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 Slovenia.

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 in Slovenia has improved considerably in the past decade.

Slovenia’s strong economic growth has been accompanied by strong health indicators. Life expectancy at birth has grown rapidly since independence and now exceeds that of both the European Union (EU) and the European Region, but has not yet reached the level of the EU(15) — the countries that joined the EU prior to 2004. As in other countries, women in Slovenia live longer than men, but the difference has been shrinking. In 1990, women lived 8 years longer than men, while in 2015, that difference had been reduced to 6.1 years, a reduction of 24%. Life expectancy at birth in 2016 was 79 years for males and 84 years for females. Slovenia’s high life expectancy at birth is in part due to very low rates of infant and under-5 mortality — almost half of those in the EU. Maternal mortality, however, has yet to reach the level of the EU, but is much lower than the average for the European Region as a whole.

Noncommunicable Diseases (NCDs) continue to represent the major burden of diseases in Slovenia, estimated to account for 87% of all deaths. Tobacco prevalence among people aged ≥ 15 years accounts for 21% (males 23%, females 19%), pure alcohol consumption per capita among people aged 15 years and over is 10,3 l/year, overweight and obesity show a slight increase since 2010 with 61% overweight and 25% of obesity (2016). Suicide (29.3/100 000 for men and 6,1/100000 for women) and traffic accidents (10.7/100 000 for men and 2.4/100 000 for women) are important causes of premature mortality. Incidences of communicable diseases in Slovenia are low, which is among other owed to traditionally good immunization coverage and other preventive measures. The incidence and the prevalence of diabetes have increased substantially in recent years. Incidences of infectious diseases are low, but outbreaks of syphilis and pertussis have been reported. The rates of HIV infection, AIDS and tuberculosis have remained low for several decades, substantially below the European average.

Public health in Slovenia is improving, but there remain some challenges for the future. Good health needs to be maintained across the life-course and improved for the poorest and most vulnerable in the community. As life expectancy improves, it is important that the quality of life in older age is maintained. The country's population is ageing fast and Slovenia faces high risks on the long-term sustainability of public finances stemming from the projected increase in pension-related public spending, healthcare and long-term care expenditure.

Slovenia spent 8.5% of GDP on health in 2016, corresponding to PPP$ 2772 per capita. Both of these amounts are less than the EU average. In contrast, although countries in the WHO European Region spent more on health as a share of GDP than did Slovenia, in absolute terms, Slovenia spent more per capita (in PPP$), reflecting its higher than average level of economic development. Health care services in Slovenia are financed mainly by compulsory and complementary health insurance, public health services from the state budget. The entitlement to health care services is universal.

Slovenia has a long history of commitment to solidarity and publicly provided health services and principles of solidarity and fairness in health financing. It has also prioritized equity and universal access to health care, as evidenced by its national health plans since 2000. For these reasons Slovenia is well on its way towards achieving SDG 3.8 — universal health coverage (UHC).

Primary Health Care (PHC) in Slovenia to a large degree fulfils the characteristics that the Astana Declaration indicates makes PHC “the most inclusive, effective and efficient approach to enhancing people’s physical and mental health”. These characteristics include care that is “comprehensive, integrated, accessible and affordable for everyone and everywhere”.

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

The Agenda 2030 - Sustainable Development Goals (SDGs) and Health 2020 provide motives to develop whole-of-government policies and approaches to create healthier society and to reduce health inequalities for the entire population that has the right to the highest attainable standard of health and well-being. The Slovenian Development Strategy 2030, which is the overall development framework of the State, is a response to the Vision of Slovenia 2050 document, a review of the current situation in the economic, social and environmental spheres, and global trends and challenges; the document therefore incorporates UN sustainable development goals. It is primarily aimed at the policymakers responsible for its implementation, while the effects of the document will be felt by the Slovenian population, individuals and society as a whole, who are at its core. Slovenia is strengthening health promotion, investing in primary prevention and screening programmes, all aimed at further reducing premature mortality from the leading causes of death. Slovene government is aware that sustaining a resilient healthy population relies on whole-of-society action, on involving local people and generating community ownership of health-related issues. Health is seen as a contributing as well as benefitting sector to the attainment of the 2030 Agenda for Sustainable Development. That was highlighted in the first Voluntary National Review on the implementation of the 2030 agenda that Slovenia presented in July 2017.

The following high priorities within frame of GPW 13 have been agreed for collaboration:

One billion more people benefiting from universal health coverage

  • Outcome 1.1: Improved access to quality essential health services
    • Output 1.1.1:  Primary Health Care including health workforce and strengthening mental health services at primary health care level
    • Output 1.1.4:  Health System governance
    • Output 1.2.1: Strengthening Health System capacity and sustainable public financing for health
    • Output 1.3.2: More equitable access to health products, Health Technology Assessment
    • Output 1.3.5: Addressing antimicrobial resistance (AMR)

One billion more people better protected from health emergencies

  • Outcome 2.1: Countries prepared for health emergencies
    • Output 2.1.2: Emergency preparedness strengthened

One billion more people enjoying better health and well-being

  • Outcome 3.1: Determinants of health addressed
    • Output 3.1.1: Reduced risk factors through multi sectoral approaches and focus on health literacy
    • Output 3.2.2: Health and well–being realized through health in all polices and health settings interventions

More effective and efficient WHO better supporting country

  • Outcome 4.1: Strengthened country capacity in data and innovation
    • Output  4.1.1: Evidence informed policy and research.

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

This BCA for Slovenia supports the realization of Slovenia’s national health policies and plans, namely National Health Plan 2016-2025. The National Health Plan is a strategic document that addresses the key problems of health. It sets the basis for the development of health care in Slovenia over the next 10-year period and for proposed legislation on health insurance and health care activities, and it maintains the core vision of quality and affordable public health.

It is closely aligned with the Vision of Slovenia 2050 and the Slovenia’s Development Strategy 2030, central goal of which is ensuring a high quality of life for all.

This BCA for Slovenia has already identified the related key SDG targets and indicators and supports the realization of the Slovene priorities for collaboration with WHO.

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

Annex 2

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