Annual progress report towards the implementation of the Roadmap for health and well-being in the Western Balkans (2021–2025) 2The Roadmap for Health and Well-being in the Western Balkans 2021–2025 (WBRM) is the first subregional strategy for health and well-being endorsed by the Prime Ministers of Albania, Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia. Support from the European Union (EU) and the engagement of prominent Western Balkan (WB) subregional health- related organizations was obtained for WBRM at its endorsement at the Central European Initiative (CEI) Summit in Budva, Montenegro, on 3 December 2021. WHO/Europe1 combines multi-country/area* efforts and tailored country/area support to advance the WBs and partners coalescing in working towards attaining vital milestones of progress in achieving their 2023–2025 WBRM objectives. This digest is intended to present a snapshot rather than a detailed account of WHO/Europe’s engagement in the WBs and should be read in conjunction with the WHO Regional Office for Europe’s published documents and progress reports, including the Report of the Regional Director on the work of WHO/Europe in 2021–2022 presented at the 72nd Session of the Regional Committee Accelerating attainment of WBRM objectives WBRM accelerates the implementation of the European Programme of Work, 2020–2025 – “United Action for Better Health in Europe” (EPW) amongst WB countries/area and partners and forges partnership, solidarity and opportunities for synergistic action in attaining its political, investment and technical objectives. In WBRM the WBs have designated ten action areas and seventeen reform initiatives to guide their and their partners’ efforts and investments in technical cooperation, thus contributing to progress across the EPW priorities and flagships in the WBs. WHO/Europe pursues facilitative leadership in convening countries/area and partners and contributes technical support to advancing WBRM achievements primarily through five avenues (Fig. 1). Fig. 1. Key avenues of WHO/Europe support to WBRM WBRM meetings of ministers WHO/Europe’s presence in the WBs Convening partners and partnerships for synergistic support to CARM WHO/Europe’s WB Special Envoy WBRM technical meetings of countries and partners • Joint yearly and individual political events with WB ministers of health. • High-level meetings with ministers of health and WB counterparts facilitated by the WHO heads of offices. • Collaboration with subregional organizations and partners. • Supports coherence of WHO/Europe’s action across WBRM areas, with countries and partners. • Subregional and country gatherings of technical experts from the WBs and partners for investment alliance and powering human resource capacities for advancement of WBRM action areas and reform initiatives. Yearly WBRM technical meetings convened by WHO/Europe gather WB and partner experts for dialog and exchange in powering up joint action. At the June 2021 First Technical Meeting over 80 experts focused on developing WBRM and deciding on the critical action areas and reform initiatives. The second technical meeting on WBRM implementation in May 2022 gathered over one hundred participants from the WBs, partners and subregional organizations to discuss five of the action areas/ reform initiatives that they found critical to accelerating progress under WBRM. At the meeting, WHO/Europe presented its overview of 2021–2022 (Box 1). * All references to “area” in this document should be understood as Kosovo. All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 1 The WHO Regional Office for Europe (WHO/Europe) consists of the head office in Copenhagen, Denmark; 32 country offices (for Israel, host agreement is being finalized); field, liaison, representation and sub-offices including subregional WHO Health Emergencies Programme (WHE) hubs; five geographically dispersed offices (GDOs); one WHO-hosted Partnership; and one office for Health Systems Financing. It is through these offices that Programme budget 2022–2023 has been delivered, with the support of a broad partnership community, including over 265 WHO collaborating centres. 3• WBRM is a political and technical catalyzer – a country/area-owned pathway establishing clear directions for subregional cooperation at the highest level (heads of state). • The first technical council dialogue opened exchange across five selected WBRM action areas and initiatives and agreed to continue action on primary health care, digital health, mental health, childhood obesity and health emergencies. • Accelerating synergistic action within the WBs requires ensuring coherence among the plans and activities of health authorities and their synergistic effort to build on country/area-level health goals. • Coordinating across partners and partnerships is essential for policy coherence and accelerating united action under WBRM. Box 1. Key conclusions of the May 2022 subregional technical meeting on WBRM implementation Positioning health high atop the WB development agenda The EU accession process is a key driver of reform and motivation for WB governments to progress across a range of normative and policy areas. The WBs’ partnership portfolio has largely emerged within this context of aspiring EU integration and EU neighborhood policy. EU engagement with the WBs has been enhanced through the development of the Economic and Investment Plan to support economic recovery and convergence. WHO/Europe has participated at the EU–WB leader forums since 2020, promoting health as central to the WB’s socioeconomic development agenda. In their Joint Statement of endorsement for WBRM, the WB Prime Ministers articulated their consensus and solidarity around WBRM priorities and joint commitments for accelerating socioeconomic development with health at the centre. The Prime Ministers also explicitly linked WBRM actions and initiatives with accelerating EU accession, thus regarding their WBRM as a tool to the accession progress. WHO/Europe’s contribution to the EU progress reports for the WBs consider WBRM related action results in a wide range of health and health related issues that impact progress across all EU report chapters. WHO/Europe’s cooperation with the EU took on a new and greater importance during 2022 and grew stronger amid united action to build long-term resilience and sustainability in the wake of the war in Ukraine and the consequent refugee crisis. A dedicated EU Project Management Office in the head office in Copenhagen and WHO country offices ensured the swift implementation of an EU project worth US$ 1.6 million in the WBs. These investments, among others, helped facilitate better health and protection for the close to 20 million people in this subregion. WHO facilitates health collaboration with three main subregional organizations that support the progression of WBRM: • CEI. CEI continues to be a strong advocate for WBRM at the highest global political forums, as exemplified by the 2022 United Nations General Assembly (UNGA) Resolution on Cooperation between the United Nations and the Central European Initiative. CEI’s first Plan of Action 2021–2023 established a strong health chapter under which WBRM has been supported, mainly in primary health care (PHC), digital and mental health, and emergencies. “We commend the European Union for reflecting health in the ‘Green Deal,’ and the Western Balkan Prime Ministers for their commitment to the Roadmap for Health and Well-being, where they acknowledge that investments in health breed stability and economic development – with a seven-fold economic return on every Euro invested in non- communicable diseases”. Statement of the WHO Regional Director for Europe, Dr. Hans Henri P. Kluge, at the Berlin Summit, November 2022 “[The UNGA] notes the activities of the CEI in mitigating the adverse effects of the COVID-19 pandemic for its Member States and welcomes the Initiative’s response capacity for effectively tackling health-related challenges, including through consolidated cooperation with the Regional Office for Europe of the World Health Organization, and in particular the joint endorsement of the World Health Organization’s Roadmap for health and well- being in the Western Balkans (2021–2025) at the Summit of the Heads of Government of the Member States of the CEI under the Presidency of Montenegro in 2021.” The UNGA Resolution on Cooperation between the United Nations and the Central European Initiative (2022) 4• Regional Cooperation Council (RCC). Collaboration between the RCC and WHO/Europe progresses through meetings of the WHO Regional Director of Europe and the RCC Secretary General – with the last meeting held as part of the Health in the Well-being Economy Forum in March 2022; through monthly meetings of the institutional focal points; and through WHO/Europe expert technical support to the RCC South East Europe (SEE) Strategy 2030. The WHO European Office for Investment for Health and Development in Venice, Italy, is supporting the RCC with the Annual Interim Implementation Report of the SEE 2030 strategy, particularly on the theme of overall quality and access to health services and other quality of life determinants in the post-pandemic environment. The Office will also support the development of a SEE-specific Inclusive Growth Index. Joint contribution to WBRM manifests results under the labels of the WB Green Agenda, Digital Transformation, Youth Lab and the SEE Strategy 2030 monitoring and evaluation. • SEE Health Network (SEEHN). The historically close collaboration of WHO/Europe and SEEHN focused in 2022 on implementing WBRM as central to the SEEHN Ministerial Pledge 2022–2026 to accelerate closing the health gap between the WB and EU Member States of SEEHN. SEEHN, as the first specialized public health organization in SEE, joined hands with WHO/Europe in 2022–2023 in the areas of digital health, mental health and human resources for health. Since 2021 WHO/Europe has been convening quarterly managerial meetings of the three subregional organizations relating to yearly plans of joint activities and providing coherence and