The European Neighbourhood Policy (ENP) and health

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1 INFORMAL BACKGROUND DOCUMENT The European Neighbourhood Policy (ENP) and health General The European Neighbourhood Policy (ENP) was developed in 2004, with the objective of avoiding the emergence of new dividing lines between the enlarged European Union (EU) and our neighbours and instead strengthening the prosperity, stability and security of all concerned. In this way, it also addresses the strategic objectives set out in the December 2003 European Security Strategy. The European Neighbourhood Policy (ENP) was first outlined in a European Commission Communication in March 2003, followed by a more developed Strategy Paper of May This document sets out in concrete terms how the EU proposes to work more closely with these countries. As part of its report on implementation, in December 2006, the Commission also made proposals as to how the policy could be further strengthened. The EU offers our neighbours a privileged relationship, building upon a mutual commitment to common values (democracy and human rights, rule of law, good governance, market economy principles and sustainable development). The ENP goes beyond existing relationships to offer a deeper political relationship and economic integration. The level of ambition of the relationship will depend on the extent to which these values are effectively shared. The ENP remains distinct from the process of enlargement although it does not prejudge, for European neighbours, how their relationship with the EU may develop in future, in accordance with Treaty provisions. The European Neighbourhood Policy applies to the EU's immediate neighbours by land or sea: Algeria, Armenia, Azerbaijan, Belarus, Egypt, Georgia, Israel, Jordan, Lebanon Libya, Moldova, Morocco, the Palestinian Authority, Syria, Tunisia and Ukraine. Although Russia is also a neighbour of the EU, our relations are instead developed through a strategic partnership covering four common spaces. The central element of the European Neighbourhood Policy is the bilateral ENP Action Plan agreed between the EU and each partner. These set out an agenda of political and economic reforms with short and medium-term priorities. Implementation of twelve ENP Action Plans (those agreed in early 2005 with Israel, Jordan, Moldova, Morocco, the Palestinian Authority, Tunisia and Ukraine; and those agreed more recently with Armenia, Azerbaijan, Egypt, Georgia and Lebanon) is underway. Implementation is jointly promoted and monitored through the joint institutions created by the bilateral agreements (Partnership and Cooperation Agreements, or Association Agreements in the framework of the EuroMediterranean Partnership) with those partners, in particular in the relevant sub-committees. Since the ENP builds upon existing agreements between the EU and the partner in question, the ENP is not yet activated for Belarus, Libya or Syria since no such Agreements are yet in force. ENP is supported, in the period , through a new instrument, the European Neighbourhood and Partnership Instrument (ENPI) The amount of available EC funding is nearly 12 billion, 32% greater, in real terms, than the amount available in

