ABOUT THIS SECTOR
In line with the 2010 Communication and Council Conclusions on 'the EU role in Global Health' , the EU pursues a rights-based approach to health. The European Commission (EC) therefore supports countries to design policies that maximise health benefits on an equitable basis. The strengthening of all areas of a health system, including the availability of qualified health workers, the provision of affordable medicines and the adequate financing of the sector, is key to moving towards universal health coverage with quality health services accessible and affordable for all. At the same time the Commission sees health as a truly cross-sectoral area of its external action, choosing to support global actions such as the Global Fund to fight AIDS, Tuberculosis and Malaria and Gavi, the vaccine alliance and partner country efforts to strengthen national health systems.
The Commission strives to foster partner countries' ownership of development policies and reforms while implementing aid effectiveness principles, that address the root causes of existing challenges and constraints to sustainable development. Expanding the capacity of health systems to respond to health care needs as well as promoting health in all sectors, in line with Agenda 2030 and the Sustainable Development Goals(SDGs) , are also means to address the root causes of ill health and contribute to sustainable development. EU external actions in support to Health Systems Strengthening (HSS) contribute at the same time to the achievement of Universal Health Coverage (UHC) Both HSS and UHC are presented in greater detail in the Policy section.
The Commission also supports health and health system strengthening through global partnerships, through for example promoting aid effectiveness principles in global fora and on the boards of global health initiatives, such as the Global Fund and GAVI and is an active partner in the International Health Partnership for UHC 2030. Taking the Global Fund and GAVI for instance, by responding to the challenges posed by communicable diseases through support to resilient and sustainable health systems, these partnerships help countries reduce the disease burden and strengthen their own processes and mechanisms, such as policy and governance mechanisms, procurement and distribution of medicines, or through the development of cold chain supply for vaccines.
At the same time intersectoral partnerships are key to address development priorities such as nutrition, gender, climate change, health security and migration. Indeed, by tackling health determinants at the population as well as at the individual level, such partnerships help ‘bend’ the curve of avoidable morbidity and, in turn, enhance the ability of healthcare systems to respond successfully to healthcare demands and needs.
A recent facet of health system strengthening involves integrated approaches to Health Security and the implementation of the International Health Regulations. The Commission therefore supports preparedness as a pro-active capacity building process. This concept is also further addressed in the Policy section.
In view of increasing engagement in a growing number of fragile states, the Commission abides to the New Deal for Engagement in Fragile States, with a strong emphasis on resilience. From a health system strengthening and development point of view, resilience involves country owned preparedness: adequate disease surveillance, decision-making processes, regulations, communications and response plans, within the health system and beyond.
Transition from relief and emergency aid to development and ownership therefore needs careful consideration. As demonstrated by the Ebola outbreak, resilience also involves long-term health assets, such as universal access to quality individual care and prevention, building communities’ trust in health systems and fostering partnerships between health systems and populations for detecting and responding to health threats.
At country level, the Commission supports sector coordination mechanisms and platforms, and encourages the participation of civil society organisations and other stakeholders to policy dialogue with a view to achieve universal health coverage. The Commission regularly hosts Global Health Policy Forum meetings with Brussels-based stakeholders active in the field of health policy development, enabling participants to enter into a dialogue with the Commission, to receive updated information about the Global Health agenda and to present their views, activities and priority issues.
Key EU policy documents related to health:
In 2010 the Commission adopted a Communication outlining the EU role in global health, that saw Member States adopt Council Conclusions calling on the EU and its Member States to “act together in all relevant internal and external policies and actions by prioritizing their support on strengthening comprehensive health systems in partner countries, which are central to all global health challenges”. Furthermore three related Commission staff working documents accompanied the Communication focusing on Contributing to universal coverage of health services through development policy, on Global health – responding to the challenges of globalisation, and on European research and knowledge for global health.
The Commission’s development instruments and programmes offer financial and technical support to governments for their health sector development programmes and encourages civil society and other stakeholders to contribute through advocacy and increasing demand for quality health care and by reaching underserved populations, in order to achieve Universal Health Coverage. Rather than favouring individual disease interventions, the Commission follows a comprehensive approach that i) provides specific support for action on the main public health challenges, and ii) helps partner countries strengthen their health systems in a coordinated, comprehensive way so that no one is left behind, ensuring that essential quality health services are available to all, and financial barriers to access to services are eliminated in line with the notion of UHC developed by WHO.
