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 Romania.

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

The health status of the population has improved in the last decade, but remains below European Union (EU) standards. Romania in 2017 had one of the lowest average life expectancies in the EU, at 75.3 years, compared with an EU average of 80.9. Romania has one of the highest rates of infant mortality in the EU – 6.7 per 1 000 live births compared to the EU average of 3.6 in 2017.

The leading cause of death is cardiovascular diseases, while mortality rate for cancers has increased in recent years (lung, colorectal, breast cancers). More than half of all deaths in Romania can be attributed to behavioural risk factors, including poor diet, tobacco use, alcohol consumption, and low physical activity (62%), well above the EU average (44%).

Access to healthcare remains a key challenge, also in relation to equality of opportunities. Low funding and inefficient use of public resources limit the health systemʼs effectiveness, against the background of a sizeable shortage of doctors and nurses.

Key public health problems remain high infant mortality rate (6.7 per 1 000 live births), highest notification of tuberculosis in the European Union (68.5 versus 11.4 per 100 000 population), highest cervical cancer deaths in EU (14.2 deaths/100 000 versus 3.5/100 000), the high level of under reported nosocomial infections in hospitals while the leading causes of death in adults are cardiovascular diseases. Measles remains endemic in Romania.

The main strategic document in the health field is represented by the National Health Strategy 2014-2020. Beyond this, many sectoral strategies have been developed with the timeline 2014-2020 at national level, in an attempt to define a coordinated framework for reforming those sectors and to access, in this purpose, the EU funds (e.g. the strategy for child protection, the strategy for long life learning, the strategy for promoting active ageing, the strategy for social inclusion and poverty reduction, the strategy regarding persons with disabilities etc). Most of these strategies have objectives or areas involving the health sector, but the synergy and coordination in their implementation should be improved.

The Department of Sustainable Development will submit periodic reports to the EU on the progress made by Romania in terms of the implementation of the 2030 Agenda for Sustainable Development. Romania had presented voluntary reports to the high-level Political Forum on Sustainable Development in 2018, and aims to present at least two more reports by 2030.

The areas for collaboration in Romania are aligned with Romanian Sustainable Development Strategy.

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

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;
    • 1.1.4 Countries’ health governance capacity strengthened for improved transparency, accountability, responsiveness and empowerment of communities;
    • 1.1.5 Countries enabled to strengthen their health workforce.
  • 1.2. Reduced number of people suffering financial hardship; outputs:
    • 1.2.1 Countries enabled to develop and implement more equitable health financing strategies and reforms to sustain progress towards universal health coverage;
    • 1.2.2 Countries enabled to produce and analyse information on risk protection, equity and health expenditures and to use this information to track progress and inform decision-making.
  • 1.3. Improved access to essential medicines, vaccines, diagnostics and devices for primary health care; outputs:
    • 1.3.2 Improved and more equitable access to health products through global market shaping and supporting countries to monitor and ensure efficient and transparent procurement and supply system;
    • 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; outputs:
    • 2.1.1 All-hazards emergency preparedness capacities in countries assessed and reported;
    • 2.1.2 Capacities for emergency preparedness strengthened in all countries;
    • 2.1.3 Countries operationally ready to assess and manage identified risks and vulnerabilities.

    2.3. Health emergencies rapidly detected and responded to; outputs:

    • 2.3.2 Acute health emergencies rapidly responded to, leveraging relevant national and international capacities;
    • 2.3.3 Essential health services and systems maintained and strengthened in fragile, conflict and vulnerable settings.

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

  • 4.1. Strengthened country capacity in data and innovation; outputs:
    • 4.1.1 Countries enabled to strengthen data, analytics and health information systems to inform policy and deliver impacts;
    • 4.1.3 Strengthen evidence base, prioritization and uptake of WHO generated norms and standards and improved research capacity and ability to effectively and sustainably scale up innovations, including digital technology, in countries.

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

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

  • National Health Strategy 2014-2020
  • Romania’s Sustainable Development Strategy 2030
  • National Strategy on Climate Change 2013-2020 and National Action Plan for the implementation of the National Strategy on climate changes and economic growth based on low carbon emissions for 2016-2020
  • Law No. 104 / 15.06.2011 regarding air quality (published in the Official Gazette no. 452 / 28.06.2011)
  • National Strategy on social inclusion and poverty reduction for the period 2015-2020
  • National Strategy for the protection and promotion of children's rights 2015-2020
  • National Strategy for promoting equal opportunities and treatment between women and men and the prevention and combating of domestic violence 2018-2021
  • National Strategy for the prevention of emergency situations
  • Strategy for consolidation and development the General Inspectorate for Emergency Situations 2016-2025
  • National strategy of the customs authority for prevention and control of illicit trafficking in cigarettes and tobacco products 2019-2021
  • Strategy for education and professional training in Romania
  • National Strategy for Research, Development and Innovation 2014-2020

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

Annex 2

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