2 ENP and health Good health improves and extends the lives of citizens, reduces poverty and contributes to socio-economic development. Health reform is ongoing in most ENP countries. This should lead to healthier lifestyles and better access to more affordable health-care services for all. Certain ENP partners face specific challenges from communicable diseases such as HIV/AIDS and Tuberculosis (notably Eastern Europe and, in particular, Ukraine). Communicable diseases represent potential cross-border risks to both the EU and our neighbourhood. Noncommunicable diseases (cardio-vascular; cancer etc) remain the major health challenge in the ENP region, as in the EU. The ENP covers a very broad range of areas (democracy, human rights, social and economic issues, environment, energy, education etc) including health. All the ENP Action Plans refer to public health cooperation including increased dialogue, health sector reform, progressive involvement of partners in EU related health activities/networks, health information, communicable diseases, health security. In addition, health is present in other parts of the Action Plans. For example it is an element of socio-economic development and poverty reduction, while joint work on the environment, food safety, RTD, road safety or the information society (e-health) also contributes to better health. Implementation of the health objectives of ENP Action Plans is ongoing. Health dialogue with ENP countries is increasing, in particular through the health related sub-committees of the Association/Partnership and Cooperation Agreements. The European Commission has started to invite ENP countries to EU health events such as the Commission-managed HIV/AIDS Think Tank and the network of competent authorities on health information and knowledge. Under the EU Public Health programme, Mediterranean ENP partners were associated to a Network for Communicable Diseases Control in Southern Europe and Mediterranean countries (EpiSouth project). In the Euro-Mediterranean context, a Ministerial was held in December The 2006 Tampere Euro-Mediterranean Foreign Ministers Conference has suggested holding a workshop in 2007 on surveillance and control of communicable diseases, which could serve as a preparatory step towards a Euro-Mediterranean Ministerial Conference on Health. The EU has funded, in particular under the MEDA and TACIS programmes health-projects for example in Egypt, Georgia, Moldova, Morocco, Syria, Tunisia, West Bank/Gaza and Ukraine. In Egypt, the EU is among the major health donors. In the Ukraine, the EU supports health sector reform and the fight against HIV/AIDS and Tuberculosis. Primary health care is supported inter alia in Moldova. Other examples are macroeconomic support programmes for reform of the health insurance system in Tunisia and Morocco. Further health projects will be decided, in the period under the European Neighbourhood and Partnership Instrument. The European Commission is interested in increasing health cooperation with EU neighbours and there is potential to do so. Health policy dialogue can be further strengthened including on the implementation of key international health instruments (Framework Convention on Tobacco Control, International Health Regulation). ENP considerations will be included in the upcoming new EU health strategy which will address, inter alia, global health issues. The European Commission will continue to invite ENP partners to selected EU health meetings and events. It is open to explore with partners possibilities to gradually participate in the 2

3 future EU Health programme. In ENP context it is also useful, as appropriate, to seek for cooperation and coordination opportunities with international actors such as the WHO. ENP partners could get more involved in the EU communicable disease networks and seek to enhance cooperation (in the medium/long term) with the Stockholm based European Centre for Disease Prevention and Control (ECDC). *************************************************************************** See for more information on the European Neighbourhood Policy: 3

4 EXCERPTS OF ENP ACTION PLANS ANNEX - MAIN PUBLIC HEALTH PROVISIONS ENP country Health Information Communicable diseases Other Epidemiological surveillance and monitoring Morocco (85) Raise the level of public health and epidemiological safety, in line with EU legislation and in cooperation with the WHO, by participation in information networks * Exchange information and know-how on health indicators and data collection: exchanges of experience between Morocco and Member States on health information systems; training on the collection, management and use of indicators in decision-making. *Organise seminars and meetings to exchange information in the field of health safety. *Ensure Morocco's participation as an observer in the network of competent authorities. * Encourage association with/participation in networks for the surveillance of transmissible diseases. *Develop a network of laboratories. *Strengthen the regional epidemiological observatories and border health inspection services. * Develop health watch and alert systems through the establishment of a national specialist unit in the Health Ministry. Increase health system decentralisation *Improve basic health care at regional level. *Pursue decentralisation of the treatment of cancer sufferers, in particular to the newly created centres. *Take measures to integrate Morocco into the EU health information system. *Encourage establishment of the Food Health and Quality Control Agency (ACQSA) with the support of the CSER (Scientific Council of Risk Evaluation). 4

5 Jordan (67) Increase the level of health security, health information and knowledge *Exchange of information and know-how on health indicators and data collection *Invite relevant Jordanian authorities as observers in the meetings of the Network of Competent Authorities *Develop the Technical and administrative conditions to integrate Jordan in the EU public health information and knowledge system (68) Communicable Disease Surveillance and Health Security (Epidemiological Surveillance and Control) *Participation in Communicable Disease Networks and dedicated surveillance networks *Develop adequate laboratories networking Tunisia (78) Raise the level of public health and epidemiological safety, in line with EU legislation and in cooperation with the WHO, by participation in information networks. Information and knowledge: *Encourage Tunisia's participation as an observer in the network of competent authorities; technical and administrative capacity for integration into the EU public health information system and take measures to integrate Tunisia into that system (EUPHIN); *exchange information and know-how on health indicators and the collection of data, in particular for the 50 priority indicators selected by the EU; Epidemiological surveillance and monitoring *Encourage inclusion and participation in networks for the surveillance of transmissible diseases; *develop a network of laboratories. (79) Build capacity for treating non-transmissible diseases in accordance with WHO strategy *Participation in Euro- Mediterranean networks for research on cancer and cardiovascular diseases. *organise seminars and meetings to exchange information in the field of health safety; 5