efficacy of collaborative efforts, with the last meeting held in January 2023. Accelerating action under WBRM’s technical objective WBRM was developed to support the implementation of the EPW in the WBs in the areas prioritized explicitly by the WBs (Table 1). WHO/Europe has contributed to WBRM advances mainly through three action streams, namely: 1) ensuring the WBs is well reflected/included in Regional and global initiatives; 2) creating specific opportunities for subregional cooperation and dialogue in the WBs, and 3) implementing biennial cooperative agreement programmes of work in individual WB countries/area. Table 1. Collaboration between the EPW priorities and flagships and WBRM action areas and initiatives EPW Priorities WBRM action areas and reform initiatives Priority 1: Moving toward universal health coverage (UHC) 1. Ensure financial protection and access to medicines • Initiative on Financial Protection UHC • Medicines and Medical Supplies Collaborative Initiative 2. Safeguard the quality of health care and patient safety • Innovation Hub for Quality of Care and Provider Performance 3. Preserve human capital for health • Initiative to Expand and Retain Human Capital for Health • Initiative for Health Worker Education Flagship Initiative 1: The Mental Health Coalition 4. Promote mental health and social care services • Mental Health and Social Care Leadership Coalition Flagship Initiative 2: Empowerment through digital health 5. Strengthen PHC through digital transformation • PHC Reform Initiative • Initiative for Digital Health Transformation in PHC Priority 2: Protection against health emergencies 6. Increase resilience to health emergencies • The platform for Leadership and Governance for Emergency Preparedness and Response • Health Emergency Preparedness and Response Capacity Building Initiative Priority 3. Promoting health and well- being 7. Combat avoidable non-communicable diseases • Taxation, Legislation, and Regulation Initiative for Health • Non-communicable disease Targets and Data Network 8. Create healthy and green environments • The Platform for Climate, Environment, and Health • Road Safety Initiative 9. Combat antimicrobial resistance • Initiative for intersectoral antimicrobial resistance leadership and governance • Integrated Antimicrobial Stewardship Programme initiative in health-care facilities Flagship Initiative 3: The European Immunization Agenda 10. Extend vaccination benefits across the life course • Immunization Agenda Flagship Initiative 4: Healthier behaviour: incorporating behavioural and cultural insights Cross-cutting 5Highlights of EPW-related Regional and global achievements that have powered up WBRM action WHO/Europe’s support for WBs runs strong, as demonstrated by the establishment and implementation of WBRM. Developing a comprehensive and feasible WBRM has been simultaneously a political and technical process, and both aspects should be repeatedly acknowledged as WBRM action progresses. Given the contemporary complexities, one-dimensional approaches were ill suited to addressing multi-dimensional health problems and the needs of present and future WB country/area generations. Instead, WBRM comprises flexible, integrative and holistic approaches that can rapidly adapt to changing circumstances and an ever-growing evidence base and set the tone of the overall motion of WBRM. The WHO Regional Director for Europe has been frequently present in the WBs and met high-level authorities across-the- government on over 40 direct bilateral occasions. Such a strong presence supported the establishment of health as a driver of overall socioeconomic progress and has helped to increase social capital for health through strengthened and inclusive collaboration among stakeholders and partners, thus channeling and generating wider support for the WBs and their subregional health engagements. Hundreds of technical missions have been coordinated by the WHO heads of offices and their teams, focusing on individual country/area needs. At the same time, these endeavors have been increasing the awareness of WBRM’s role in facilitating policy coherence for health and sustainable development across the WBs by encouraging countries/ area to consider the effects of their actions in a holistic manner; within and beyond their own borders, now and in the future, as well as the impact for sustainable development. Overall, the WHO Regional Office for Europe published over 450 publications in 2022–2023: reports, policy briefs, operational guidance, health profiles, fact sheets and others, each providing evidence to support WBRM action across each of the action areas or advice for future efforts. Recent reports continue to demonstrate WHO’s role as a beacon for the endeavors of the WBs and their partners, including the European Health Report 2021 and those relating to a number of different topics, including obesity; antimicrobial resistance (AMR) surveillance; the health and care workforce; childhood cancer inequality; the scaling up of action on climate change mitigation and health adaptation; alcohol digital environments; and challenges and policy options for better health, as well as Regional and seasonal influenza surveillance reports, reports and updates from the WHO Technical Advisory Group on COVID-19 and other technical groups, networks and WHO centres of excellence. In the same period, there have also been multiple potent initiatives that include the WBs, some of which are highlighted in this Digest (Box 2). Technical support and capacity-building efforts remain a sturdy focus of WHO/Europe. Gathering experts across the vast and diverse European Region allows joint learning and knowledge exchange and stimulates awareness of cross-border health considerations, especially related to building Regional and global resilience in the face of multiple crises of global health impact. Hundreds of Regional events in the past year alone have supported technical networking and the strengthening of professional communities, equipping them with tools and training material. For an illustration of the magnitude of country support across the Region in 2022, WHO/Europe conducted 419 support missions and deployments to 27 countries and areas, including in the WBs; mobilized 40 partners under the Global Outbreak Alert and Response Network and facilitated the deployment of eight Emergency Medical Teams. Supplies worth US$ 96 million, including vaccines, were procured for 31 countries/area in the Region. WHO/Europe’s efforts to build country-level capacity resulted in hundreds of webinars, trainings and workshops related to the COVID-19 response, which engaged more than 55 500 participants. 6• WHO/Europe’s Access to Novel Medicines Platform – is a neutral platform for the public and private sectors to reshape political discourse, create partnerships, build momentum for change, and identify potential, pragmatic solutions to improve access to effective novel high-cost medicines in the Region. • The Pan-European Mental Health Coalition – under which WHO/Europe continues to support countries engaging in dialogues on mental health frameworks and scaling up activities such as WHO Quality Rights, the Anti-stigma Toolkit, Helping Adolescents Thrive and the WHO Mental Health Gap Action Programme. • The WHO Regional Director for Europe’s Advisory Council on Innovation for Noncommunicable Diseases and its six signature initiatives – alcohol, cardiovascular disease, childhood obesity, data and digital health, digital marketing and greener cities – aims to design innovative approaches to the respective topics. • A cloud-based platform for real-time collaboration and peer-to-peer knowledge sharing between member cities and the entire Healthy Cities Network. • Regional Behavioural and CulturaI Insights Technical Advisory Group has been established, and 49 official country focal points have been nominated and engaged in developing a behavioural and cultural insights action framework for 2022–2027. Box 2. Exemplifying WHO/Europe’s support to WBRM through regional initiatives The Seventy-second Regional Committee for Europe in 2022 brought forward the resolution, Delivering United Action for Better Health – a strategy for collaboration between the WHO Regional Office for Europe and Member States in the WHO European Region. The strategy describes the Regional Office’s offer across its six core capabilities: three technical capabilities in the areas of moving towards UHC, protecting against emergencies and promoting population health and well-being, and three enabling capabilities in the areas of leadership, communications and operations for health. Member States emphasized the role of the Region’s subregional collaboration strategies, roadmaps, and memorandums of understanding in facilitating valuable collaboration among groups of countries with shared agendas and the added value of technical and programmatic networks in the sharing of learning across the Region, including the subregional networks. Highlights: WHO targeted technical support at the subregional level across WBRM prioritized areas EPW Core priority 1: Moving towards UHC and its flagships WBRM action area 1: Ensure financial protection and access to medicines. The WHO Barcelona Office for Health Systems Financing (Spain) continued its work on monitoring financial protection as part of a three-year EU-funded project to strengthen health financing for UHC in the WBs (the Directorate-General for Neighborhood and Enlargement Negotiations, 2021–2023). The WHO Barcelona Office has been collaborating with experts from the WBs to produce new or updated analyses of financial protection (affordable access to health care) to monitor progress towards UHC through WBRM and to foster policy dialogue. Reports on financial protection in the WBs have been initiated, starting with the North Macedonian report, which was launched at a virtual event with over 100 health system stakeholders in November 2021, while the reports for Bosnia and Herzegovina, Kosovo2, Montenegro and Serbia are under way. Preliminary findings from the analysis performed to feed the reports served to fuel high-level policy dialogue events, such as that held for Bosnia and Herzegovina in Banja Luka in March 2023, and contributed to the RCC SEE 2030 interim implementation monitoring report. Capacity building efforts continued through the 10th edition of the WHO Barcelona Course on Health Financing for UHC in September 2022, with more than 50 experts, including 15 from the WBs, gathering to review effective ways of improving health financing policy and accelerating progress towards UHC. Experts and policy-makers from the WBs will continue with dialogue and exchange, and ensure the subregional contribution to progressing UHC as part of the WHO Barcelona Forum on Financial Protection in Europe, which will gather around 100 experts from across the WHO European Region in June 2023, and as part of the 11th edition of the WHO Barcelona Course on Health Financing for UHC to be held in November 2023. 