World Health Organization Regional Office for Europe
Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18 E-mail: postmaster@euro.who.int Web site: www.euro.who.int
The WHO Regional Office for Europe
The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves.
Member States
Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan
This report describes the work done by the WHO Regional Office for Europe in 2004–2005 with about 550 core staff and a budget of US$ 159 893 937. It is built around nine functions:
1. operations in countries; 2. health systems; 3. communicable diseases; 4. noncommunicable diseases,
lifestyles and health determinants, and family and community health;
5. health and environment; 6. health intelligence and publishing
for public health; 7. infrastructure and logistics; 8. administrative services; and 9. governance.
The aim is to show more transparently how the Regional Office used its human and financial resources in its efforts to provide services matched to countries’ needs.
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ISBN 92-890-1385-0
iHealth intelligence and publishing for public health
The work of WHO in the European Region, 2004–2005
Biennial report of the Regional Director
ii The work of WHO in the European Region, 2004-2005
The World Health Organization was established in 1948 as the specialized agency
of the United Nations responsible for directing and coordinating authority for
international health matters and public health. One of WHO’s constitutional
functions is to provide objective and reliable information and advice in the field
of human health. It fulfils this responsibility in part through its publications
programmes, seeking to help countries make policies that benefit public health
and address their most pressing public health concerns.
The WHO Regional Office for Europe is one of six regional offices throughout
the world, each with its own programme geared to the particular health problems
of the countries it serves. The European Region embraces some 880 million
people living in an area stretching from the Arctic Ocean in the north and the
Mediterranean Sea in the south and from the Atlantic Ocean in the west to the
Pacific Ocean in the east. The European programme of WHO supports all countries
in the Region in developing and sustaining their own health policies, systems and
programmes; preventing and overcoming threats to health; preparing for future
health challenges; and advocating and implementing public health activities.
To ensure the widest possible availability of authoritative information and
guidance on health matters, WHO secures broad international distribution of
its publications and encourages their translation and adaptation. By helping
to promote and protect health and prevent and control disease, WHO’s books
contribute to achieving the Organization’s principal objective – the attainment by
all people of the highest possible level of health.
iiiHealth intelligence and publishing for public health
The work of WHO in the European Region, 2004–2005
Biennial report of the Regional Director
iv The work of WHO in the European Region, 2004-2005
ISBN 92-890-1385-0 EUR/RC56/4
© World Health Organization 2006
All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization.
Book design: Sven Lund Printed in Denmark
Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the WHO/Europe web site at http://www.euro.who.int/pubrequest.
WHO Library Cataloguing in Publication Data
The work of WHO in the European Region, 2004–2005 : biennial report of the
Regional Director.
1.Regional health planning 2.World Health Organization 3.Europe
ISBN 92 890 1385 0 (NLM Classification : WA 540)
vHealth intelligence and publishing for public health
Abbreviations and acronyms vi
Introduction 1
Operations in countries 2
Health systems 10
Communicable diseases 18
Noncommunicable diseases 29
Environment and health 37
Health intelligence and publishing for public health 43
Infrastructure and logistics 51
Administrative services 53
Governance 56
Programme management and implementation 63
1.
2.
3.
4.
5.
6.
7.
8.
9.
Annex 1.
Contents
vi The work of WHO in the European Region, 2004-2005
Organizations
CDC Centers for Disease Control and Prevention, United States of America
CE Council of Europe
CEE-HRN Central and Eastern European Harm Reduction Network
CIDA Canadian International Development Agency
EATG European AIDS Treatment Group
EC European Commission
DG ENV Directorate-General for the Environment
DG SANCO Directorate-General for Health and Consumer Affairs
ECDC European Centre for Disease Prevention and Control
EEA European Environment Agency
EMCDDA European Monitoring Centre for Drugs and Drug Addiction
EU European Union
EuroHIV European Centre for the Epidemiological Monitoring of AIDS
EUROSTAT Statistical Office of the European Communities
FAO Food and Agriculture Organization of the United Nations
GTZ German Agency for Technical Cooperation
IOM International Organization for Migration
OECD Organisation for Economic Co-operation and Development
PATH Program for Appropriate Technology in Health
REC Regional Environmental Center for Central and Eastern Europe
UNAIDS Joint United Nations Programme on HIV/AIDS
UNDP United Nations Development Programme
UNECE United Nations Economic Commission for Europe
UNEP United Nations Environment Programme
UNFPA United Nations Population Fund
UNHCR United Nations High Commissioner for Refugees
UNICEF United Nations Children’s Fund
UNMIK United Nations Interim Administration Mission in Kosovo
USAID United States Agency for International Development
WFP World Food Programme
Abbreviations and acronyms vi Die Arbeit der WHO in der Europäischen Region 2004–2005
viiHealth intelligence and publishing for public health
Country groups
CCEE countries of central and eastern Europe
CIS Commonwealth of Independent States
SEE south-eastern Europe
Technical and administrative terms
3 by 5 UNAIDS/WHO initiative whose target was that 3 million more people with HIV/AIDS
should receive antiretroviral treatment by the end of 2005
ARV/ART antiretroviral medicines/antiretroviral therapy
BCA biennial collaborative agreement (with a country)
CEHAPE Children’s Environment and Health Action Plan for Europe
CISID centralized information system for infectious diseases
DALY disability-adjusted life-years
DOTS directly observed treatment, short-course (WHO strategy for tuberculosis control)
DOTS-Plus WHO strategy to tackle multidrug-resistant tuberculosis
GAVI Global Alliance for Vaccines and Immunization
GIFT Global Information Full Text
HAART highly active antiretroviral therapy
HEN Health Evidence Network project
Hib Haemophilus influenzae type b
HINARI Health InterNetwork Access to Research Initiative
HiTs Health Systems in Transition (country profiles)
ICD-10 International Statistical Classification of Diseases and Related Health Problems,
10th revision
ICF International Classification of Functioning, Disability and Health
MDGs Millennium Development Goals
MDR-TB multidrug-resistant tuberculosis
NGOs nongovernmental organizations
SARS severe acute respiratory syndrome
STIs sexually transmitted infections
TB tuberculosis
WOW Way of Working (Regional Office process and group)
viiAbbreviations and acronyms
viii The work of WHO in the European Region, 2004-2005
The late Dr LEE Jong-wook, WHO Director-General, 2003–2006 (second from right), with Dr Marc Danzon, WHO Regional Director for Europe (far right)
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1Introduction
1 Regional Director’s report – Implementation of the programme budget 2004–2005. Copenhagen, WHO Regional Office for Europe, 2006 (EUR/RC56/Inf.Doc./1; http://www.euro.who.int/Document/RC56/einfdoc01.pdf).
There are many possible ways to report on the work done during a period of two years (2004 and
2005) by a core team of 550 staff with a budget of around US$ 160 million.
The approach used in this report was chosen to increase understanding of how the resources,
both financial and human, allocated by WHO’s governing bodies were used in 2004–2005. A desire to
improve transparency also guided this choice.
This report provides an opportunity to share with the governing bodies and other interested
readers the new internal tools created in 2005 for Executive Management to monitor more efficiently
the work of the WHO Regional Office for Europe.
To facilitate understanding of the activities included in the programme budget, the report is built
around nine functions corresponding to its nine chapters:
1. operations in countries;
2. health systems;
3. communicable diseases;
4. noncommunicable diseases, lifestyles and health determinants, and family and community health;
5. health and environment;
6. health intelligence and publishing for public health;
7. infrastructure and logistics;
8. administrative services; and
9. governance.
Of course, the traditional information document on the implementation of the programme budget
2004–2005 is also available.1
For each of the nine functions, the report provides information on the main activities during the
biennium, the financial resources spent and the number of staff involved.
Introduction
Marc Danzon WHO Regional Director for Europe
2 The work of WHO in the European Region, 2004–2005
Spent: US$ 12 951 433
Proportion of total expenditure: 8.1%
Staff: 120, including 112 in the field
This chapter makes a distinction between the 29 countries in the WHO European Region where the
Regional Office has country offices and BCAs,2 and the 23 with no country offices as yet. The Regional
Office established country offices in Member States to ensure coordination of the activities in each
country and to act as the interface with WHO. Country offices are quite different from the technical
centres also located in countries but serving the whole Region on a specific technical matter (2). Through the strategy for working with countries, “Matching services to new needs” that was
adopted in 2000, the Regional Office serves all the Region’s 52 Member States in various ways. The
following are examples of cooperation in four countries with country offices.
Countries with country offices: examples of cooperation
KyrgyzstanKyrgyzstan Kyrgyzstan is an example of the application of the European approach to strengthening health
systems (3), launched in September 2005. It is the first country in the European Region to
institutionalize its efforts to reform and strengthen its health system by establishing a Centre for
Health System Development, opened by the President of Kyrgyzstan in Bishkek.
The Regional Office continues to support the implementation of the national health reform
programme, which moved into its second phase – called Manas Taalimi – in 2005 and is scheduled
to continue until 2010. It focuses on aligning medical practices and education with internationally
recognized standards, integrating priority programmes such as those on TB and reproductive
health into the health system, strengthening health financing, mobilizing society and empowering
communities in the field of health promotion.
Turkey Turkey The rapid and well-coordinated response of national and international agencies to the 2005 outbreak
of avian influenza is another good example of well-functioning partnerships and collaboration with
Member States (see also pp. 11,12,16,18,19–20, 52). Acting as one WHO, the Organization combined
2 The BCAs can be found in the information on individual countries available in the Country Information section of the Regional Office web site (1).
1. Operations in countries
3Operations in countries
the knowledge and expertise of its national, regional and global experts to support the Turkish
Government in coordinating the different ministries and national institutes involved. This in turn
ensured a common response from other international agencies such as FAO, the World Bank, the EU
and ECDC, thus avoiding duplication of effort and guaranteeing a timely and appropriate response.
