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 the Republic of Turkey.

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 multicounty (for subregional needs).

Annex 1: GPW 13 results framework

Back to top

Health situation analysis

Turkey has shown impressive commitment to health and to addressing health inequalities with significant improvements in many of health outcome indicators. Since the launch of the Health Transformation Program, Turkey has recorded a palpable increase in life expectancy and large corresponding reductions in maternal, infant and child mortality. Regional disparities in Turkey have been curtailed through a fundamental shift with strong reliance on a robust Primary Health Care (PHC) services network for universal health coverage. Barring a few most of the population health status indicators match or even exceed the averages for the WHO European Region. Furthermore, by improving access to quality health services, focus on International Health Regulations (2005), disaster risk reduction, addressing noncommunicable diseases (NCDs) with a multisectoral approach, and social determinants of health are some of other key priorities identified in relevant national strategies. Inclusion of refugees, migrants and other vulnerable populations also under these schemes while preserving strong focus on primary health care services are few other attainment strategies for sustainable development based on right to health as basic human right to realize full human potential at all ages.

In addition to the above points, there is a need for continued improvement of capacities and capabilities to support the Early Warning and Response System (EWRS) with the allocation of dedicated resources to different elements of health security with a multisectoral approach focusing on laboratory and field epidemiology capacities. International Health Regulations (2005), together with the Sendai Framework for Disaster Risk Reduction, including all-hazards, multi-sectoral health emergency preparedness, readiness, and response capacities is another public health priority in the country helping to reduce mortality, disease, injury and disability from disease outbreaks and disasters.

With the importance given to preventive and PHC services in the area, and health-security related intervention namely International Health Regulations (2005) core capacities, disaster risk reduction, improvements are already evident as reflected by lowering disease burden from communicable diseases. Nonetheless in current age of global connectivity with emerging/re-emerging pathogens, increased monitoring through robust, multi-sectoral, and integrated early warning and response systems is merited to mitigate these risks for optimal health security in a country that harbours the largest refugee burden at global level and serves as a transit route for tens of thousands of regular and irregular migrants on an annual basis. Also adopting the most effective interventions to improve access to comprehensive testing, diagnosis and treatment services for key, vulnerable and other specific populations is another key component of the agenda.

Furthermore, as an upper middle-income country, Turkey also faces a growing NCD burden. Integration of early high-impact noncommunicable disease interventions to primary health care for early diagnoses and detection, effective management and timely treatment is a key area of collaboration, while Turkey has already made impressive progress to implement many recommended core-population interventions for NCDs under the “Multisectoral Action Plan of Turkey for Noncommunicable Diseases 2017–2025”, featuring various vertical programmes and providing a strategic perspective covering risk factors and response of the health system.

Depressive and anxiety disorders are also on the rise and transition towards community-based mental health services approach is ongoing to ensure that people with mental health disorders receive early diagnosis, treatment, referral and care delivered by competent teams across different levels of the care system. Efforts are made to increase inclusiveness, accessibility and to ensure the sustainability of the mental health service delivery models with the establishment of strong capacities on primary health care level.

Climate change and extreme weather events affect various health determinants, namely air quality, safe water, food security, etc., and are expected to have an overwhelmingly negative health and development impact in the coming years. Therefore, focus upon Sendai Framework and Disaster Risk Reduction, International Health Regulations (2005) to improve health security by reducing vulnerabilities, mitigating hazards and risks, and by creating an enabling environment for healthy cities, housing, schools, and workplaces are of key importance for improving and sustaining achievements under health and sustainable development.

In addition to the above points, horizontally mainstreaming gender equality and equity that enhance participation, build resilience, and empower communities and addressing social determinants of health and health literacy are key areas requiring country-wide interventions to deliver improved health outcomes.

Back to top

GPW 13 prioritized outcomes and links to Health 2020 and the 2030 Agenda in the Republic of Turkey

Turkey and WHO closely collaborate in achievement of the Thirteenth General Programme of Work, 2019–2023 (GPW 13). With GPW 13, WHO provides a high‐level strategic vision for collaboration in Turkey with the aim of turning the bold vision of GPW 13 into reality by delivering impact for people at the country level in line with the concepts, principles and values underpinning 2030 Agenda for Sustainable Development.

In this regard, WHO supports Turkey to strengthen national health system to progress towards Universal Health Coverage, meaning the goal of ensuring that all people and communities have access to and can use the high-quality promotive, preventive, curative, rehabilitative and palliative health services that are appropriate to their needs and expectations, while not exposing the user to financial hardship. All three outcomes under the first strategic priority are identified as key collaboration areas with outcome 1.1. being the most prominent.

Establishment of stronger capacities for emergency preparedness and response, and convergence between health sector and other sectors to further improve necessary health security capacities are another identified collaboration area. The health crisis in Syria and WHO role in supporting the Ministry of Health for comprehensive and effective public health interventions to improve the health status of Syrians under Temporary Protection in Turkey place further importance on collaboration under the second strategic priority.

Joining forces on promotion of healthier populations is another key component of collaboration between WHO and the Ministry of Health of Turkey. Addressing health determinants, increasing health literacy, reducing risk factors through multisectoral action, promotion of healthy settings with health-in-all-policies approach and strengthening collaboration on health-information systems are identified public health priorities listed in development, health sector and thematic strategies, policies and plans. Promotion of healthy lifestyles and settings to reduce risk factors is a high priority intervention area in the country for materializing technical collaboration with WHO.

Health issues referred above are addressed in two key documents, the 11th National Development Plan and the Strategic Plan of the Ministry of Health 2019-2023. These documents together establish the ground for Sustainable Development Goals (SDGs) action in Turkey as well as its monitoring. In line with this background, Turkey presented its second Voluntary National Review on July 2019 with strong references to health-sector developments in the past decade. For identification of best modalities for collaboration in the health sector, governance issue requires stronger engagement between WHO and the Ministry of Health. As key health partners with rooted tradition of collaboration, WHO and Ministry of Health will strive together to develop and implement evidence informed health policies to address health needs with stronger understanding of whole-of-government, whole-of-society, multisectoral cooperation and broader determinants of health.

Annex 1: GPW 13 results framework

Back to top

Linkage of the BCA with national and international strategic frameworks for the Republic of Turkey

This BCA for the Republic of Turkey supports the realization of Turkey’s national health policies and plans listed in the 11th National Development Plan, the Strategic Plan of the Ministry of Health 2019-2023 and other health specific national policies and plans. This BCA derives from the United Nations Development Cooperation Strategy Turkey 2016-2020 and establishes a ground for action in line with the upcoming United Nations Sustainable Development Cooperation Framework Turkey 2021-2025.

Back to top

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 the Republic of Turkey. It seeks to facilitate strategic collaboration and enable WHO to make a unique contribution.

Annex 2

Back to top