2 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 7WBRM action area 2: Safeguard quality of health care and patient safety The new WHO European Centre of Excellence for Quality in Care and Patient Safety in Athens, Greece, launched in March 2022, has been focusing its work on country support, promoting quality of care-related innovations, including by supporting WBRM initiatives. Notably, the Centre has supported Albania, Montenegro and North Macedonia in strengthening quality accreditation, developing patient safety action plans and capturing patients’ voices, partnering with Harvard University, the Organization for Economic Cooperation and Development and the European Observatory on Health Systems and Policies. The WBs health technology assessment experts met under the context of WBRM and launched the health technology assessment document repository. Most recently, the Centre supported the ignition of the Joint WHO and CEI project on quality of care in hematology as part of WBRM. WBRM action area 3: Preserve human capital for health More than 1600 health professionals across south-eastern Europe have been trained in occupational health and safety in the context of COVID-19 through a project supported by WHO/Europe. The Actions to strengthen the resilience of health workers in south-eastern Europe in response to COVID-19 and beyond the implementation of WHO/ILO [International Labour Organization] guidance and mapping of priority needs for occupational health and safety programs for health workers project report was published in September 2022. The project was implemented through the South-East European Network on Workers’ Health (SEENWH), a seasoned platform of occupational health experts coordinated by the WHO Collaborating Centre for Occupational Health at the Institute of Occupational Health of the Republic of North Macedonia in Skopje. SEEHNWH activities have contributed to the WBRM Initiative for Health Worker Education that contributes to preserving human capital for health in the WBs and demonstrate both the decisive role of the WHO Collaborative Centers in the WBs and the synergistic strength of the WB’s subregional health worker networks. BRM action area 4: Promote mental health and social care services WHO/Europe’s flagship mental health initiative has made great strides in motivating mental health action following the adoption of the European Framework for Action on Mental Health, 2021–2025. WHO/Europe’s Mental Health Flagship team met with WB representatives and experts in Tirana in October 2022 to recommit and revamp mental health reforms in line with WBRM; to establish a mental health network; and to scale up partnerships with grassroots organizations to promote mental health among young people. The Tirana Youth4Health Forum brought 150 young participants, government, and civil society partners together in October 2022 to engage in genuine dialogue, build trust and to find better ways to include youth in policy decisions for health. The Mental Health Flagship team are also working in partnership with the United Nations Children’s Fund (UNICEF) under the UNICEF and WHO Joint Programme on Mental Health and Psychosocial Well-being and Development of Children and Adolescents, in Albania, North Macedonia and Serbia, with a focus on strengthening mental health policy; building capacity for mental health leadership and governance; developing comprehensive, multisectoral services and promotion and prevention activities; and strengthening information systems, evidence and research. WBRM action area 5: Strengthen PHC through digital transformation PHC The WHO European Centre for Primary Health Care in Almaty, Kazakhstan (PHC Centre) initiated action in the WBs in 2022, focusing mainly on intercountry dialogue, to strengthen national strategies and priorities on PHC through exchange and collaboration at subregional level. The joint WHO and CEI PHC project was established in 2022 as a health platform for WB collaboration, which supported the transformation of the project’s activities into a WB hub for WBRM. The WB hub hosts a significant yearly subregional health collaborative event to build and connect technical communities in the WBs with EU equivalents, to expand knowledge and experiences contributing to all WBRM areas of action. The second PHC intercountry dialogue meeting was held in September 2022 at the CEI headquarters in Trieste, Italy, as a three-day international event organized by the CEI Secretariat and gathering over 85 participants, while around 90 people participated in thematic webinars and online consultations. The investment in PHC capacity-building has continued, with the WBs invited to complete implementable performance monitoring projects at the annual PHC performance monitoring and management training programme – a joint initiative with the Collaborating Centre at Amsterdam Medical University that in 2022 involved 31 participants in 6 cohorts. 8Digital health WHO/Europe established the Western Balkan Digital Health Network in 2021 to serve as a WBRM umbrella for collaboration and strategic investments in building mature and potent digital ecosystems to support health in the WBs. The second and third meeting of the Network took place in 2022, with representation from Member States and international organizations and with a focus on governance, legislation and digital health literacy. The Network also held a workshop on Ethics and Governance for Artificial Intelligence, supported by Network, and other international experts. The Network, in the context of the WBRM, continues to promote the implementation of the EPW and the newly adopted Regional digital health action plan for the WHO European Region 2023–2030, towards inclusive digital societies centred on people, gender equality and health equity as an integral part of broader socioeconomic reforms in the WBs and – in sync with the EU Digital Agenda for the Western Balkans – full integration into the EU. The Health Systems in Action country profiles developed by WHO/Europe for Bosnia and Herzegovina, Montenegro and North Macedonia, each integrated digital health. Partnership investments and engagements further boosted activities within the WBRM Initiative for Digital Health Transformation in PHC, mainly through the abovementioned joint WHO and CEI PHC project, as well as through the March 2022 CEI High-level policy-making event entitled Building an IDEAHL Europe, held at the European Parliament and co-sponsored by WHO/Europe, which focused on digital empowerment and health literacy. Additionally, the conclusions from the Western Balkans Digital Summit in September 2022 in Pristina, organized by the RCC as part of SEE2030 implementation, confirmed the WB’s common ambition to jointly progress digital transformation and regional cooperation, under the Common Regional Market. The above developments and activities were accompanied by subregional technical events including on investing in digitalization in the WBs, donor coordination meetings, the telemedicine network approach and scaling up innovative PHC models and digital solutions to better address noncommunicable diseases and mental health. In parallel, specific country/area technical consultations moved forward on e-appointments in North Macedonia; on sustainable adoption of digital health solutions at the First Albanian Health Congress; and a health information system assessment in Montenegro focusing on mortality data, civil registration and vital statistics reporting, to be followed by study visits and training. EPW Core Priority 2: Protecting against health emergencies WBRM action area 6: Increase resilience to health emergencies WHO/Europe, working through the WHO Health Emergencies Programme, plays a vital role in supporting all Member States across the four stages of the emergency management cycle: prevention, preparedness, response and recovery. Through the Programme, emergency preparedness capacity-building activities have been conducted in the areas of risk communication, community engagement and infodemic management; infection prevention and control; emergency preparedness and contingency planning; laboratory strengthening; epidemiological surveillance; clinical management and medical countermeasures; monitoring of public health and social measures during epidemics and pandemics; points of entry; and more. Established in 2018, WHO/Europe’s WB emergency hub conducts support missions, mobilizes partners under the Global Outbreak Alert and Response Network, and facilitates the deployment of Emergency Medical Teams. During 2021–2022 the hub trained over 300 WB experts in 14 subregional capacity-building workshops on a wide range of all-hazards emergency preparedness and response issues. It also successfully implemented three intra-action reviews, 16 direct technical support missions, 4 strategic risk assessment exercises and over 25 online consultations. Key milestones at the country level include Albania’s emergency response plan for the University Hospital Mother Teresa; Bosnia and Herzegovina’s laboratory bioinformatic-specific sequencing; Kosovo’s3 points of entry capacity-building and health security capacity assessment; Montenegro’s improved hospital readiness through the adoption of the WHO hospital safety index tool; North Macedonia’s enhanced public health emergency operations centre functionality; and Serbia’s National Action Plan for Health Security. 