AlbaniaAlbania Collaboration with Albania focused on providing strategic support to fight HIV/AIDS along with other
United Nations agencies. From 2001 to 2004, the Regional Office chaired a United Nations theme
group on HIV/AIDS, which involved UNDP, UNICEF, UNDP, UNFPA, UNHCR, IOM, WFP and the World
Bank. The establishment of this theme group improved the coordination of these agencies in the
country. The group has run meetings, round-tables, and fora with Albanian government organizations,
NGOs and international organizations, which have been identified as an important factor in
maintaining a low HIV prevalence in the country.
Russian Federation Russian Federation In the Russian Federation, the Regional Office, along with several international partners contributed
to the development of stewardship and health policy in the Chuvash Republic.
Local resident hands over his chickens to a health expert for culling during avian flu outbreak in Turkey
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4 The work of WHO in the European Region, 2004–2005
As a result, the Chuvash Ministry of Health published a plan to strengthen the health system by
strengthening primary health care, including introducing general practitioners, reducing inpatient
beds in hospitals, restructuring emergency and diagnostic services, improving financial and human
resources, developing strategies for greater public involvement and emphasizing the development of
healthy communities.
This has led to improvement in the key indicators of health and health system performance: a
substantial increase in the birth rate, a decrease in the death rate, a decrease of over 30% in infant
mortality and an even larger reduction in the maternal mortality rate.
Stability Pact Initiative
In September 2001, the Dubrovnik Pledge (4) was endorsed by eight countries in SEE: Albania, Bosnia
and Herzegovina, Bulgaria, Croatia, the Republic of Moldova, Romania, Serbia and Montenegro and
The former Yugoslav Republic of Macedonia. Since then, they have worked closely together, within
the framework of the Social Cohesion Initiative of the Stability Pact for South Eastern Europe (5); to carry out cross-border health projects (on mental health, social and health information systems,
communicable diseases, food control, blood safety and tobacco control), and to reconstruct their
societies and restore neighbourly relations (see also pp. 5,11,19, 29, 33).
The second phase began with the Second Health Ministers’ Forum (6), held in November 2005
in Skopje. The participants emphasized that reforming and strengthening the health system in each
country were essential to meeting the health challenges of its population; providing high-quality,
accessible and affordable health services; and bridging the current health gap between the SEE
countries and the EU.
Seventeen partners signed the Skopje Pledge (7), in which ministers of health and finance of the
eight countries unanimously agreed that public expenditure in health should not be seen as a cost,
but as an investment for the future.
Countries without country offices
In 23 other countries, the Regional Office deployed several processes to tailor its work to the needs of
each individual Member State.
The Office enhanced its work on assessing countries’ strategic health needs. This formed the
background for strategic discussions about potential BCAs with these countries. The assessment
reports analyse each country’s health system challenges, national health priorities and possible health
priorities for Regional Office collaboration (8). Negotiations that may lead to BCAs and plans for their
implementation began with Andorra, Belgium, Germany and Norway.
The Regional Office and individual health ministries began mutual secondment of staff to support
country-specific collaboration. In Germany, for example, WHO seconded a staff member to the
5Operations in countries
Ministry of Health to pilot the development and adoption of a BCA and the setting up of a WHO
country office in Germany.
Responding to specific requests, the Regional Office also contributed to, for example:
• the adoption and implementation of the national health plan of Portugal;
• a joint OECD–WHO review of the health system of Switzerland;
• the development of a new law on public health in Greece and preparedness for the public health
aspects of the Olympic Games in Athens;
• various health activities during the successive EU presidencies of the Netherlands (priority
medicines in Europe), Luxembourg (coordination of the EU response to the tsunami in South-east
Asia) and the United Kingdom (health inequalities, patient safety and pandemic preparedness);
and
• a rapid assessment of public health needs in the Turkish Cypriot community in Cyprus.
Partnerships at country level and resource mobilization
During the biennium, the Regional Office continued its strategic coordination with key partners. At
the regional level, it maintained and strengthened collaboration with the EC, the CE, sister United
Nations organizations (such as UNICEF, UNFPA and the World Bank), bilateral development agencies,
civil-society organizations and private-sector partners.
For the first time, the Office had direct agreements with DG SANCO on five common projects, for
a total of €2.5 million, on the surveillance of communicable diseases, mental health, environmental
health, health systems and obesity: topics of high priority to the Regional Office. Member States have
thereby explicitly supported close collaboration and coordination between the Regional Office and
the EC.
The Regional Office supported the creation of ECDC in Stockholm. A Memorandum of
Understanding was signed, clarifying the role of each partner and building mechanisms for close
collaboration from the start. The Regional Office has seconded two of its staff to provide direct
support to ECDC.
As mentioned later in this report, the Regional Office organized ministerial conferences on
environmental health in Budapest, Hungary and on mental health in Helsinki, Finland, with strong
financial and political support from the EU, the CE, the World Bank and many civil-society organizations
(see pp. 30–31, 37–38).
With the World Bank, the Regional Office has developed its activities in the field and in the
Flagship courses for Europe (see p. 15), to train relevant staff in the eastern part of the Region in
health systems matters.
The main work with the CE took place within the framework of the Stability Pact and the update
of the Health for All framework in 2004 (see p. 58).
6 The work of WHO in the European Region, 2004–2005
For the last few years, WHO has highlighted the importance of country-focused work and the
crucial role of partnerships. The Regional Office made particular efforts in the biennium to strengthen
coordination with its key partners at the country level and to build its country offices’ capacity to
develop partnerships.
Global health agenda and country work
The Regional Office works with countries in both the eastern and western parts of the Region, not as an
end in itself, but to pursue the global health agenda in collaboration with Member States.
The Global FundThe Global Fund The Regional Office has emphasized supporting Member States in their work related to the Global
Fund to Fight AIDS, Tuberculosis and Malaria since the Fund’s activities began in 2002.
Currently, 41 “components” in 22 countries in the European Region have been approved in the
5 rounds of applications for grants from the Fund (10 in the fifth round). To date, the European
Region has received 11% of the total funding granted. This was achieved with significant involvement
Ministerial conferences were held in Budapest and Helsinki with strong support from key partners
© W
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7Operations in countries
of the Regional Office at both the regional and country levels. In 2003, the Office was a member
of around 80% of the Fund’s country coordination mechanisms. By the end of the biennium, its
representation was 100%.
Collaboration with the Global Fund has been particularly strong on (see also pp. 23, 24, 26):
• TB projects in the Republic of Moldova, Romania, the Russian Federation and Uzbekistan;
• HIV/AIDS projects in Estonia, Kazakhstan, the Republic of Moldova, the Russian Federation,
Tajikistan and Ukraine; and
• malaria projects in Georgia, Kyrgyzstan and Tajikistan.
MDGs monitoring and its impact on Regional Office programmesMDGs monitoring and its impact on Regional Office programmes The Office presented a strategy on the MDGs (9,10) to the WHO Regional Committee for Europe in
2005 and created a task force that oversees its implementation.
Through its country work, the Regional Office has scaled up its support to countries in marking
their progress towards achieving the MDGs. Measures to improve monitoring of the indicators for the
seven health-related MDGs are being taken in all 52 countries in the Region and a comprehensive
assessment was recently conducted. An internal mechanism for monitoring other regions’ and
organizations’ work on the MDGs is being put in place.
According to the recent assessment, the European Region is making uneven progress. Along with
other international agencies, the Office has therefore supported work to tackle health-related MDGs in
26 countries, through the implementation of the BCAs. Eight of the CCEE and central Asian countries
are likely to achieve five of the seven MDGs, and Hungary and Poland are expected to achieve all seven.
Nevertheless, achieving the MDGs remains a big challenge for a number of countries.
Improved management of country work
Better planning and management Better planning and management Effective work in the country offices is essential to the success of Regional Office programmes in
countries.
The BCAs for 2004–2005 (2) were implemented successfully in most countries: 98% of planned
activities were implemented. The financial implementation rate for the previous biennium was around
92%.
Performance appraisals of country workPerformance appraisals of country work The Regional Office has improved its performance appraisals of country work. Annual reporting to
Member States on country-specific collaboration was set up on a country-by-country basis in 2004.
In addition, a number of key performance indicators are being tested to increase transparency
and accountability. In 2005, six indicators to measure various aspects of planning and implementing
8 The work of WHO in the European Region, 2004–2005
country work were pilot-tested, with the focus on timeliness and quality. For example, 80% of the
signed BCAs were consistent with countries’ priority needs as identified by strategic assessment
reports (9). In addition, an external audit noted substantial improvement in the reporting from the
country offices, with over 80% of reports being of good quality and submitted on time.
In general, the performance appraisal system proved to be useful in increasing the efficiency of
country work.
Country days Country days To raise the profile of country work within the Regional Office, so-called country days were
introduced, involving all programmes and divisions, as well as country health officials. A typical
country day includes a number of activities in which different aspects of the collaboration between
the Office and a particular country are jointly assessed.
Country days help to improve the coordination of the various technical responses to country
needs. The most recent country days held in the biennium focused on Estonia, Kyrgyzstan, the
Republic of Moldova and Turkey.
References3
1. Country information [web site]. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.
euro.who.int/countryinformation).
2. Strategy of the WHO Regional Office for Europe with regard to geographically dispersed offices.
Copenhagen, WHO Regional Office for Europe, 2004 (EUR/RC54/9; http://www.euro.who.int/
document/rc54/edoc09.pdf).
3. Next phase of the WHO Regional Office for Europe’s country strategy: strengthening health systems. Copenhagen, WHO Regional Office for Europe, 2005 (EUR/RC55/9 Rev.1 + EUR/RC55/
Conf.Doc./5; http://www.euro.who.int/document/RC55/edoc09rev1.pdf).