6 Palestinian Authority *Upgrade the Palestinian Public health system, and examine ways to improve sustainability beyond the conflict *Strengthen the administrative capacity of the Ministry of Health *Strengthen coordination with relevant international organisations and health service providers, including NGOs Israel 5. Increase the level of health security and epidemiological safety in Israel based on global standards taking into account EU legislation and in co-operation and with the support of the WHO. Relate the information system of Israel to the health indicator process underway in the EU. *Exchange of information and know-how on health indicators and data collection regulations *Encourage dialogue on health policy issues *Invite relevant Israeli authorities as observers in the meetings of the Network of Competent Authorities *Take measures to integrate Israel in the EUPHIN system *Examine scope for Israeli participation through umbrella organisations in the EU Health Forum * Participation in Communicable Disease Networks and dedicated surveillance networks *Develop laboratories networking 6

7 Integrate Israel in the EUPHIN health information and knowledge system. Moldova (80) Increase the level of health security and epidemiological safety in Moldova in line with EU legislation and in cooperation and with the support of the WHO. Relate the information system of Moldova to the health indicators process underway in the EU. Health information and knowledge: *Organise collection of information on health indicators Communicable Disease Surveillance and Health Security: *Exchange information and technical expertise in order to facilitate participation in EU Network for the Prevention and Control of Communicable Diseases *Participation in dedicated surveillance networks, in particular those collecting data and information on HIV/AIDS, sexually transmitted infections, and hepatitis C and B. Reform of health system: *Improve the primary health care system and the prevention of diseases, such as the HIV/AIDS epidemic, notably in rural and deprived communities and within vulnerable groups *Modernisation of emergency services *Health services autonomy, especially for hospitals * Monitoring of the mandatory health insurance implementation *Improve the training standards in general practice for health professionals with graduate and undergraduate education 7

8 Ukraine (71) Increase the level of health security and epidemiological safety in Ukraine in line with EU legislation and in cooperation and with the support of the WHO. Develop links between the information system of Ukraine and the health indicator process underway in the EU. Integrate Ukraine in the EUPHIN health information and knowledge system. Health information and knowledge: *Exchange of information and know-how on health indicators and data collection; * Invite relevant Ukrainian authorities as observers in the meetings of the Network of Competent Authorities. *Explore joint technical and administrative measures necessary to integrate Ukraine in the EUPHIN system as it becomes fully operational. Communicable Disease Surveillance and Health Security (Epidemiological Surveillance and Control) * Exchange information and technical expertise in order to facilitate participation in EU Network for the Prevention and Control of Communicable Diseases (Decision No 2119/98/EC) * Participation in dedicated surveillance networks, in particular those collecting data and information on HIV/AIDS, sexually transmitted infections, and hepatitis C and B. *Exchange of information and best practice in implementing measures to combat major communicable disease outbreaks. *Exchange information and technical expertise in order to upgrade the laboratory capacity to facilitate the networking of relevant laboratories between Ukraine and the EU. *To enhance the building up of human capacity to develop and implement joint public health projects, which address the HIV/AIDS epidemic in the country according the national strategy. 8

9 ARMENIA Priority area 3: Encourage further economic development, enhance poverty reduction efforts and social cohesion, thereby contributing to the long term objective of sustainable development, including the protection of the environment; Specific actions:. Continue reforms of the health sector ;. 4.3 Economic and social reform, poverty reduction and sustainable development Further progress in poverty reduction Introduce effective employment creation and poverty reduction measures aimed at significant reduction in the number of people with income below the poverty line and improved social cohesion, including sustainable systems for education, health and other social services with access for all 4.7 People-to people contacts Public Health Health sector reform Continue health sector reform, notably to: improve access and affordability for the entire population in particular for social vulnerable groups, improve the organisation, the legal framework, quality and efficiency of the sector and its institutions including laboratories; train health workers including through exchange of information and experience; increase the share of primary health care services and of prevention and health promotion activities in the total health care budget; implement a sustainable healthcare finance strategy including a health insurance scheme; improve quality of and access to information on the health status, risks and determinants; 9