3 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 9EPW Core Priority 3: Promoting health and well-being WBRM Action area 7: Combat avoidable noncommunicable diseases As part of the childhood obesity signature initiative of the WHO Regional Director for Europe’s Advisory Council on Innovation for Noncommunicable Diseases, subregional obesity policy dialogues were launched in Skopje, North Macedonia in May 2022 at a high-level event attended by the First Lady of North Macedonia and the Minister of Health. These policy dialogues, coupled with a training course on childhood obesity management for primary care physicians, further gathered vital health sector stakeholders in the WBs to guide the implementation of evidence-based policy interventions, applying a noncommunicable disease framework in addressing obesity. Furthermore, in May 2022 the WBRM Technical Council meeting discussed obesity as one of its first technical topics due to its seriousness in the WBs. A report on COVID-19 and childhood obesity including the WBs was launched in May under the Childhood Obesity Surveillance Initiative. WHO/Europe is currently working with the WBs and experts to develop an initiative for tobacco control, focusing on addressing industry interference and novel tobacco products. Policy dialogues followed by training workshops on strengthening the implementation of the WHO Framework Convention on Tobacco Control in the WBs were coupled with igniting reviews of the drafts of the tobacco control bill and the national tobacco control strategy in Montenegro and Serbia. A subregional workshop on the rapid exchange of information during food safety emergencies in the WBs, held in May 2022 in Belgrade, Serbia, supported the rapid exchange of information relating to food safety emergencies. In addition, support to the WBs continued in promoting a coordinated and comprehensive approach to physical activity across different sectors, and physical activity workshops were held that scoped the PHC system, urban planning and transport, monitoring and surveillance systems, and the development of practical guidelines and a national communication campaign – moving towards more comprehensive country/area plans. WBRM action area 8: Create healthy and green environments Working through its European Centre for Environment and Health (Bonn, Germany) (ECEH), WHO/Europe advanced the political commitment and the engagement of the health constituency in the climate and health agenda and to further accelerate policy and action under the COP26 Health Programme. The ECEH has started policy dialogues on environment and health priorities and climate change to provide political input to the preparations of the Seventh Ministerial Conference on Environment and Health to better reflect the agenda and priorities of the WBs, and to support WBs in developing evidence-informed policies and actions and to facilitate the uptake of WHO tools. The second online edition of the Bonn Environment and Health School took place in November 2021, which included participants from the WB, to build technical and leadership capacities in areas such as air quality, climate change, green recovery and defining the environment and health research agenda through a problem-based learning process. The ECEH also led the capacity-building activities, which included the WBs, in chemical risk assessment and the development of tools and educational materials, including on mercury and health, contributing to the implementation of the WHO Chemicals Roadmap and international environmental agreements, like the Minamata Convention on Mercury. ECEH engagements in the WBs supported significant achievements, most notably in strengthening capacities in integrated/ intersectoral road safety data systems and the development of cause of death registry systems. The intersectoral character of activities coalesced numerous partners such as the Western Balkans Road Safety Observatory, the European Commission’s Directorate-General for Mobility & Transport, Bloomberg Philanthropies, World Bank and others. The WBs also participated in the Road Policing Survey and the compilation of case studies for the Technical Manual on Road Policing. WBRM action area 9: Combat AMR Efforts of WHO/Europe and partners to strengthen antimicrobial stewardship programs have intensified with the further development of tools and training materials for health-care professionals and managers, including from the WBs. Among these is the highly accessed open online course on OpenWHO.org, entitled Antimicrobial Stewardship: a competency-based approach, and functional antimicrobial stewardship programmes as part of COVID-19 pandemic response efforts to ensure proper treatment, avoid shortages and control AMR. The WBs participated in a Knowledge, Attitudes and Behaviour survey on AMR which provided baseline information to inform targeted awareness and behaviour change campaigns. In Serbia, a new training course entitled Leadership skills for effective multisectoral coordination and collaboration for addressing AMR, was piloted. AMR surveillance activities in the WBs in 2022 allowed the subregion to contribute to high-quality data and networking in the Central Asian and European Surveillance of Antimicrobial Resistance network, the Global Antimicrobial Resistance and Use Surveillance System, and the 10 WHO Antimicrobial Medicines Consumption Network. WHO/Europe also supported WB participation in the European Society of Clinical Microbiology and Infectious Diseases postgraduate education course, Clinical microbiology testing in settings with limited resources and high prevalence of AMR: the role of diagnostic stewardship, and in the EURGen-RefLabCap project, a four-year project on the provision of EU networking and support for public health reference laboratory functions for AMR in priority health care-associated infections. Point-prevalence surveys on antimicrobial use and health care-associated infections were performed in Serbia and Kosovo.4 In-depth assessments of infection prevention and control programmes and the revision of infection prevention and control manuals were conducted in Kosovo4 and North Macedonia. In addition, WHO rolled out AMR-related curricula and training in the WBs. Such developments built capacities to progress the development and implemention of individual WB countries/area action plans – as discussed at the last subregional meeting of experts and policy-makers in 2022. WBRM action area 10: Extend vaccination benefits across the life course As part of the implementation of the strategic priorities outlined in the European Immunization Agenda 2030, targeted policy dialogue and a planning meeting were organized in 2022 with national immunization programme managers of the WBs together with Regional and global partners to draft the operational framework of implementation and to guide the development of national plans of action to address immunization inequity in the WBs. This dialogue laid the grounds to identify programmatic areas of intervention linked to immunization inequity and leaving no one behind, including the expansion of evidence-informed decision-making on the introduction/scale-up of new and underutilized vaccines in national immunization schedules. In line with the scale-up of the COVID-19 vaccination, specific emphasis was laid on ensuring accessibility of the vaccine to the identified vulnerable populations as well as using similar platforms to deliver seasonal influenza vaccines. As a local initiative to improve the access of COVID-19 vaccines to the population, the COVID-19 vaccination mobile health caravan rally in the WBs continues to bring health services and advice closer to where people live: UNICEF and the European Commission partnered with WHO/Europe to add scope and value to such initiatives. During the reporting period, WHO/Europe also provided strategic support in the development of tailored communication plans for the scale-up of HPV vaccination, communication training for health-care workers on human papillomavirus and COVID-19 vaccination and COVID-19 vaccination monitoring, with a focus on reporting and use of data for action. These activities are aligned to the principles of the European Immunization Agenda 2030 towards building resilient immunization systems. CONCLUSION Multiple, simultaneous, complex emergencies and consequent responses impacting our Region, and their consequent responses, characterize the 2022–2023 period. WHO/Europe mobilized and sought to respond to each emergency while focusing on the three core priorities and flagship initiatives of the EPW. WHO/Europe’s work is driven by these priorities and substantial advancements have been made within each of these over the past two years that have benefited WBs. This has included delivering workshops and training; setting up critical new initiatives; providing invaluable data and evidence to inform policy and decision-making; leading the health response amid major overlapping emergencies; and more. WHO/Europe has also provided specific and tailored technical support to the subregion in various health areas scoped by WBRM. This support under the WBRM technical objective has allowed the WB to focus their visionary efforts in 2022–2023 on PHC, digital health, mental health, childhood obesity and emergencies, as well as continuing to work on empowering the health workforce and increasing fiscal space for health. In all, WHO/Europe contributed to progress across WBRM objectives through high-level promotion, technical contribution, investments and significant efforts to facilitate WB leadership in their joint endeavors with partners towards full delivery on WBRM. The WB countries/area’s growing integration in the subregion and with the EU and solid subregional collaboration has contributed to the realization of their political objective under WBRM and facilitated the increased investment of partners and of the WBs in health, as central to developing economic well-being. 