4. The Dubrovnik Pledge [web site]. Copenhagen, WHO Regional Office for Europe, 2004 (http://www.
euro.who.int/stabilitypact/pledge/20040610_1).
5. Stability Pact for South Eastern Europe. Initative for Social Cohesion [web site]. Brussels, Stability
Pact for South Eastern Europe, 2005 (http://www.stabilitypact.org/soc-cohesion/default.asp).
6. Second Health Ministers’ Forum [web site]. Copenhagen, WHO Regional Office for Europe, 2005
(http://www.euro.who.int/stabilitypact/network/20050511_1).
7. The Skopje Pledge. Brussels, Stability Pact for South Eastern Europe, 2005 (http://www.
stabilitypact.org/soc-cohesion/54634-kmi%20Skopje%20pledge.pdf).
8. Country strategic health needs: report and priorities for WHO collaboration, 2004–2010. Copenhagen, WHO Regional Office for Europe, 2005 (series of unpublished documents).
3 All electronic references were accessed on 18 May 2006.
9Operations in countries
9. UN Millennium Development Goals. New York, United Nations, 2000 (http://www.un.org/
millenniumgoals/).
10. The WHO Regional Office’s strategy on the Millennium Development Goals in Europe. Copenhagen, WHO Regional Office for Europe, 2005 (EUR/RC55/Inf.Doc./1; http://www.euro.who.
int/Document/RC55/einfdoc01.pdf).
10 The work of WHO in the European Region, 2004–2005
Spent: US$ 23 329 000
Proportion of total expenditure: 14.6%
Staff: 65, including 26 in the field
The mission of the Regional Office is to support Member States in developing their own health
policies, health systems and public health programmes, preventing and overcoming threats to health,
anticipating future challenges and advocating public health.
The BCAs between the Regional Office and 29 Member States (1) are structured according to the
four functions of countries’ health systems, an approach promoted by the Office. As Regional Office
staff implement their programmes, they consider how the programmes affect these functions: service
delivery, stewardship, resource generation and financing. The work on health systems carried out with
Member States in the biennium is therefore presented under these headings.
Service production and delivery
Strengthening and reforming primary health careStrengthening and reforming primary health care Because strengthening and reforming primary health care is a main priority in most Member States,
the Regional Office carried out many activities with this aim in the biennium, in countries such as
Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Russian Federation, Turkey and Uzbekistan. The work
emphasized improving the quality of care (developing a national quality improvement strategy in
Uzbekistan), strengthening the primary level of care (policy dialogues in Georgia and the Russian
Federation) and integrating specialized services (workshops on child health in Kazakhstan, family
health in Turkey, STIs in Uzbekistan and reproductive health in Kyrgyzstan). The work focused on
identifying Member States’ needs to improve the performance of their primary health care systems.
This was also the basis for the 2006–2007 BCAs (1).
Making hospital reformsMaking hospital reforms Making successful hospital reforms remains a big challenge for most countries. While important
partners have concentrated mainly on hospital infrastructure, the Regional Office put greater
emphasis in the biennium on supporting performance assessment, reforms and master plans for
hospitals, and quality and safety processes, as well as introducing health promotion activities into the
daily routine.
For example, the Office reviewed policies and proposed strategies to improve equity, efficiency and
effectiveness in the hospital system.
2. Health systems
11Health systems
It also supported the introduction of accreditation systems to improve the quality of hospital care.
It led the project for a performance-assessment tool for quality improvement of hospitals in
Europe. The tool is a framework with six dimensions: clinical effectiveness, staff guidance, efficiency,
safety, patient-centredness and responsive governance. It has been pilot-tested in 40 hospitals in
Belgium, Canada, Denmark, France, Slovakia and South Africa.
The Regional Office also led the health promoting hospitals project, which encompasses
740 European hospitals in a network to improve health promotion and quality in hospitals. The
network includes hospitals in 24 European countries: Austria, Belgium, Bulgaria, the Czech Republic,
Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Israel, Italy, Kazakhstan,
Lithuania, Norway, Poland, the Russian Federation, Slovakia, Spain, Sweden, Switzerland and the
United Kingdom.
Finally, the Office developed emergency medical services in Albania, Andorra and Slovenia. It
gave special emphasis to accreditation and quality assurance, and tools are being developed in
collaboration with partners and WHO collaborating centres. With the threat of a possible pandemic
resulting from avian influenza, efforts in 2005 concentrated mainly on advising countries on
emergency preparedness plans for hospitals. Triage in emergency medical departments has been
introduced in Albania and the Chuvash Republic, Russian Federation.
Strengthening public health servicesStrengthening public health services Several activities to strengthen public health services were initiated and implemented during the
biennium. Two major meetings took place – in Malta and Budapest, Hungary – on the reform of
the public health services in the countries of the former USSR. A major achievement in the Social
Cohesion Initiative of the Stability Pact for South Eastern Europe was focusing on strengthening the
delivery of public health services as a part of overall health system reforms in the SEE countries.
Disaster preparedness and responseDisaster preparedness and response Providing support to Member States when disaster hits is an important element of the Regional
Office’s work in and with countries. This includes work on health services; during the biennium, this
work focused mainly on continuing to strengthen national health systems’ capacity to cope with
the health aspects of crises. Based on recommendations published in Strengthening health systems’ response to crisis (2), 18 Member States collaborated on promoting disaster-risk reduction in the
health sector.
North Caucasus The North Caucasus region of the Russian Federation – especially the 1.5 million people in the
republics of Chechnya, Ingushetia and North Ossetia – remains in the grip of a long-term
humanitarian crisis marked by conflict and poverty. The Russian health authorities are working with
partners including the Regional Office to address the public health challenges in the region, focusing
12 The work of WHO in the European Region, 2004–2005
particularly on the needs of vulnerable groups. For example, the Office works closely with UNICEF to
expand the Integrated Management of Childhood Illness strategy and build capacity in obstetrical
and neonatal care through promoting the Making Pregnancy Safer initiative. The Office continues to
strengthen primary health care services in the Republic of Chechnya, focusing on reducing mother-
to-child transmission of HIV. It also supports programmes offering mental health and psychosocial
support to traumatized children and victims of mine accidents.
In addition, the Regional Office works with partners to strengthen health-sector systems to
prepare for, respond to and mitigate the consequences of emergencies. In collaboration with the EC,
the Office is finalizing a joint United Nations project on capacity building to strengthen the health
system in the Republic of Chechnya.
Kosovo (Serbia and Montenegro) The WHO humanitarian programme in Kosovo focused on addressing the health situation of the
internally displaced population in three temporary camps in north Mitrovica. This is the site of one of
the most challenging environmental disasters in the European Region, which has not been properly
addressed. The Regional Office has succeeded in bringing the problem closer to solution through close
collaboration with the UNMIK team in Kosovo.
On top of the extremely poor hygienic conditions in the camps, the results of surveys of soil
in the affected area and the blood of the population highlighted the concomitant problem of
prolonged exposure to lead and other heavy metals and chemicals. The international community
is now addressing this problem, which mostly affects children and pregnant women. The progress
achieved is very promising. The Office’s response was made possible mainly through the generous
support of the Government of Norway and the strong political support of the Minister of Health of
Serbia.
Avian influenza In addition, the Regional Office mobilized technical assistance to strengthen health systems’
preparedness to respond to human avian influenza cases in the Region, in such affected countries as
Turkey. It continues to work with Member States to upgrade their health systems’ capacity to deal
with the health consequences of a potential human influenza pandemic.
Natural disasters Several natural disasters struck Member States in the European Region, predominantly triggered
by extreme weather events that caused mudslides and severe floods. Although such disasters rarely
attract the broad attention of the international mass media, they destroy the livelihoods of affected
communities and overwhelm local health systems. The Regional Office and its country teams
organized assessment missions and arranged the delivery of essential medicines and supplies to
stricken areas.
13Health systems
In the aftermath of the devastating earthquakes and subsequent tsunami that affected South-east
Asia, several experts joined the global one-WHO response team providing support to the operations
of the WHO Regional Office for South-East Asia. The Regional Office provided the same support to
the operations of the WHO Regional Office for the Eastern Mediterranean after the earthquake in
Pakistan.
The recommendations mentioned above (2) emphasized four core functions of the Regional Office
in emergencies:
1. to gather and share relevant health information;
2. to identify gaps in preparedness and response;
3. to ensure coordination of health action; and
4. to strengthen the capacity of local systems.
Resource generation
PharmaceuticalsPharmaceuticals The Regional Office supported policies, strategies and regulations for pharmaceuticals, and strategies
for the rational use of medicines, with particular emphasis on access to medicine, ensured through
either selection or reimbursement policies.
Floods, such as this in Romania in 2005, are the most common natural disaster in the Region
© S
ca np
ix
14 The work of WHO in the European Region, 2004–2005
Many countries across the Region have benefited from programmes to improve the mechanisms
for medicine selection and regulation, access to ARV, the containment of antimicrobial resistance, and
patient safety.
In the area of pharmacy practice, the Regional Office issued a CD-ROM (3), collating all the model
programmes of the EuroPharm Forum and providing tools for running professional programmes at the
national level, in May 2005.
Human resources for healthHuman resources for health Human resources for health are crucial to health systems; lack of them hinders the scaling up of
priority health interventions and the attainment of the MDGs. During the biennium, activities were
implemented in Member States across the Region on staff migration, the accreditation of basic
medical educational programmes with the World Federation for Medical Education, and nursing.
Publications were issued on, for example, programmes of basic nursing and midwifery education in
Europe (4) and the implementation of the Munich Declaration on nurses and midwives as a force for
health (5). The Regional Office met with the government chief nurses from 85% of the countries in
the Region, in December 2005, to discuss educational issues.