10 AZERBAIJAN Priority area 6 Support balanced and sustained economic development, with a particular focus on diversification of economic activities, development of rural areas, poverty reduction and social/territorial cohesion; promote sustainable development including the protection of the environment Specific actions: Continue the reform of the health sector; improve quality coverage and efficiency and establish effective management systems; 4.4. Economic and social reform, poverty reduction and sustainable development Ensure a closer approximation to EU standards in the area of social policy (gender equality, labour law and health and safety at work). 4.7 People-to-people contacts Public health Continue health sector reform Continue health sector reform notably to: improve access and affordability for the entire population; improve the organisation, quality and efficiency of the sector and its institutions; increase the share of primary health care services and of prevention and health promotion activities in the total health care budget; implement a sustainable health care financing strategy; improve quality of and access to information on the health status, risks and determinants in Azerbaijan; strengthen the National Centre for public health monitoring and establish the register of specific diseases (thalassanemia, diabetes, TB, cancer), improve the registration system of birth and death, control the communicable diseases and promote health safety; Exchange of information and technical expertise with a view to facilitating Azerbaijan s participation in communicable diseases networks, for example those dealing with sexually transmitted diseases, in particular HIV/AIDS and Hepatitis B and C). 10

11 GEORGIA Priority area 3: Encourage economic development and enhance poverty reduction efforts and social cohesion, promote sustainable development including the protection of the environment; further convergence of economic legislation and administrative practices. Specific actions: Undertake reform of the social assistance and health care sectors including establishing an effective legal base and effective management systems;. 4.4 Economic and social reform, poverty reduction and sustainable development Take significant steps to reduce levels of poverty Continue reforms in the education and health sectors, and ensure transparency and accountability of the reformed (former budgetary) organisations; 4.7 People-to-people contacts Public health Health sector reform Continue health sector reform inter alia through enhancing the policy and regulatory framework with a view to notably: improve access and affordability for whole population; improve the organisation, quality, and efficiency of the sector and its institutions, including the Ministry of Labour, Health and Social Affairs; increase the share of primary health care services and of prevention and health promotion activities in the total health care budget; implement a sustainable healthcare finance strategy; improve the quality of and access to information on health statistics, risks and determinants in Georgia; enhance the quality of health workers including through training. 11

12 EGYPT Social development c) Public Health Support and cooperate in the development of health sector reform Continue the development of the health sector through: implement re-organization and decentralization of the health sector; improve accessibility and affordability including in rural areas and with a focus on women/children including those with disabilities; elaborate a system for Social Health Insurance covering the whole population; ensure the efficiency of institutions including laboratories; enhance human resources capacity; enhance health security and epidemiological safety; strengthen family health models, including maternal mortality and reproductive health issues. Increase the level of health security, health information and knowledge Exchange of information and know-how on health indicators and data collection. Invite Egypt as observer in the meetings of the Network of Competent Authorities. Communicable Disease Surveillance and Health Security (Epidemiological Surveillance and Control) Participation in Communicable Disease Networks and dedicated surveillance networks. Enhance response to infectious diseases, such as HIV/AIDS and hepatitis C. 12

13 LEBANON 2.7. People-to-people contacts Public Health Improve the health sector through reform Pursue health sector reform (e.g. enhance national capacities, increase sector efficiency, improve primary health care, enhance access for the poor in particular in rural areas, health financing reform). Increase the level of health security, health information and knowledge Exchange of information and know-how on health indicators and data collection. Participate, as observer, in the meetings of the Network of Competent Authorities. Communicable Disease Surveillance and Health Security (Epidemiological Surveillance and Control) Participate, gradually, in the European Communicable Disease and dedicated surveillance networks. 13

14 This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.