4 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 11 Bibliography5 1. Thirteenth General Programme of Work, 2019−2023. In: World Health Organization [website]; Geneva: World Health Organization; 2023 (https://www.who.int/about/what-we-do/thirteenth-general-programme-of-work-2019---2023). 2. The European Programme of Work, 2020–2025: United Action for Better Health. Copenhagen: WHO Regional Office for Europe; 2021(https://apps.who.int/iris/handle/10665/339209). 3. Roadmap for Health and Well-being in the Western Balkans (2021-2025): European Programme of Work (2020– 2025) - United Action for Better Health. Copenhagen: WHO Regional Office for Europe; 2021 (https://apps.who.int/iris/ handle/10665/345932). 4. Compendium of the Roadmap for Health and Well-being in the Western Balkans (2021–2025): European Programme of Work (2020–2025) – United Action for Better Health. Copenhagen: WHO Regional Office for Europe; 2021 (https://apps.who. int/iris/handle/10665/345936). 5. Seventy-second Regional Committee for Europe: Tel Aviv, 12–14 September 2022: report of the Regional Director: the work of WHO/Europe in 2021–2022. Copenhagen: WHO Regional Office for Europe; 2022 (https://apps.who.int/iris/ handle/10665/361900). 6. Seventy-second Regional Committee for Europe: Tel Aviv, 12–14 September 2022: delivering United Action for Better Health – a strategy for collaboration between the WHO Regional Office for Europe and member states in the WHO European Region (https://apps.who.int/iris/handle/10665/361848). 5 All references were accessed on 18 May 2022. World Health Organization Regional Office for Europe UN City, Marmorvej 51 DK-2100, Copenhagen Ø, Denmark Tel: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eurocontact@who.int Website: www.who.int/europe 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. 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Annual progress report towards the implementation of the Roadmap for health and well-being in the Western Balkans (2021–2025) 2The Roadmap for Health and Well-being in the Western Balkans 2021–2025 (WBRM) is the first subregional strategy for health and well-being endorsed by the Prime Ministers of Albania, Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia. Support from the European Union (EU) and the engagement of prominent Western Balkan (WB) subregional health- related organizations was obtained for WBRM at its endorsement at the Central European Initiative (CEI) Summit in Budva, Montenegro, on 3 December 2021. WHO/Europe1 combines multi-country/area* efforts and tailored country/area support to advance the WBs and partners coalescing in working towards attaining vital milestones of progress in achieving their 2023–2025 WBRM objectives. This digest is intended to present a snapshot rather than a detailed account of WHO/Europe’s engagement in the WBs and should be read in conjunction with the WHO Regional Office for Europe’s published documents and progress reports, including the Report of the Regional Director on the work of WHO/Europe in 2021–2022 presented at the 72nd Session of the Regional Committee Accelerating attainment of WBRM objectives WBRM accelerates the implementation of the European Programme of Work, 2020–2025 – “United Action for Better Health in Europe” (EPW) amongst WB countries/area and partners and forges partnership, solidarity and opportunities for synergistic action in attaining its political, investment and technical objectives. In WBRM the WBs have designated ten action areas and seventeen reform initiatives to guide their and their partners’ efforts and investments in technical cooperation, thus contributing to progress across the EPW priorities and flagships in the WBs. WHO/Europe pursues facilitative leadership in convening countries/area and partners and contributes technical support to advancing WBRM achievements primarily through five avenues (Fig. 1). Fig. 1. Key avenues of WHO/Europe support to WBRM WBRM meetings of ministers WHO/Europe’s presence in the WBs Convening partners and partnerships for synergistic support to CARM WHO/Europe’s WB Special Envoy WBRM technical meetings of countries and partners • Joint yearly and individual political events with WB ministers of health. • High-level meetings with ministers of health and WB counterparts facilitated by the WHO heads of offices. • Collaboration with subregional organizations and partners. • Supports coherence of WHO/Europe’s action across WBRM areas, with countries and partners. • Subregional and country gatherings of technical experts from the WBs and partners for investment alliance and powering human resource capacities for advancement of WBRM action areas and reform initiatives. Yearly WBRM technical meetings convened by WHO/Europe gather WB and partner experts for dialog and exchange in powering up joint action. At the June 2021 First Technical Meeting over 80 experts focused on developing WBRM and deciding on the critical action areas and reform initiatives. The second technical meeting on WBRM implementation in May 2022 gathered over one hundred participants from the WBs, partners and subregional organizations to discuss five of the action areas/ reform initiatives that they found critical to accelerating progress under WBRM. At the meeting, WHO/Europe presented its overview of 2021–2022 (Box 1). * All references to “area” in this document should be understood as Kosovo. All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 1 The WHO Regional Office for Europe (WHO/Europe) consists of the head office in Copenhagen, Denmark; 32 country offices (for Israel, host agreement is being finalized); field, liaison, representation and sub-offices including subregional WHO Health Emergencies Programme (WHE) hubs; five geographically dispersed offices (GDOs); one WHO-hosted Partnership; and one office for Health Systems Financing. It is through these offices that Programme budget 2022–2023 has been delivered, with the support of a broad partnership community, including over 265 WHO collaborating centres. 3• WBRM is a political and technical catalyzer – a country/area-owned pathway establishing clear directions for subregional cooperation at the highest level (heads of state). • The first technical council dialogue opened exchange across five selected WBRM action areas and initiatives and agreed to continue action on primary health care, digital health, mental health, childhood obesity and health emergencies. • Accelerating synergistic action within the WBs requires ensuring coherence among the plans and activities of health authorities and their synergistic effort to build on country/area-level health goals. • Coordinating across partners and partnerships is essential for policy coherence and accelerating united action under WBRM. Box 1. Key conclusions of the May 2022 subregional technical meeting on WBRM implementation Positioning health high atop the WB development agenda The EU accession process is a key driver of reform and motivation for WB governments to progress across a range of normative and policy areas. The WBs’ partnership portfolio has largely emerged within this context of aspiring EU integration and EU neighborhood policy. EU engagement with the WBs has been enhanced through the development of the Economic and Investment Plan to support economic recovery and convergence. WHO/Europe has participated at the EU–WB leader forums since 2020, promoting health as central to the WB’s socioeconomic development agenda. In their Joint Statement of endorsement for WBRM, the WB Prime Ministers articulated their consensus and solidarity around WBRM priorities and joint commitments for accelerating socioeconomic development with health at the centre. The Prime Ministers also explicitly linked WBRM actions and initiatives with accelerating EU accession, thus regarding their WBRM as a tool to the accession progress. WHO/Europe’s contribution to the EU progress reports for the WBs consider WBRM related action results in a wide range of health and health related issues that impact progress across all EU report chapters. WHO/Europe’s cooperation with the EU took on a new and greater importance during 2022 and grew stronger amid united action to build long-term resilience and sustainability in the wake of the war in Ukraine and the consequent refugee crisis. A dedicated EU Project Management Office in the head office in Copenhagen and WHO country offices ensured the swift implementation of an EU project worth US$ 1.6 million in the WBs. These investments, among others, helped facilitate better health and protection for the close to 20 million people in this subregion. WHO facilitates health collaboration with three main subregional organizations that support the progression of WBRM: • CEI. CEI continues to be a strong advocate for WBRM at the highest global political forums, as exemplified by the 2022 United Nations General Assembly (UNGA) Resolution on Cooperation between the United Nations and the Central European Initiative. CEI’s first Plan of Action 2021–2023 established a strong health chapter under which WBRM has been supported, mainly in primary health care (PHC), digital and mental health, and emergencies. “We commend the European Union for reflecting health in the ‘Green Deal,’ and the Western Balkan Prime Ministers for their commitment to the Roadmap for Health and Well-being, where they acknowledge that investments in health breed stability and economic development – with a seven-fold economic return on every Euro invested in non- communicable diseases”. Statement of the WHO Regional Director for Europe, Dr. Hans Henri P. Kluge, at the Berlin Summit, November 2022 “[The UNGA] notes the activities of the CEI in mitigating the adverse effects of the COVID-19 pandemic for its Member States and welcomes the Initiative’s response capacity for effectively tackling health-related challenges, including through consolidated cooperation with the Regional Office for Europe of the World Health Organization, and in particular the joint endorsement