Clinical technologyClinical technology Clinical technology activities focused on policy development, quality management programmes,
patient safety, HIV/AIDS prevention and blood safety.
As part of the 3 by 5 initiative, the Regional Office supported the prevention of nosocomial HIV/
AIDS transmission, as well as the strengthening of the quality of care delivery and patient safety.
A forum in April 2005 in Austria, involving all western European countries, enhanced dialogue
among Member States on patient safety issues. In November 2005, the Regional Office organized a
meeting on patient safety, held in London and hosted by the United Kingdom EU presidency, with the
52 European Member States.
e-healthe-health Member States’ needs for e-health support and services from the Regional Office increased
substantially throughout the biennium, in response to both rising e-readiness (people’s mental
receptiveness and infrastructures’ technical capacity) and the roles and responsibilities detailed in a
2005 World Health Assembly resolution (6). The first worldwide analysis of the e-health situation in all Member States was performed in 2005
with 52% of European Member States responding and illustrating this increase. The results (7) were
used to develop a credible and achievable Regional Office strategy and corresponding work plan.
Based on the survey, several seminars took place in 2005 to better focus the Regional Office’s
e-health activities. As a result, a position paper was drafted that should lead to a strategy to guide the
Regional Office’s future activities.
15Health systems
Health financing
Activities comprised mainly country work, based on a framework that facilitates country-specific
analysis of the performance, organization and context of health financing systems as a basis for
assessment and recommendations. Work took place in many Member States across the Region, focusing
principally on dialogue, analysis and recommendations on health financing policy. In addition, guidance
was provided on the use of national health accounts.
A new development was the start of work on the intersection of health financing with specific
disease control or other vertical programmes. For example, the Regional Office programmes on health
financing, TB and HIV/AIDS worked together to address health-system obstacles to the effective
delivery of TB and HIV interventions in the Baltic countries.
At the regional level, the Regional Office and the World Bank Institute, under a formal partnership
agreement, delivered seven Flagship training courses during the biennium (four Region-wide, two for
groups of countries and one for a single country) on health sector reform and sustainable financing
and on poverty, equity and health systems. Beyond capacity building, these courses provided an
important avenue for the dissemination of the Office’s approach to health financing policy in the
Region.
An intensive effort was made to improve the quality of the estimates of health expenditure in
countries in the European Region that are produced each year for the world health report (8). The result
was the reduction of the previous underreporting of private health spending for many of the countries
in the eastern part of the Region.
The Regional Office aims to build on the accomplishments of the biennium to promote shared
learning from the evidence. In particular, the framework for health financing systems mentioned above,
the experience gained from supporting countries and the improved health expenditure estimates will
all contribute to a new study by the Regional Office and the European Observatory on Health Systems
and Policies on lessons on implementing health financing reforms from and for countries in transition.
Stewardship and governance of the health sector
Role of the ministry of healthRole of the ministry of health Strengthening the ministry’s stewardship role has been a priority for health system development in
many countries. The CIS countries and CCEE face significant challenges in transforming their health
ministries from the providers of health services into the stewards of the system. This requires political
will, organizational reform and intensive capacity building. In the biennium, the Regional Office
supported Member States by:
• offering policy advice and guidance in developing their national health policy documents and
strategic plans for the health sector;
16 The work of WHO in the European Region, 2004–2005
• providing evidence on effective policies and facilitating the exchange of experience among
countries; and
• organizing policy dialogues and stakeholders’ fora.
Examples of this include:
• a policy dialogue in Tallinn, Estonia in 2005 on health financing reforms;
• policy dialogues in Moscow, Russian Federation on primary health care, in Georgia on stewardship
and financing, in Kyiv, Ukraine on options for health system reform, and in Vilnius, Lithuania on
human resources policies to improve overall health system performance;
• a meeting in Madrid in April 2005, bringing together senior decision-makers from Bulgaria,
Croatia, Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, the Netherlands,
Poland, Romania, Slovakia, Slovenia, Spain, the United Kingdom and Turkey, with participation by
the EC; and
• a workshop in Banja-Luka, Bosnia and Herzegovina in November 2005 on the appropriate public/
private mix in and the regulation of the health sector.
In other countries, such as Armenia and Kazakhstan, the Regional Office started the process to
establish and institutionalize assessment of health system performance.
Futures Fora Futures Fora The Regional Office organized four Futures Fora for senior policy-makers from countries in which the
Regional Office does not have country offices. The Fora give policy-makers a platform for sharing
know-how and experience in steering their health systems to cope with emerging public health
challenges.
• The forum on crisis communication, hosted by Iceland, generated a set of options and tools to
assist chief government health policy-makers in communicating during crises, based on country
case studies on SARS, avian influenza and dioxin exposure in the environment.
• The forum on unpopular decisions in public health, in Malta, put forward different means of
easing the adoption of measures on, for example, tobacco control, alcohol harm reduction,
hospital bed closures and health service user charges.
• The forum on governance of patient safety, in Austria, channelled the impetus of the global
alliance on patient safety into the European Region, building on the activities of the United
Kingdom EU presidency in the second half of 2005.
• The forum on health systems and public participation delivered a logical framework and specific
tools for leading health policy-makers to increase public involvement in policy decision-making.
17Health systems
The Regional Office publishes the findings of the Fora as policy briefs in English and Russian (9), and health ministries translate some of them into local languages.
References
1. Country information [web site]. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.
euro.who.int/countryinformation).
2. Strengthening health systems’ response to crisis: towards a new focus on disaster preparedness. Report on a WHO workshop, Skopje, The former Yugoslav Republic of Macedonia, 13–15 July 2004. Copenhagen, WHO Regional Office for Europe, 2005 (http://www.euro.who.int/document/
e87920.pdf).
3. de Boer W, Bult K, Teräsalmi E et al. The EuroPharm Toolbox. A CD-ROM for professional management. Copenhagen, WHO Regional Office for Europe, 2005 (http://www.euro.who.int/
eprise/main/WHO/Progs/EPF/Activities/20050720_1).
4. Fleming V, Holmes A. Basic nursing and midwifery education programmes in Europe. Copenhagen,
WHO Regional Office for Europe, 2005 (http://www.euro.who.int/document/e86582.pdf).
5. Büscher A, Wagner L. Munich Declaration: Nurses and Midwives: a Force for Health. Analysis of implementation of the Munich Declaration 2004. Copenhagen, WHO Regional Office for Europe,
2004 (http://www.euro.who.int/document/e86640.pdf).
6. World Health Assembly resolution WHA 58.28 on eHealth. In: Fifty-eighth World Health Assembly. Geneva, 16–25 May 2005. Resolutions and decisions annex. Geneva, World Health Organization,
2005:108–110 (document WHA58/2005/REC/1; http://www.who.int/gb/ebwha/pdf_files/WHA58-
REC1/english/Resolutions.pdf).
7. E-health tools and services. Needs of the Member States. Geneva, World Health Organization,
2006 (http://www.who.int/kms/initiatives/tools_and_services_final.pdf).
8. The world health report [web site]. Geneva, World Health Organization, 2006 (http://www.who.int/
whr/en).
9. Futures Fora. Publications [web site]. Copenhagen, WHO Regional Office for Europe, 2006 (http://
www.euro.who.int/futuresfora/publications/publications).
18 The work of WHO in the European Region, 2004–2005
Spent: US$ 32 843 283
Proportion of total expenditure: 20.5%
Staff: 95, including 47 in the field
Despite substantial recent progress in control in most Member States, communicable diseases
continue to be an important cause of illness and death, and thus remain a major public health priority
in the Region. Key priorities include surveillance and response, immunization systems and the control
of vaccine-preventable diseases, TB, STIs and HIV/AIDS, and malaria.
The Regional Office has increasingly supported Member States in developing and improving
policies, systems and interventions to reduce mortality and morbidity from major communicable
diseases, as well as rapidly to detect, identify and respond to threats from epidemic-prone, pandemic
and emerging infectious diseases. Avian influenza and countries’ preparedness for a possible new
pandemic influenza virus have recently come into special focus.
Surveillance and response
Fighting communicable diseaseFighting communicable disease The Regional Office supported national capacities to detect and react to outbreaks. Several key areas
were further developed: strengthening advocacy and partnerships, developing early-warning and
response capacity at both the country and regional levels, strengthening national surveillance systems
in general and strengthening networks to improve collaboration between countries.
As part of the revision of the International Health Regulations (1), a regional consultation was held
with all 52 Member States in the Region, financially supported by the Government of Switzerland.
Capacity buildingCapacity building Priority was given to supporting countries in SEE and the CIS, where surveillance systems are not yet
fully adapted for the timely detection and investigation of and response to infectious disease events.
In-depth assessments were made in Bulgaria and Kazakhstan, leading to an EU-funded project to
improve the surveillance system in Bulgaria. Technical assistance was given to 20 countries, including
national workshops on communicable diseases, and technical expertise to assist Member States in
preparing national plans and project proposals to strengthen surveillance systems.
Other work sought to strengthen the prevention and control of priority diseases in selected
countries, early warning systems and the use of geographical information systems. The Regional
Office also supported national plans to contain the threat of antimicrobial resistance. Two major
3. Communicable diseases
19Communicable diseases
disease outbreaks were investigated: Q-fever in Bosnia and Herzegovina and Crimean–Congo
haemorrhagic fever in Turkey.
In addition, workshops were organized for the countries participating in the Social Cohesion
Initiative of the Stability Pact for South Eastern Europe, in connection with a consultation on
hospital-acquired infections.
The Office indirectly supported the 25 Member States of the EU by taking part in advisory and
expert fora, such as the health security group of DG SANCO and the advisory board of ECDC.
Finally, the Office’s capacity for outbreak alert, verification and response was strengthened, and
a more systematic approach to the rumour alert and follow-up process with Member States was
established.