In 2015 the Commission identified a comprehensive methodology for measuring the results of its external action. This methodology is described in the related Staff Working Document EU International Cooperation and Development Results Framework. See the first results report based on this methodology.
Key background concepts:
Health is defined in WHO’s Constitution (1946) as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, The health status of an individual or of a population is determined by numerous factors, beyond the exposure to a communicable disease. For example lifestyle, nutrition, inequalities, cultural norms, humanitarian or other crises, national policies and broader social, economic and environmental factors, all are conducive or detrimental to health. In turn, … […]the health of all peoples is fundamental to the attainment of peace and security”.
Health systems strengthening (HSS) is defined by WHO as ”(i) the process of identifying and implementing the changes in policy and practice in a country’s health system, so that the country can respond better to its health and health system challenges; (ii) any array of initiatives and strategies that improves one or more of the functions of the health system and that leads to better health through improvements in access, coverage, quality, or efficiency”.
The Commission applies a health systems strengthening approach to its work in supporting partner countries, implemented in line with aid effectiveness principles. Key requirements for a strong health system rests on the six building blocks as defined by WHO . These include the ability to provide quality services, fit-for-purpose facilities, essential equipment and medicines, sufficient numbers of well-trained health workers, sound public health information and information systems, effective management and good governance, and adequate health financing policies, backed by political commitments and evidence- and needs-based policies and strategies. With reference to health security, health systems strengthening involves primarily preparedness, as well as linkages and coordination with emergency and humanitarian responses, such as those facilitated by DG ECHO.
Health systems are as strong as their weakest block, and the Commission stresses the need for coherence in actions supporting stronger health systems. Key to HSS is national ownership of health policies and strategies: through its external action, the Commission always supports the leading role of national institutions in designing and implementing reforms aimed at strengthening health systems in all their components, with a view to achieve Universal Health Coverage.
Universal health coverage is defined by WHO as ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services. is deeply intertwined with HSS, and remains a key goal of the EU external action. Included in the targets for SDG3, UHC relates to the identification of quality and necessary services being provided to the population, to the ability of the population to access these services, and to measures put in place to avoid that direct payment of health services may result in further impoverishment of users.
The achievement of UHC is therefore grounded in the concept of equity, in the protection of the right to health, and in the definition of adequate and sustainable health financing policies.
In this respect, health financing policies defined by partner countries play a crucial role in laying down the path towards achieving universal health coverage. In fact, these policies determine how available domestic and international resources are used to finance a given set of health services, and how payment for these services is shared between the State and the population
Overarching EU external policy documents and global commitments:
The adoption of the 2030 Agenda for Sustainable Development and of the SDGs in 2015 have paved the way for an ever more comprehensive and intersectoral approach to health in the area of development cooperation. In a significant shift from the Millennium Development Goals, the Sustainable Development Goals (SDGs) entail not only the universality and global implementation of the Sustainable Development Agenda, but under SDG3, also aim to ensure healthy lives and the promotion of well-being for all at all ages as essential to sustainable development. The SDG Health Goal not only focuses on reducing mortality from communicable and non-communicable diseases, but also addresses mental health, substance and tobacco abuse, road traffic accidents sexual and reproductive health and rights, and limiting adverse effects of chemical contamination. At the same time SDG3 also takes up issues related to access to and development of medicines, the health workforce, countries’ emergency preparedness and response, and the implementation of adequate health financing strategies in all countries, with a view of achieving universal health coverage.
Agenda 2030 defines a shared approach to global challenges related to people, planet and prosperity. In response the Commission, in November 2016, set out a strategic approach for achieving sustainable development in Europe and around the world with the adoption of a proposal for a new European Consensus on Development a Communication on a renewed Partnership with countries of Africa, the Caribbean and the Pacific as well as a Communication on next steps for a sustainable Europe future . In June 2016, the Commission had already set out a Global Strategy for the EU’s Foreign and Security Policy, with the common aim of strengthening the impact of EU cooperation with partners across the world, whilst promoting sustainability at home and abroad, supporting peace, democracy and good governance that reinforces resilience at all levels and promotes shared and sustainable prosperity for all. In September 2016 the Commission adopted a new European External Investment Plan (EEIP) to encourage investment in Africa and the EU Neighbourhood to strengthen EU partnerships and contribute to achieve the SDGs.
The Commission supports full involvement of civil society organisations and local authorities in policy and decision-making processes, as that is an essential element for the achievement of sustainable development, good governance, accountability and transparency. As of 2014, the Commission and EU Member States jointly engage in the development of Roadmaps for engagement with civil society at partner country level.