of the World Health Organization’s Roadmap for health and well- being in the Western Balkans (2021–2025) at the Summit of the Heads of Government of the Member States of the CEI under the Presidency of Montenegro in 2021.” The UNGA Resolution on Cooperation between the United Nations and the Central European Initiative (2022) 4• Regional Cooperation Council (RCC). Collaboration between the RCC and WHO/Europe progresses through meetings of the WHO Regional Director of Europe and the RCC Secretary General – with the last meeting held as part of the Health in the Well-being Economy Forum in March 2022; through monthly meetings of the institutional focal points; and through WHO/Europe expert technical support to the RCC South East Europe (SEE) Strategy 2030. The WHO European Office for Investment for Health and Development in Venice, Italy, is supporting the RCC with the Annual Interim Implementation Report of the SEE 2030 strategy, particularly on the theme of overall quality and access to health services and other quality of life determinants in the post-pandemic environment. The Office will also support the development of a SEE-specific Inclusive Growth Index. Joint contribution to WBRM manifests results under the labels of the WB Green Agenda, Digital Transformation, Youth Lab and the SEE Strategy 2030 monitoring and evaluation. • SEE Health Network (SEEHN). The historically close collaboration of WHO/Europe and SEEHN focused in 2022 on implementing WBRM as central to the SEEHN Ministerial Pledge 2022–2026 to accelerate closing the health gap between the WB and EU Member States of SEEHN. SEEHN, as the first specialized public health organization in SEE, joined hands with WHO/Europe in 2022–2023 in the areas of digital health, mental health and human resources for health. Since 2021 WHO/Europe has been convening quarterly managerial meetings of the three subregional organizations relating to yearly plans of joint activities and providing coherence and efficacy of collaborative efforts, with the last meeting held in January 2023. Accelerating action under WBRM’s technical objective WBRM was developed to support the implementation of the EPW in the WBs in the areas prioritized explicitly by the WBs (Table 1). WHO/Europe has contributed to WBRM advances mainly through three action streams, namely: 1) ensuring the WBs is well reflected/included in Regional and global initiatives; 2) creating specific opportunities for subregional cooperation and dialogue in the WBs, and 3) implementing biennial cooperative agreement programmes of work in individual WB countries/area. Table 1. Collaboration between the EPW priorities and flagships and WBRM action areas and initiatives EPW Priorities WBRM action areas and reform initiatives Priority 1: Moving toward universal health coverage (UHC) 1. Ensure financial protection and access to medicines • Initiative on Financial Protection UHC • Medicines and Medical Supplies Collaborative Initiative 2. Safeguard the quality of health care and patient safety • Innovation Hub for Quality of Care and Provider Performance 3. Preserve human capital for health • Initiative to Expand and Retain Human Capital for Health • Initiative for Health Worker Education Flagship Initiative 1: The Mental Health Coalition 4. Promote mental health and social care services • Mental Health and Social Care Leadership Coalition Flagship Initiative 2: Empowerment through digital health 5. Strengthen PHC through digital transformation • PHC Reform Initiative • Initiative for Digital Health Transformation in PHC Priority 2: Protection against health emergencies 6. Increase resilience to health emergencies • The platform for Leadership and Governance for Emergency Preparedness and Response • Health Emergency Preparedness and Response Capacity Building Initiative Priority 3. Promoting health and well- being 7. Combat avoidable non-communicable diseases • Taxation, Legislation, and Regulation Initiative for Health • Non-communicable disease Targets and Data Network 8. Create healthy and green environments • The Platform for Climate, Environment, and Health • Road Safety Initiative 9. Combat antimicrobial resistance • Initiative for intersectoral antimicrobial resistance leadership and governance • Integrated Antimicrobial Stewardship Programme initiative in health-care facilities Flagship Initiative 3: The European Immunization Agenda 10. Extend vaccination benefits across the life course • Immunization Agenda Flagship Initiative 4: Healthier behaviour: incorporating behavioural and cultural insights Cross-cutting 5Highlights of EPW-related Regional and global achievements that have powered up WBRM action WHO/Europe’s support for WBs runs strong, as demonstrated by the establishment and implementation of WBRM. Developing a comprehensive and feasible WBRM has been simultaneously a political and technical process, and both aspects should be repeatedly acknowledged as WBRM action progresses. Given the contemporary complexities, one-dimensional approaches were ill suited to addressing multi-dimensional health problems and the needs of present and future WB country/area generations. Instead, WBRM comprises flexible, integrative and holistic approaches that can rapidly adapt to changing circumstances and an ever-growing evidence base and set the tone of the overall motion of WBRM. The WHO Regional Director for Europe has been frequently present in the WBs and met high-level authorities across-the- government on over 40 direct bilateral occasions. Such a strong presence supported the establishment of health as a driver of overall socioeconomic progress and has helped to increase social capital for health through strengthened and inclusive collaboration among stakeholders and partners, thus channeling and generating wider support for the WBs and their subregional health engagements. Hundreds of technical missions have been coordinated by the WHO heads of offices and their teams, focusing on individual country/area needs. At the same time, these endeavors have been increasing the awareness of WBRM’s role in facilitating policy coherence for health and sustainable development across the WBs by encouraging countries/ area to consider the effects of their actions in a holistic manner; within and beyond their own borders, now and in the future, as well as the impact for sustainable development. Overall, the WHO Regional Office for Europe published over 450 publications in 2022–2023: reports, policy briefs, operational guidance, health profiles, fact sheets and others, each providing evidence to support WBRM action across each of the action areas or advice for future efforts. Recent reports continue to demonstrate WHO’s role as a beacon for the endeavors of the WBs and their partners, including the European Health Report 2021 and those relating to a number of different topics, including obesity; antimicrobial resistance (AMR) surveillance; the health and care workforce; childhood cancer inequality; the scaling up of action on climate change mitigation and health adaptation; alcohol digital environments; and challenges and policy options for better health, as well as Regional and seasonal influenza surveillance reports, reports and updates from the WHO Technical Advisory Group on COVID-19 and other technical groups, networks and WHO centres of excellence. In the same period, there have also been multiple potent initiatives that include the WBs, some of which are highlighted in this Digest (Box 2). Technical support and capacity-building efforts remain a sturdy focus of WHO/Europe. Gathering experts across the vast and diverse European Region allows joint learning and knowledge exchange and stimulates awareness of cross-border health considerations, especially related to building Regional and global resilience in the face of multiple crises of global health impact. Hundreds of Regional events in the past year alone have supported technical networking and the strengthening of professional communities, equipping them with tools and training material. For an illustration of the magnitude of country support across the Region in 2022, WHO/Europe conducted 419 support missions and deployments to 27 countries and areas, including in the WBs; mobilized 40 partners under the Global Outbreak Alert and Response Network and facilitated the deployment of eight Emergency Medical Teams. Supplies worth US$ 96 million, including vaccines, were procured for 31 countries/area in the Region. WHO/Europe’s efforts to build country-level capacity resulted in hundreds of webinars, trainings and workshops related to the COVID-19 response, which engaged more than 55 500 participants. 