Scaling up advocacy and partnershipsScaling up advocacy and partnerships Advocacy and partnership relations have been nurtured by a regularly updated web site (2), and a
quarterly bulletin, CD news (3). The Office received funding or secondments for communicable disease work from the EC, the
governments of France, Belgium, Sweden, Switzerland and the United Kingdom, a partnership
programme in the Netherlands, and the Asian Development Bank.
Avian influenza and influenza pandemic threats
The threat of an influenza pandemic has been debated for several years and – with the increasing
spread of the avian influenza H5N1 virus in southern Asia – has become a concern for Member States
in the European Region, especially for countries bordering China, such as Kazakhstan, Kyrgyzstan,
the Russian Federation and Tajikistan. During 2004, discussions among several Member States and
DG SANCO led to an initiative to strengthen national preparedness plans for a possible new pandemic
influenza virus. The Regional Office organized a first regional workshop on pandemic preparedness
planning in collaboration with DG SANCO in March 2005, and a second with DG SANCO and ECDC in
October 2005 (4,5). The first outbreaks of H5N1 were reported in the Russian Federation and Kazakhstan in the
summer of 2005. Joint missions of technical experts from the Regional Office, DG SANCO and ECDC
visited six countries to assess the strengths and weaknesses of their national preparedness plans
for influenza and, increasingly, avian influenza. More attention was given to improving seasonal
influenza surveillance, particularly laboratory capacity to diagnose human influenza in all Member
States.
In addition, the Regional Office led technical missions to strengthen national preparedness plans
in six countries (Greece, Kazakhstan, Poland, Romania, Turkey and the United Kingdom) and to
undertake assessments of the risk of H5N1 transmission from poultry to human beings in affected
countries, which included Romania and Ukraine in 2005. Finally, the Office joined missions to support
20 The work of WHO in the European Region, 2004–2005
the development of national integrated project proposals for capacity building in national pandemic
influenza plans, coordinated by the World Bank.
Vaccine-preventable diseases and immunization
Sustained progress against vaccine-preventable diseasesSustained progress against vaccine-preventable diseases The Regional Office has developed a number of disease-control initiatives for polio eradication,
diphtheria control, measles and rubella elimination, and the prevention of congenital rubella
infection. They provide a major opportunity to boost routine immunization programmes.
The Region has made progress in the provision and maintenance of immunization services. Most
countries have over 90% coverage with routine vaccines. The introduction of new and underused
vaccines into routine immunization programmes has accelerated across the Region. Notably, rubella
vaccine is now used in 48 countries, while universal hepatitis B immunization was introduced in 44.
By 2005, 33 countries had introduced and routinely implemented immunization with Hib vaccine; a
remarkable reduction of reported Hib incidence followed in most of these countries.
A great achievement and historic milestone was the certification of the Region as polio free in
June 2002. During the biennium, the Region retained this status through strong polio surveillance and
Most countries in the Region have over 90% coverage with routine vaccines
© W
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21Communicable diseases
quality-assured laboratory work (6). In 2005, it became the first WHO region ever to complete phase I
of containment for polioviruses.
The elimination of measles and rubella and the prevention of congenital rubella infections moved
closer as 28 countries met the measles-elimination criterion: an incidence of less than 1 per million in
2005. The Regional Office supported campaigns against measles and rubella in Belarus, Cyprus, Italy,
Kazakhstan, Tajikistan and Turkey, with the largest targeting 19.8 million children. The 2005 Regional
Committee resolution on measles and rubella elimination and the prevention of congenital rubella
infection (7) ensured political commitment to and priority for the target. The strategy (8) is to improve
surveillance and immunization coverage by strengthening routine immunization systems, an approach
unique among WHO regions.
Building capacity for immunizationBuilding capacity for immunization The Regional Office focused its support to countries on building capacity to strengthen immunization
systems, promoting safe, high-quality immunization practices and improving surveillance and
monitoring. Member States received policy and technical support:
1. in developing and revising their national immunization policies and plans;
2. for training to build managerial and technical capacity at the national and district levels;
3. in monitoring and assessing performance;
4. in coordinating activities; and
5. for advocacy, communication and partnership.
For instance, country-tailored projects were carried out to strengthen information management
systems and monitor district-level performance in Belarus, Bulgaria, the Republic of Moldova and
Ukraine. A strategy called Reaching Every District (9) used innovative methods – such as sustainable
outreach in Armenia, Azerbaijan, Georgia and Tajikistan – to reach hard-to-reach vulnerable
populations.
Governments’ understanding of the costs, financing mechanisms and efficacy of immunization
programmes was improved, particularly in GAVI-eligible countries. This further reaffirmed countries’
ownership of immunization services and responsibility for ensuring that they are sustainable, of good
quality and accessible by all population groups. The Office gave technical support, including training,
to countries to ensure sustainable long-term national immunization plans.
Continued improvements were made to CISID (10), a web-based tool for collecting, analysing and
monitoring information on infectious diseases.
Scaling up advocacy of immunizationScaling up advocacy of immunization The first European Immunization Week (11), in October 2005, was hailed as a success. At least
10 Member States took part, 6 with technical and (in some instances) financial support from the
22 The work of WHO in the European Region, 2004–2005
Office: Belarus, Ireland, Italy, Serbia and Montenegro, Tajikistan and The former Yugoslav Republic of
Macedonia.
The goal was to raise awareness of and advocate immunization, with the core message that
immunizing every child is vital. Member States used the Week:
• to promote safe immunization practices;
• to provide information to health care providers and parents;
• to advocate immunization to particular communities; and/or
• to improve vaccine coverage among vulnerable populations.
The initiative will be an annual event, involving a growing number of Member States.
Funding and partnershipsFunding and partnerships Collaboration continued with traditional partners such as UNICEF, CDC, USAID, GAVI, CIDA, the
Government of the Netherlands, the Children’s Vaccine Programme of PATH, Rotary International and
the World Bank.
Closer links were established with new partners, particularly ECDC, the Vishnevskaya-Rostropovich
Foundation, the March of Dimes and the Hib initiative. WHO partners in the GAVI-funded Accelerated
Development and Introduction Plans for new vaccines include CDC, Johns Hopkins University and the
London School of Hygiene and Tropical Medicine.
Key challengesKey challenges Some 600 000 children across the European Region still remain unvaccinated and thus susceptible
to preventable diseases. Vulnerable population groups still exist in every country, reflecting great
disparities in immunization coverage rates between and within countries. The key challenges are
securing resources, political commitment and public awareness, and maintaining demand for
immunization services.
Responding to the TB crisis
Fighting TBFighting TB TB is out of control in many CCEE and members of the CIS. As a result, the Regional Committee called
for a scaled-up response in 2002 (12). Of the 52 Member States, 43 are implementing the DOTS strategy to varying extents (including
all CIS countries), up from 34 in 2001. Some 30 countries have implemented DOTS countrywide as a
national TB control strategy. On average, 47% of the population in the Region is currently provided
with services using the DOTS strategy, up from 17% in 2001.
As a response to the European epidemic of MDR-TB, DOTS-Plus pilot projects were strengthened
in Estonia, Latvia and three oblasts in the Russian Federation. Further, 11 new projects were approved
23Communicable diseases
in 8 countries (Azerbaijan, Georgia, Kyrgyzstan, Lithuania, the Republic of Moldova, Romania, the
Russian Federation and Uzbekistan) in collaboration with the WHO Green Light Committee. In
addition, a WHO collaborating centre for research and training in management of MDR-TB was
established at the State Centre of Tuberculosis and Lung Diseases of Latvia at the end of 2004.
A grant from GTZ enabled the Regional Office to help prepare proposals with TB components
for the Global Fund to Fight AIDS, Tuberculosis and Malaria. In the fifth round of applications,
12 countries got help from the Office in making proposals, 8 countries submitted proposals to the
Fund, and 4 had their proposals approved.
Capacity buildingCapacity building Enabling health systems to achieve more effective TB control is one of the main priorities for the
Region. This was discussed at a technical advisory group meeting in 2005, using a paper on the
challenges and opportunities for the health systems of the Baltic and CIS countries.
Working closely with many other technical and financial partners, the Regional Office is
the leading partner for TB control in countries. With the Regional Office’s enhanced TB control
programmes at both the Region level and in country offices in Balkan countries, the Caucasus, central
Asia, the Russian Federation and Ukraine, TB control in the Region has substantially improved.
In addition, to facilitate the response to the sharp increase in HIV-related TB, the Regional Office
launched two projects on TB/HIV co-infection. One, supported by the French Government, focused
on the Baltic countries, and the other, supported by the Netherlands Government, covered human
resource development in the Region and in groups of countries.
Key challengesKey challenges TB remains a serious public health problem in the Region, causing a reported nearly 69 000 deaths
and almost 450 000 new cases in 2004, with 80% of cases occurring in the eastern part of the Region.
These are some of the highest figures in two decades. In western Europe, social marginalization and
immigration from countries with high TB burdens have resulted in spots of increasing incidence,
especially in large cities.
Major constraints on effective TB control in the Region are the high rate of MDR-TB, mostly in the
countries of the former USSR, the rapid growth of the HIV epidemic in the eastern part of the Region
and the still limited political and financial commitment to TB control.
The WHO Regional Director for Europe declared TB a regional emergency in February 2005, in a
letter calling on all Members States facing a high TB burden to increase their expenditure on rational,
health-systems-based strategies to tackle the disease and the social conditions that encourage it. The
Regional Director also called on the Region’s wealthier countries and the EU to pay more attention
to the crisis and to increase their financial contribution to TB control. A ministerial forum for the
European Region will be held in October 2006.
