetary terms for Malta in 2017 is estimated to be in excess of 400 million Euro annually. Self-harm and suicide are related to mental health disorders. In 2014, 4.2% of deaths in Malta were attributed to mental and behavioural disorders (EU average 3.7%) with dementia being the most common cause. The death rate for intentional self-harm, (suicides) was 8.3% per 100,000 (EU average 11.3) with men being almost seven times more likely to die from intentional self-harm than women. Deaths from intentional self-harm in over 65 years occur solely in men and such deaths are 1.5 times more common in this age group than in persons under 65 years.

Road traffic injuries are the leading killer among children and young people aged 5-29. The total number of road traffic fatalities during 2018 amounted to 18, one fatality less than those recorded during 2017 (NSO, 2019). The total number of road traffic crashs that occurred during 2018 amounted to 14,378, down by 4.2% when compared to 2017.  

Low mortality rates from infectious diseases can be attributed to the widespread availability of antibiotics and antiviral drugs. The free syringe distribution programme for intravenous drug users, which started in Malta in the late 1980s, has resulted in low rates of HIV infection in this transmission category. An upward trend in the incidence of HIV in men having sex with men has been observed. No cases of children infected through mother-to-child transmission have been reported. HIV infection has been identified as a priority area for action in this field and a strategy is currently being developed. A free childhood immunization programme for all children has resulted in lower morbidity and mortality from vaccine-preventable infectious diseases. Substantial work has also been done in the development of emergency response plans for microbial emergencies and pandemic crises. Capacity building and training in emergency preparedness (in particular Hospital Incident Command Training for Management) will help consolidate existing services, particularly in view of the increasing demands on the national emergency and response services.

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

The following high and medium priorities within frame of GPW 13 have been choosen for collaboration:

  • 1.1 - Improved access to quality essential health services
  • 2.1 - Country health emergency preparedness strengthened
  • 2.3 - Health emergencies rapidly detected and responded to
  • 3.1 - Determinants of health addressed  leaving no one behind
  • 3.2 - Reduced risk factors through multi sectoral approaches
  • 3.3 - Health and well-being realized through Health in all policies and healthy settings interventions.

This BCA for Malta supports the realization of Malta’s national health policies and plans. This BCA has already identified the related key Sustainable Development Goals and supports the realization of the Malta’s Country Cooperation Strategy (CCS).  

Malta has been an active contributor to the development of the Health 2020 framework document and has supported the initiative being led by the WHO European Office for Investment for Health and Development in addressing the specific issues related to its implementation in small Member States. A number of policies, strategies and action plans based on Health 2020 principles have been developed over the past years and are currently being implemented. Malta has also been active in WHO governance issues at both the global and regional levels.

Addressing social determinants and tackling social inequalities remain one of the priorities for Malta as part of the implementation of Health 2020 and ensuring SDG principle of “leaving no one behind”. The Maltese health system is going through a series of rapid changes and developments. Pluralism in the ownership and management of public hospital facilities provide opportunities but also introduce new challenges and require Maltese authorities to establish the required governance structures to address these new realities. Close monitoring of the financial sustainability of new initiatives is one such challenge. The need for stronger intersectoral collaboration is increasingly acknowledged and further support in this regard is still seen as a priority.

Malta will work in partnership to implement the action plan and to promote the strategic objectives of Health 2020 through participation in WHO regional activities as an active member of the Small Countries Initiative, while also promoting the strategic objectives of Health 2020 with national stakeholders.

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

This BCA for Malta supports the realization of Malta’s national health policies and plans. These include the National Health Systems Strategy (2014-2020), National Cancer Plan (2017-2021), National Diabetes Strategy (2016-2020), Food and Nutrition Action Plan (2015-2020), Healthy Weight for Life Strategy (2012-2020), Sexual Health Strategy (2011) and Action Plan and the Mental Health Strategy for Malta (2020-2030).

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

Annex 2

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