6• WHO/Europe’s Access to Novel Medicines Platform – is a neutral platform for the public and private sectors to reshape political discourse, create partnerships, build momentum for change, and identify potential, pragmatic solutions to improve access to effective novel high-cost medicines in the Region. • The Pan-European Mental Health Coalition – under which WHO/Europe continues to support countries engaging in dialogues on mental health frameworks and scaling up activities such as WHO Quality Rights, the Anti-stigma Toolkit, Helping Adolescents Thrive and the WHO Mental Health Gap Action Programme. • The WHO Regional Director for Europe’s Advisory Council on Innovation for Noncommunicable Diseases and its six signature initiatives – alcohol, cardiovascular disease, childhood obesity, data and digital health, digital marketing and greener cities – aims to design innovative approaches to the respective topics. • A cloud-based platform for real-time collaboration and peer-to-peer knowledge sharing between member cities and the entire Healthy Cities Network. • Regional Behavioural and CulturaI Insights Technical Advisory Group has been established, and 49 official country focal points have been nominated and engaged in developing a behavioural and cultural insights action framework for 2022–2027. Box 2. Exemplifying WHO/Europe’s support to WBRM through regional initiatives The Seventy-second Regional Committee for Europe in 2022 brought forward the resolution, Delivering United Action for Better Health – a strategy for collaboration between the WHO Regional Office for Europe and Member States in the WHO European Region. The strategy describes the Regional Office’s offer across its six core capabilities: three technical capabilities in the areas of moving towards UHC, protecting against emergencies and promoting population health and well-being, and three enabling capabilities in the areas of leadership, communications and operations for health. Member States emphasized the role of the Region’s subregional collaboration strategies, roadmaps, and memorandums of understanding in facilitating valuable collaboration among groups of countries with shared agendas and the added value of technical and programmatic networks in the sharing of learning across the Region, including the subregional networks. Highlights: WHO targeted technical support at the subregional level across WBRM prioritized areas EPW Core priority 1: Moving towards UHC and its flagships WBRM action area 1: Ensure financial protection and access to medicines. The WHO Barcelona Office for Health Systems Financing (Spain) continued its work on monitoring financial protection as part of a three-year EU-funded project to strengthen health financing for UHC in the WBs (the Directorate-General for Neighborhood and Enlargement Negotiations, 2021–2023). The WHO Barcelona Office has been collaborating with experts from the WBs to produce new or updated analyses of financial protection (affordable access to health care) to monitor progress towards UHC through WBRM and to foster policy dialogue. Reports on financial protection in the WBs have been initiated, starting with the North Macedonian report, which was launched at a virtual event with over 100 health system stakeholders in November 2021, while the reports for Bosnia and Herzegovina, Kosovo2, Montenegro and Serbia are under way. Preliminary findings from the analysis performed to feed the reports served to fuel high-level policy dialogue events, such as that held for Bosnia and Herzegovina in Banja Luka in March 2023, and contributed to the RCC SEE 2030 interim implementation monitoring report. Capacity building efforts continued through the 10th edition of the WHO Barcelona Course on Health Financing for UHC in September 2022, with more than 50 experts, including 15 from the WBs, gathering to review effective ways of improving health financing policy and accelerating progress towards UHC. Experts and policy-makers from the WBs will continue with dialogue and exchange, and ensure the subregional contribution to progressing UHC as part of the WHO Barcelona Forum on Financial Protection in Europe, which will gather around 100 experts from across the WHO European Region in June 2023, and as part of the 11th edition of the WHO Barcelona Course on Health Financing for UHC to be held in November 2023. 2 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 7WBRM action area 2: Safeguard quality of health care and patient safety The new WHO European Centre of Excellence for Quality in Care and Patient Safety in Athens, Greece, launched in March 2022, has been focusing its work on country support, promoting quality of care-related innovations, including by supporting WBRM initiatives. Notably, the Centre has supported Albania, Montenegro and North Macedonia in strengthening quality accreditation, developing patient safety action plans and capturing patients’ voices, partnering with Harvard University, the Organization for Economic Cooperation and Development and the European Observatory on Health Systems and Policies. The WBs health technology assessment experts met under the context of WBRM and launched the health technology assessment document repository. Most recently, the Centre supported the ignition of the Joint WHO and CEI project on quality of care in hematology as part of WBRM. WBRM action area 3: Preserve human capital for health More than 1600 health professionals across south-eastern Europe have been trained in occupational health and safety in the context of COVID-19 through a project supported by WHO/Europe. The Actions to strengthen the resilience of health workers in south-eastern Europe in response to COVID-19 and beyond the implementation of WHO/ILO [International Labour Organization] guidance and mapping of priority needs for occupational health and safety programs for health workers project report was published in September 2022. The project was implemented through the South-East European Network on Workers’ Health (SEENWH), a seasoned platform of occupational health experts coordinated by the WHO Collaborating Centre for Occupational Health at the Institute of Occupational Health of the Republic of North Macedonia in Skopje. SEEHNWH activities have contributed to the WBRM Initiative for Health Worker Education that contributes to preserving human capital for health in the WBs and demonstrate both the decisive role of the WHO Collaborative Centers in the WBs and the synergistic strength of the WB’s subregional health worker networks. BRM action area 4: Promote mental health and social care services WHO/Europe’s flagship mental health initiative has made great strides in motivating mental health action following the adoption of the European Framework for Action on Mental Health, 2021–2025. WHO/Europe’s Mental Health Flagship team met with WB representatives and experts in Tirana in October 2022 to recommit and revamp mental health reforms in line with WBRM; to establish a mental health network; and to scale up partnerships with grassroots organizations to promote mental health among young people. The Tirana Youth4Health Forum brought 150 young participants, government, and civil society partners together in October 2022 to engage in genuine dialogue, build trust and to find better ways to include youth in policy decisions for health. The Mental Health Flagship team are also working in partnership with the United Nations Children’s Fund (UNICEF) under the UNICEF and WHO Joint Programme on Mental Health and Psychosocial Well-being and Development of Children and Adolescents, in Albania, North Macedonia and Serbia, with a focus on strengthening mental health policy; building capacity for mental health leadership and governance; developing comprehensive, multisectoral services and promotion and prevention activities; and strengthening information systems, evidence and research. WBRM action area 5: Strengthen PHC through digital transformation PHC The WHO European Centre for Primary Health Care in Almaty, Kazakhstan (PHC Centre) initiated action in the WBs in 2022, focusing mainly on intercountry dialogue, to strengthen national strategies and priorities on PHC through exchange and collaboration at subregional level. The joint WHO and CEI PHC project was established in 2022 as a health platform for WB collaboration, which supported the transformation of the project’s activities into a WB hub for WBRM. The WB hub hosts a significant yearly subregional health collaborative event to build and connect technical communities in the WBs with EU equivalents, to expand knowledge and experiences contributing to all WBRM areas of action. The second PHC intercountry dialogue meeting was held in September 2022 at the CEI headquarters in Trieste, Italy, as a three-day international event organized by the CEI Secretariat and gathering over 85 participants, while around 90 people participated in thematic webinars and online consultations. The investment in PHC capacity-building has continued, with the WBs invited to complete implementable performance monitoring projects at the annual PHC performance monitoring and management training programme – a joint initiative with the Collaborating Centre at Amsterdam Medical University that in 2022 involved 31 participants in 6 cohorts. 8Digital health WHO/Europe established the Western Balkan Digital Health Network in 2021 to serve as a WBRM umbrella for collaboration and strategic investments in building mature and potent digital ecosystems to support health in the WBs. The second and third meeting of the Network took place in 2022, with representation from Member States and international organizations and with a focus on governance, legislation and digital health literacy. The Network also held a workshop on Ethics and Governance for Artificial Intelligence, supported by Network, and other international experts. The Network, in the context of the WBRM, continues to promote the implementation of the EPW and the newly adopted Regional digital health action plan for the WHO European Region 2023–2030, towards inclusive digital societies centred on people, gender equality and health equity as an integral part of broader socioeconomic reforms in the WBs and – in sync with the EU Digital Agenda for the Western Balkans – full integration into the EU. The Health Systems in Action country profiles developed by WHO/Europe for Bosnia and Herzegovina, Montenegro and North Macedonia, each integrated digital health. Partnership investments and engagements further boosted activities within the WBRM Initiative for Digital Health Transformation in PHC, mainly through the abovementioned joint WHO and CEI PHC project, as well as through the March 2022 CEI High-level policy-making event entitled Building an IDEAHL Europe, held at the European Parliament and co-sponsored by WHO/Europe, which focused on digital empowerment and health literacy. Additionally, the conclusions from the Western Balkans Digital Summit in September 2022 in Pristina, organized by the RCC as part of SEE2030 implementation, confirmed the WB’s common ambition to jointly progress digital transformation and regional cooperation, under the Common Regional Market. The above developments and activities were accompanied by subregional technical events including on investing in digitalization in the WBs, donor coordination meetings, the telemedicine network approach and scaling up innovative PHC models and digital solutions to better address noncommunicable diseases and mental health. In parallel, specific country/area technical consultations