24 The work of WHO in the European Region, 2004–2005
STIs and the HIV/AIDS epidemic
Since the Regional Committee called for a stronger response to HIV/AIDS in 2002 (13), STIs and the
HIV/AIDS epidemic have been a top Regional Office priority. An estimated 2.3 million people in the
European Region live with HIV/AIDS, and HIV cases and AIDS deaths are rising significantly.
During the biennium, numerous STI outbreaks were documented throughout the Region.
Outbreaks of syphilis, gonorrhoea, chlamydia and other STIs often disproportionately affect vulnerable
groups, such as men who have sex with men or people living with HIV/AIDS. They are indicators of an
overall weakening of prevention efforts in the Region.
Meeting the 3 by 5 regional targetMeeting the 3 by 5 regional target People who have HIV and live in countries that provide HAART, can lead almost normal lives, with
significantly better quality of life and extended life expectancy.
The WHO/UNAIDS 3 by 5 initiative aimed to increase access to this life-saving treatment. The
European Region met its target: significantly to expand the number of countries providing HAART and
to enrol an additional 100 000 patients in treatment programmes. Yet the treatment gap continues
to grow, as does the number of people acquiring HIV and progressing to AIDS, especially in eastern
Europe.
With the initiative over, it is time to consider how best to move quickly towards satisfying the
basic objective of the global WHO plan (14): universal access to prevention, treatment, care and
support services by 2010.
Normative guidance and technical assistanceNormative guidance and technical assistance To scale up access to ART, health care professionals were equipped with the most up-to-date advances
in the treatment and care that should be offered to people living with HIV/AIDS. In 2004, the Regional
Office published HIV/AIDS treatment and care protocols for the CIS (15). These are being revised and
expanded.
A significant decrease in the price of ARV was achieved by the end of 2005, through grants from
the Global Fund to Fight AIDS, Tuberculosis and Malaria and loans from the World Bank for HIV/AIDS
programmes in 19 Member States, and with support from Regional Office country teams. In a number
of countries, the Office played a key role in:
• pilot-testing the successful mobilization of resources to expand harm-reduction activities;
• strengthening the involvement of people living with HIV/AIDS in decision-making and ART service
delivery;
• supporting the adoption of standardized evidence-based European therapy regimens; and
• training service-providers in ART and key prevention interventions.
25Communicable diseases
Capacity buildingCapacity building The Regional Office and GTZ collaborated on building capacity to scale up HIV/AIDS responses. By
pooling knowledge and expertise from the entire Region, they worked to create sustained mechanisms
for developing human resources for STI/HIV/AIDS prevention, treatment and care. Three knowledge
hubs were created (16):
• in Zagreb, Croatia on STI/HIV/AIDS surveillance, monitoring and evaluation;
• in Vilnius, Lithuania on harm reduction for injecting drug users; and
• in Kyiv, Ukraine on HIV/AIDS treatment and care.
They developed training curricula and materials based on WHO guidance and standards for
high-quality, continuing training.
Over 40 courses were given during the biennium to more than 700 health care providers from
almost all the CCEE. The goal was to equip them with core competencies to introduce and scale up
STI/HIV/AIDS prevention, treatment and care.
Funding and partnerships Funding and partnerships Since the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia (17) in
February 2004, the Regional Office developed and strengthened strategic partnerships with the
EC, including ECDC and the EMCDDA; research centres, such EuroHIV and the Copenhagen HIV
Programme; and NGOs, such as EATG, CEE-HRN and AIDS Action Europe.
Key challengesKey challenges At the end of 2005, priority challenges included reducing the pervasive stigma of HIV/AIDS and
discriminatory attitudes among health providers, and removing legal barriers to essential prevention,
treatment and care services for vulnerable groups.
Closing the gap between east and west, and ensuring the sustainable provision of universal
STI/HIV/AIDS prevention, treatment and care, require the reorganization of service delivery systems.
These will enable and maintain access to safe, effective, affordable and equitable commodities and
programmes.
Intensifying the response to malaria
Fighting malariaFighting malaria The fight against malaria intensified after the endorsement of a Regional Committee resolution
(18) in 2002. The aim is to reduce the impact of malaria on the population’s health to the lowest
possible level achievable with the available financial and human resources and the existing control
technologies and tools.
26 The work of WHO in the European Region, 2004–2005
The Regional Office supported countries in preventing deaths due to malaria, containing
epidemics, further reducing incidence, preventing the re-establishment of malaria transmission, and
maintaining the malaria-free status of countries and territories from which the disease had been
eliminated. To do so, the Regional Office focused on:
1. intensifying action by the Roll Back Malaria partnership in the Region and in groups of countries;
2. enhancing national capacities for decision-making;
3. investing in human resources development and capacity building;
4. improving capacities for disease management;
5. strengthening capacities for containing and preventing epidemics;
6. promoting cost-effective preventive measures;
7. strengthening surveillance and operational research capabilities;
8. ensuring community mobilization; and
9. enhancing intersectoral collaboration.
During the biennium, all malaria-affected countries supported by the Regional Office and its
partners took all possible epidemic-containment measures.
During the biennium, the Global Fund to Fight AIDS, Tuberculosis and Malaria gave grants to
Kyrgyzstan, Tajikistan and Uzbekistan, to support their national response to malaria. As a result, the
number of reported cases fell by almost a third from 2003 to 2005. A large regional epidemic was
curbed and malaria incidence was reduced so much that interruption of its transmission in some
countries may become feasible in the coming years.
Key challengesKey challenges A unique opportunity to move from malaria control to elimination was created. To confirm their
intent to take up this challenge, all malaria-affected countries in the Region endorsed a declaration
on moving from malaria control to elimination (19) in Tashkent, Uzbekistan in 2005.
Despite the conspicuous achievements in the fight against malaria, national control programmes
continue to face a number of problems and constraints, mainly financial.
References
1. International Health Regulations (IHR) [web site]. Geneva, World Health Organization, 2006
(http://www.who.int/csr/ihr/en/).
2. Communicable disease surveillance and response [web site]. Copenhagen, WHO Regional Office for
Europe, 2006 (http://www.euro.who.int/surveillance).
3. CD news [web site]. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro.who.
int/surveillance/publications/20030422_2).
27Communicable diseases
4. Pandemic influenza preparedness planning. Report on a joint WHO/European Commission workshop, Luxembourg, 2–3 March 2005. Copenhagen, WHO Regional Office for Europe, 2005
(http://www.euro.who.int/Document/E86578.pdf).
5. Pandemic influenza preparedness planning. Report on the second joint WHO/European Commission workshop, Copenhagen, 24–26 October 2005. Copenhagen, WHO Regional Office for
Europe, 2006 (http://www.euro.who.int/document/E88206.pdf).
6. Polio eradication [web site]. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro.
who.int/vaccine/20030724_4).
7. WHO Regional Committee for Europe resolution EUR/RC55/R7 on strengthening national immunization systems through measles and rubella elimination and prevention of congenital rubella infection in WHO’s European Region. Copenhagen, WHO Regional Office for Europe, 2005
(http://www.euro.who.int/Governance/resolutions/2005/20050920_3).
8. Eliminating measles and rubella and preventing congenital rubella infection. WHO European Region strategic plan, 2005–2010. Copenhagen, WHO Regional Office for Europe, 2005 (http://
www.euro.who.int/eprise/main/who/InformationSources/Publications/Catalogue/20051123_1).
9. The RED strategy [web site]. Geneva, World Health Organization, 2006 (http://www.who.int/
immunization_delivery/systems_policy/red/en/index.html).
10. CISID [online database]. Copenhagen, WHO Regional Office for Europe, 2006 (http://data.euro.
who.int/cisid).
11. European Immunization Week [web site]. Copenhagen, WHO Regional Office for Europe, 2006
(http://www.euro.who.int/vaccine/20050608_1).
12. WHO Regional Committee for Europe resolution EUR/RC52/R8 on scaling up the response to tuberculosis in the European Region of WHO. Copenhagen, WHO Regional Office for Europe, 2002
(http://www.euro.who.int/Governance/resolutions/2002/20021231_5).
13. WHO Regional Committee for Europe resolution EUR/RC52/R9 on scaling up the response to HIV/ AIDS in the European Region of WHO. Copenhagen, WHO Regional Office for Europe, 2002 (http://
www.euro.who.int/Governance/resolutions/2002/20021231_4).
14. WHO’s contribution to universal access to HIV/AIDS prevention, care and treatment. Geneva, World Health Organization, 2006 (http://www.who.int/hiv/universalaccess2010/
UA2010document._en_12may06.pdf).
15. HIV/AIDS treatment and care. WHO protocols for CIS countries. Version 1. Copenhagen, WHO
Regional Office for Europe, 2004 (http://www.euro.who.int/document/e83863.pdf).
16. WHO/GTZ back-up initiative. Knowledge hubs: strengthening countries’ capacity to get access and
use large grants [web site]. Copenhagen, WHO Regional Office for Europe, 2004 (http://www.euro.
who.int/aids/partners/20040319_1).
17. Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia. Copenhagen,
WHO Regional Office for Europe, 2004 (http://www.euro.who.int/aids/treatment/20051018_1).
28 The work of WHO in the European Region, 2004–2005
18. WHO Regional Committee for Europe resolution EUR/RC52/R10 on scaling up the response to malaria in the European Region of WHO. Copenhagen, WHO Regional Office for Europe, 2002
(http://www.euro.who.int/Governance/resolutions/2002/20021231_3).
19. Experts say WHO European Region ready to move from malaria control. Malaria-affected countries sign a declaration in Tashkent, Uzbekistan. Copenhagen, WHO Regional Office
for Europe, 2005 (Note for the Press EURO 18/05; http://www.euro.who.int/PressRoom/
pressnotes/20051020_2).
29Noncommunicable diseases
Spent: US$ 19 021 388
Proportion of total expenditure: 11.9%
Staff: 53, including 5 in the field
Good progress was made in the areas of noncommunicable diseases, lifestyles, health determinants,
and family and community health.
At the Region level, strategic frameworks and regional action plans were developed and adopted
for alcohol policy, child and adolescent health and development, and mental health (following a
WHO conference in January 2005). The Regional Office facilitated the Region-wide coordination of
acceptance of the WHO Framework Convention on Tobacco Control – the first globally binding public
health treaty. At the end of 2005, over half the countries in the Region, and the EC, were Parties to the
Convention. The development of a European strategy on noncommunicable diseases reached its final
stage, and work began on counteracting obesity, particularly including preparations for a ministerial
conference in 2006.
Achievements of Region-wide importance include: the development or update of regional
databases and information systems on alcohol, nutrition, obesity and tobacco; the launch of the
fourth phase of the Healthy Cities project; the enlargement of the European prison health network
to include over half the countries in the Region; and a review of the capacity of health promotion
systems in 16 European countries to address socioeconomic determinants of health.
The Regional Office also worked with groups of countries, through projects and activities such as:
• building support for mental health services and for the Framework Convention on Tobacco Control
within the countries covered by the Social Cohesion Initiative of the Stability Pact for South
Eastern Europe;
• taking part in the working group on social inclusion, lifestyles and work ability of the Northern
Dimension Partnership;
• building capacity for tobacco control in the CIS; and
• networking for a health-system-oriented, integrated approach to reproductive health, gender, and
maternal, child and adolescent health in the Region.
The Office provided technical support to many countries, particularly in the central and eastern
parts of the Region. Some particular achievements were related to the development and adoption
of new national legislation and programmes, such as the Public Health Law in Greece, national
action plans for tobacco in Armenia and Lithuania, and national nutrition programmes in Bulgaria,
4. Noncommunicable diseases
30 The work of WHO in the European Region, 2004–2005
Georgia and Hungary. Work was also carried out in countries to strengthen national capacity, improve
surveillance and monitoring, raise public awareness and support multisectoral mechanisms. Work in
the western countries in the Region included support to the Greek Government in developing the
public health plan for the 2004 Olympic Games in Athens, and joint planning and organization of
thematic workshops for the United Kingdom’s EU Presidency summit on inequalities and health.
Noncommunicable disease prevention and control
In 2004, the Regional Committee decided to give high priority to noncommunicable diseases and
to develop a comprehensive, action-oriented strategy for the Region by 2006 (1). It will focus on
implementation, taking account of the specific characteristics of and diversity within the European
Region, and be prepared in collaboration with Member States, intergovernmental agencies, NGOs and
other relevant partners.
Mental health
In January 2005, the Regional Office, in partnership with the EC and the CE, organized the first
Ministerial Conference on Mental Health, hosted by the Finnish Government in Helsinki (2). The
Mental Health Declaration for Europe (3) was signed at the Conference and endorsed by the Regional
Committee in September 2005. In the Declaration, health ministers recognize the urgency of facing
the challenges and building solutions in mental health. The Mental Health Action Plan for Europe (4) sets out the details of the commitments and the responsibilities of both Member States and WHO, as
stipulated in the Declaration. It gives 12 priority areas of action, such as promoting mental wellbeing,
incorporating mental health as a vital part of public health policy, reducing stigma and discrimination,
targeting services for different stages of life and ensuring access to good primary health care.
After the Conference, the Regional Office prepared an implementation plan for 2005–2010 as a
framework for its activities to carry out the Action Plan, identifying the resources required to deliver
them. A network of WHO collaborating centres in Finland, Italy, the Netherlands, Sweden and the
United Kingdom was established to support work on disorder prevention, mental health promotion,
stigma and discrimination, service delivery, information and dissemination, and research. A European
network was created to empower service users and caregivers, involving leading European NGOs.
Partnership with the EC was strengthened through close collaboration with DG SANCO on the
development of a green paper (5), and the organization with the United Kingdom EU Presidency
of an event on inequality and mental health in November 2005. The EC is supporting a project
on benchmarking progress towards meeting the milestones of the Declaration and Action Plan.
Partnership with the CE may involve a project on legislation.
Country activities included participating in and supporting assessments of countries’ needs for
and supply of mental health services, supporting the development of national policies and legislation,
31Noncommunicable diseases
supporting the development of pilot community mental health centres and accommodation, and
organizing seminars for mental health staff. A priority is the development of workforce capacity,
particularly the role and competencies of nurses and social workers.
Family and community health
In 2005, 14 countries in the Region marked World Health Day with activities on the theme “Make
every mother and child count” (6), including meetings, conferences, round-tables, seminars,
presentations and debates involving health professionals, decision-makers, partners and other
stakeholders including the public. Through the event, the Regional Office publicized many facts and
figures on maternal and child health in the Region.
The Regional Committee adopted the European Strategy for Child and Adolescent Health and
Development (7) in 2005, after two years’ consultation with Member States. Its purpose is to assist
Member States in formulating their own policies and programmes. The Strategy and an associated
toolkit (7) will enable Member States to identify any gaps in their plans and clarify their priorities for
future investment. The Strategy also provides an umbrella for the many evidence-based initiatives
currently being promoted by the Regional Office to support the health and development of children
and adolescents.
The Regional Office took a health-system approach to implementing integrated policies and
strategies on reproductive health, gender, and maternal, child and adolescent health. A meeting of
focal points in countries was organized in Antalya, Turkey in April 2005 to discuss how the Regional
Office and its partners could help countries integrate their policies and strategies in these areas.
Representatives of 18 Member States and many international partners acknowledged existing
conceptual frameworks for national policies on family and community health, and emphasized the
need for better integration of specific or targeted interventions into health systems, to improve
implementation in countries. This calls for closer collaboration between governments, health systems
specialists and family and community health experts at both the national and international levels.
Social and economic determinants of health
Through its office in Venice, Italy, the Regional Office assessed the relationship between
macroeconomic factors and health in low-, middle- and high-income countries in the Region.
The Regional Office has worked in synergy with the efforts of the global Commission on Social
Determinants of Health since its launch in March 2005. In particular, this initiative enabled an initial
review of the evidence on socioeconomic inequalities in health and the effectiveness of measures to
address them. The results will be available to Member States late in 2006.
The collection of case studies – on how health systems can confront the health inequalities caused
by socioeconomic factors such as poverty – was expanded during the biennium.
32 The work of WHO in the European Region, 2004–2005
Nutrition and food security
The Regional Office supported the development of food and nutrition policy in the Region, through
the implementation of the first regional action plan (8). A recent analysis of nutrition policies in
Member States indicated that 45 out of 52 countries have final or draft such policy documents, as a
specific action plan or as part of national public health programmes of a broader coverage.
Healthy nutrition still needs to be strengthened, however, as a detailed and comprehensive
action plan with sufficient enforcement does not always follow the adoption of a food and nutrition
policy. In 2005, the Regional Office, in collaboration with Member States, started evaluating the
implementation of the first European action plan and developing the second.
Almost all countries in the Region now have a food and nutrition policy, which advocates healthy eating ©
Sc an
pi x
33Noncommunicable diseases
The Regional Office engaged in nutrition surveillance by collecting anthropometric data on
children, adolescents and adults, and by collecting and analysing country-level data, which will
become accessible through an online database later in 2006. Overall surveillance still has to be
standardized and improved, and the Office is creating a network of centres for the collection of data
on nutritional status and related behaviour in childhood.
The Regional Office is focusing on counteracting obesity as a public health problem of particular
magnitude and difficulty. It is organizing a European Ministerial Conference in November 2006,
hosted by the Turkish Government in Istanbul, with support from the EC and several other
international partners, such as the CE, FAO, the World Bank, and the International Obesity Task Force
(9). A series of consultations with Member States, experts and other stakeholders began during the
biennium.
Tobacco control
Tobacco control has been high on the agenda of the Regional Office, particularly since the Warsaw
Ministerial Conference and the adoption of the European Strategy for Tobacco Control in 2002
(10). The focus is now on facilitating awareness of, coordination of and commitment to the
implementation of the WHO Framework Convention on Tobacco Control (11). The Regional Office
organized high-level intersectoral meetings to support the Convention in countries, with the
governments of the Czech Republic, Serbia and Montenegro, and central Asian and SEE countries.
These consultations encouraged Member States to sign and ratify the Convention (12). The Strategy and Convention are international instruments that strengthened the development of
national policies and legislation. The Regional Office provided technical support to several countries,
particularly in the eastern part of the Region, in developing and adopting national action plans,
strategies and programmes, and in reviewing and updating their legislation. It has also supported the
creation of tobacco-control resource centres in countries.
During the biennium, the Office organized training and workshops in several countries to build
capacity within governments and civil-society networks.
Finally, a project within the Social Cohesion Initiative of the Stability Pact for South Eastern
Europe supported both political commitment to the ratification and entry into force of the
Convention, and national capacity for tobacco control in the eight SEE countries.
Alcohol
Work on alcohol policy focused on the implementation of the European Alcohol Action Plan
2000–2005 (13) and the Declaration on Young People and Alcohol (14). A renewed network of
national counterparts reviewed the implementation of the Plan and launched a new phase of regional
policy in a meeting in Sweden in April 2005.
34 The work of WHO in the European Region, 2004–2005
The Regional Committee adopted a framework for alcohol policy in the European Region (15) in
September 2005. The new policy presents strategic guidance and policy options, particularly reflecting
recent developments and new challenges in alcohol policy in the Region. It also maintains and
reinforces the core principles and measures of the Action Plan, the European Charter on Alcohol (16) and the Declaration to ensure consistency and continuity.
The European alcohol information system (17) is regularly updated in collaboration with national
counterparts and international partners. The alcohol control database (18) is an important tool
for developing and assessing alcohol policies in Member States, and cross-country analysis of
consumption trends and policies. In addition, the Regional Office contributed European data to a
global WHO database (19). The Regional Office gave technical support to several countries, mainly in the eastern part of
the Region, in updating their alcohol policies and strengthening national capacity and intersectoral
mechanisms for implementation. The Office advanced knowledge of the social and health-care costs
of alcohol by supporting a study by the Swedish Ministry of Health and Social Affairs. Collaboration
with the EC on a number of alcohol policy issues was strengthened and formalized.
Prison health
A Regional Office project aims to make health in prisons part of the overall national public health
agenda and promote links between health ministries and those responsible for prison health.
The Health in Prisons Project also aims to promote equity in health and give extra attention to
disadvantaged groups. Since the project was revitalized in 2002, thanks to funding from the Dutch
Ministry of Foreign Affairs, the active network of European countries has grown from 16 to 33. In
2005, the project celebrated its tenth anniversary at a meeting (20) organized in collaboration with
the United Kingdom Department of Health and EU Presidency.
The project’s achievements include developing guidance (21) that will promote capacity building
on prison health in Member States, and starting a European database.
Support to local governments
Local governments are increasingly seen as key actors in affecting lifestyles and health, as well as
providing health and social care. A high percentage of the European population lives in cities covered
by national Healthy Cities networks: 43% in Austria, 57% in Belgium, 30% in Germany, 53% in Israel,
25% in Italy, 50% in Norway, 65% in Slovenia, 60% in Spain, 55% in Sweden, and 35% in Turkey.
The fourth phase of the Healthy Cities project was launched in 2004 with a renewed agenda,
focusing on healthy ageing, urban planning and health, and health impact assessment. A review
was made of the lessons learned from and case studies on intersectoral city strategies and plans
from around the Region that addressed the determinants of health, equity and citizen participation.
35Noncommunicable diseases
A special consultation in 2005 on the role of local governments in promoting physical activity
contributed to the preparations for the ministerial conference on counteracting obesity.
In the field of ageing, the Regional Office issued two successful publications: Palliative care. The solid facts (22) and Better palliative care for older people (23).
References
1. WHO Regional Committee for Europe resolution EUR/RC54/R4 on prevention and control of noncommunicable diseases in WHO’s European Region. Copenhagen, WHO Regional Office for
Europe, 2004 (http://www.euro.who.int/Governance/resolutions/2004/20040913_6).
2. Mental health: facing the challenges, building solutions. Report from the WHO European Ministerial Conference. Copenhagen, WHO Regional Office for Europe, 2005 (http://www.euro.
who.int/InformationSources/Publications/Catalogue/20050912_1).
3. Mental Health Declaration for Europe. Copenhagen, WHO Regional Office for Europe, 2005 (http://
www.euro.who.int/document/mnh/edoc06.pdf).
4. Mental Health Action Plan for Europe. Copenhagen, WHO Regional Office for Europe, 2005 (http://
www.euro.who.int/Document/MNH/edoc07.pdf).
5. Green paper. Improving the mental health of the population: towards a strategy on mental health for the European Union. Brussels, European Community, 2005 (COM(2005)484; http://europa.
eu.int/comm/health/ph_determinants/life_style/mental/green_paper/mental_gp_en.pdf).
6. World Health Day 2005 – Make every mother and child count. 7 April 2005 [web site].
Copenhagen, WHO Regional Office for Europe, 2005 (http://www.euro.who.int/whd05).
7. European Strategy for Child and Adolescent Health and Development [web site]. Copenhagen,
WHO Regional Office for Europe, 2005 (http://www.euro.who.int/childhealtdev/20050131_1).
8. The First Action Plan for Food and Nutrition Policy, WHO European Region, 2000–2005. Copenhagen, WHO Regional Office for Europe, 2001 (http://www.euro.who.int/Document/
E72199.pdf).
9. Ministerial Conference on Counteracting Obesity [web site]. Copenhagen, WHO Regional Office for
Europe, 2006 (http://www.euro.who.int/obesity/conference/20060216_1).
10. European Strategy for Tobacco Control. Copenhagen, WHO Regional Office for Europe, 2003
(http://www.euro.who.int/Document/E77976.pdf).
11. WHO Framework Convention on Tobacco Control. Geneva, World Health Organization, 2003
(http://www.who.int/tobacco/fctc/text/en/fctc_en.pdf).
12. Tobacco control database. Framework Convention on Tobacco Control [online database].
Copenhagen, WHO Regional Office for Europe, 2006 (http://data.euro.who.int/tobacco/
?TabID=3763).
13. European Alcohol Action Plan 2000–2005. Copenhagen, WHO Regional Office for Europe, 2002
(http://www.euro.who.int/document/E67946.pdf).
36 The work of WHO in the European Region, 2004–2005
14. Declaration on Young People and Alcohol, 2001. Copenhagen, WHO Regional Office for Europe,
2003 (http://www.euro.who.int/AboutWHO/Policy/20030204_1).
15. Framework for alcohol policy in the WHO European Region. Copenhagen, WHO Regional Office for
Europe, 2006 (http://www.euro.who.int/InformationSources/Publications/Catalogue/20060403_1).
16. European Charter on Alcohol, 1995. Copenhagen, WHO Regional Office for Europe, 2001 (http://
www.euro.who.int/AboutWHO/Policy/20010927_7).
17. European alcohol information system [web site]. Copenhagen, WHO Regional Office for Europe,
2002 (http://www.euro.who.int/alcoholdrugs/20020611_1).
18. Alcohol control database [online database]. Copenhagen, WHO Regional Office for Europe, 2006
(http://data.euro.who.int/alcohol).
19. Global alcohol database. Country data on alcohol [web site]. Geneva, World Health Organization,
2006 (http://www3.who.int/whosis/menu.cfm?path=whosis,alcohol&language=english).
20. 10th Annual Meeting and Conference of the WHO European Network for Prison and Health. De
Leeuwenhorst, the Netherlands, 21–22 October 2004 [web site]. Copenhagen, WHO Regional
Office for Europe, 2005 (http://www.euro.who.int/prisons/meetings/20050829_1).
21. Health in Prisons Project. Publications [web site]. Copenhagen, WHO Regional Office for Europe,
2006 (http://www.euro.who.int/prisons/publications/20050610_1).
22. Davies E, Higginson IJ, eds. Palliative care. The solid facts. Copenhagen, WHO Regional Office for
Europe, 2004 (http://www.euro.who.int/InformationSources/Publications/Catalogue/20050118_2).
23. Davies E, Higginson IJ, eds. Better palliative care for older people. Copenhagen, WHO
Regional Office for Europe, 2004 (http://www.euro.who.int/InformationSources/Publications/
Catalogue/20050118_1).
37Environment and health
Spent: US$ 18 836 524
Proportion of total expenditure: 11.8%
Staff: 51, including 1 in the field
Environmental health covers aspects of human health and disease that are determined by factors in
the environment, including violence and injuries. Two political developments took place in this area
during the biennium: the Fourth European Ministerial Conference on Environment and Health in 2004
and the approval of a resolution on violence and injury prevention by the WHO Regional Committee
for Europe in 2005.
The activities described here were implemented by Regional Office staff in three locations: Bonn,
Germany; Copenhagen, Denmark; and Rome, Italy.
Budapest Conference
The Fourth Ministerial Conference on Environment and Health, held in Budapest, Hungary, was
preceded by intense preparatory technical and political work to set the agenda and secure agreement
on commitments based on scientific evidence. Hundreds of experts and senior officials from most of
the countries in the WHO European Region contributed to this process.
A report (1) showed that, overall, outdoor and indoor air pollution, unsafe water and sanitation,
lead contamination and injuries cause about a third of all deaths (100 000) and about 26% of all
DALYs (equivalent to 6 million life-years lost to transient or permanent disability) in the Region each
year. The Regional Priority Goals spelled out in the CEHAPE (2), signed in Budapest, focus on the
actions necessary to reduce this burden of disease, giving special attention to the issues outlined in
the above assessment.
The Budapest Conference was attended by some 1200 delegates and observers from 50 Member
States, 11 international organizations and 11 NGOs, and 48 ministers from both the health and the
environment sectors. By design, 18 delegations included a total of 131 young people who took part in
several initiatives, including a youth parliament that developed and approved its own declaration.
The ministers of Health and Environment of Hungary and the WHO Regional Director for Europe
signed two major documents on behalf of all Member States: the Conference Declaration (3) and
the CEHAPE (2). In addition, the EU Commissioners signed a statement in support of the Conference
decisions.
The Conference Declaration addresses several key issues for environment and health in Europe and
makes strong commitments to future action. The CEHAPE is a broad framework, setting Region-wide
5. Environment and health
38 The work of WHO in the European Region, 2004–2005
goals. Member States can adapt it to their own needs, to tackle the issues most relevant to them,
as selected through their decision-making mechanisms. It is a science-based political commitment,
developed by Member States for Member States:
• to orient priority actions and policies addressing both national and regional needs; and
• to enhance the protection of children’s health from environmental hazards.
The Regional Committee endorsed the deliberations of the Budapest Conference in September 2004 (4). The Conference Declaration and the CEHAPE are political commitments that address the most
pertinent environment and health issues. While they focus on Member States’ action, they also require
the Regional Office to support countries’ decision-making through, for example, collecting and
providing evidence on the effectiveness of policies, providing data and technical tools, and sharing and
disseminating information (5). To this end, the Regional Office has developed a set of indicators for the
specific issues under its responsibility; the Office will use them to monitor its contribution and report
on its achievements and progress to its governing bodies.
After the Conference and in accordance with one of its resolutions, the European Environment
and Health Committee (6) was re-established. The Committee is composed of elected representatives
of Member States (five each from the health and the environment ministries), the EC (DG SANCO and
DG ENV), EEA, other international organizatio