moved forward on e-appointments in North Macedonia; on sustainable adoption of digital health solutions at the First Albanian Health Congress; and a health information system assessment in Montenegro focusing on mortality data, civil registration and vital statistics reporting, to be followed by study visits and training. EPW Core Priority 2: Protecting against health emergencies WBRM action area 6: Increase resilience to health emergencies WHO/Europe, working through the WHO Health Emergencies Programme, plays a vital role in supporting all Member States across the four stages of the emergency management cycle: prevention, preparedness, response and recovery. Through the Programme, emergency preparedness capacity-building activities have been conducted in the areas of risk communication, community engagement and infodemic management; infection prevention and control; emergency preparedness and contingency planning; laboratory strengthening; epidemiological surveillance; clinical management and medical countermeasures; monitoring of public health and social measures during epidemics and pandemics; points of entry; and more. Established in 2018, WHO/Europe’s WB emergency hub conducts support missions, mobilizes partners under the Global Outbreak Alert and Response Network, and facilitates the deployment of Emergency Medical Teams. During 2021–2022 the hub trained over 300 WB experts in 14 subregional capacity-building workshops on a wide range of all-hazards emergency preparedness and response issues. It also successfully implemented three intra-action reviews, 16 direct technical support missions, 4 strategic risk assessment exercises and over 25 online consultations. Key milestones at the country level include Albania’s emergency response plan for the University Hospital Mother Teresa; Bosnia and Herzegovina’s laboratory bioinformatic-specific sequencing; Kosovo’s3 points of entry capacity-building and health security capacity assessment; Montenegro’s improved hospital readiness through the adoption of the WHO hospital safety index tool; North Macedonia’s enhanced public health emergency operations centre functionality; and Serbia’s National Action Plan for Health Security. 3 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 9EPW Core Priority 3: Promoting health and well-being WBRM Action area 7: Combat avoidable noncommunicable diseases As part of the childhood obesity signature initiative of the WHO Regional Director for Europe’s Advisory Council on Innovation for Noncommunicable Diseases, subregional obesity policy dialogues were launched in Skopje, North Macedonia in May 2022 at a high-level event attended by the First Lady of North Macedonia and the Minister of Health. These policy dialogues, coupled with a training course on childhood obesity management for primary care physicians, further gathered vital health sector stakeholders in the WBs to guide the implementation of evidence-based policy interventions, applying a noncommunicable disease framework in addressing obesity. Furthermore, in May 2022 the WBRM Technical Council meeting discussed obesity as one of its first technical topics due to its seriousness in the WBs. A report on COVID-19 and childhood obesity including the WBs was launched in May under the Childhood Obesity Surveillance Initiative. WHO/Europe is currently working with the WBs and experts to develop an initiative for tobacco control, focusing on addressing industry interference and novel tobacco products. Policy dialogues followed by training workshops on strengthening the implementation of the WHO Framework Convention on Tobacco Control in the WBs were coupled with igniting reviews of the drafts of the tobacco control bill and the national tobacco control strategy in Montenegro and Serbia. A subregional workshop on the rapid exchange of information during food safety emergencies in the WBs, held in May 2022 in Belgrade, Serbia, supported the rapid exchange of information relating to food safety emergencies. In addition, support to the WBs continued in promoting a coordinated and comprehensive approach to physical activity across different sectors, and physical activity workshops were held that scoped the PHC system, urban planning and transport, monitoring and surveillance systems, and the development of practical guidelines and a national communication campaign – moving towards more comprehensive country/area plans. WBRM action area 8: Create healthy and green environments Working through its European Centre for Environment and Health (Bonn, Germany) (ECEH), WHO/Europe advanced the political commitment and the engagement of the health constituency in the climate and health agenda and to further accelerate policy and action under the COP26 Health Programme. The ECEH has started policy dialogues on environment and health priorities and climate change to provide political input to the preparations of the Seventh Ministerial Conference on Environment and Health to better reflect the agenda and priorities of the WBs, and to support WBs in developing evidence-informed policies and actions and to facilitate the uptake of WHO tools. The second online edition of the Bonn Environment and Health School took place in November 2021, which included participants from the WB, to build technical and leadership capacities in areas such as air quality, climate change, green recovery and defining the environment and health research agenda through a problem-based learning process. The ECEH also led the capacity-building activities, which included the WBs, in chemical risk assessment and the development of tools and educational materials, including on mercury and health, contributing to the implementation of the WHO Chemicals Roadmap and international environmental agreements, like the Minamata Convention on Mercury. ECEH engagements in the WBs supported significant achievements, most notably in strengthening capacities in integrated/ intersectoral road safety data systems and the development of cause of death registry systems. The intersectoral character of activities coalesced numerous partners such as the Western Balkans Road Safety Observatory, the European Commission’s Directorate-General for Mobility & Transport, Bloomberg Philanthropies, World Bank and others. The WBs also participated in the Road Policing Survey and the compilation of case studies for the Technical Manual on Road Policing. WBRM action area 9: Combat AMR Efforts of WHO/Europe and partners to strengthen antimicrobial stewardship programs have intensified with the further development of tools and training materials for health-care professionals and managers, including from the WBs. Among these is the highly accessed open online course on OpenWHO.org, entitled Antimicrobial Stewardship: a competency-based approach, and functional antimicrobial stewardship programmes as part of COVID-19 pandemic response efforts to ensure proper treatment, avoid shortages and control AMR. The WBs participated in a Knowledge, Attitudes and Behaviour survey on AMR which provided baseline information to inform targeted awareness and behaviour change campaigns. In Serbia, a new training course entitled Leadership skills for effective multisectoral coordination and collaboration for addressing AMR, was piloted. AMR surveillance activities in the WBs in 2022 allowed the subregion to contribute to high-quality data and networking in the Central Asian and European Surveillance of Antimicrobial Resistance network, the Global Antimicrobial Resistance and Use Surveillance System, and the 10 WHO Antimicrobial Medicines Consumption Network. WHO/Europe also supported WB participation in the European Society of Clinical Microbiology and Infectious Diseases postgraduate education course, Clinical microbiology testing in settings with limited resources and high prevalence of AMR: the role of diagnostic stewardship, and in the EURGen-RefLabCap project, a four-year project on the provision of EU networking and support for public health reference laboratory functions for AMR in priority health care-associated infections. Point-prevalence surveys on antimicrobial use and health care-associated infections were performed in Serbia and Kosovo.4 In-depth assessments of infection prevention and control programmes and the revision of infection prevention and control manuals were conducted in Kosovo4 and North Macedonia. In addition, WHO rolled out AMR-related curricula and training in the WBs. Such developments built capacities to progress the development and implemention of individual WB countries/area action plans – as discussed at the last subregional meeting of experts and policy-makers in 2022. WBRM action area 10: Extend vaccination benefits across the life course As part of the implementation of the strategic priorities outlined in the European Immunization Agenda 2030, targeted policy dialogue and a planning meeting were organized in 2022 with national immunization programme managers of the WBs together with Regional and global partners to draft the operational framework of implementation and to guide the development of national plans of action to address immunization inequity in the WBs. This dialogue laid the grounds to identify programmatic areas of intervention linked to immunization inequity and leaving no one behind, including the expansion of evidence-informed decision-making on the introduction/scale-up of new and underutilized vaccines in national immunization schedules. In line with the scale-up of the COVID-19 vaccination, specific emphasis was laid on ensuring accessibility of the vaccine to the identified vulnerable populations as well as using similar platforms to deliver seasonal influenza vaccines. As a local initiative to improve the access of COVID-19 vaccines to the population, the COVID-19 vaccination mobile health caravan rally in the WBs continues to bring health services and advice closer to where people live: UNICEF and the European Commission partnered with WHO/Europe to add scope and value to such initiatives. During the reporting period, WHO/Europe also provided strategic support in the development of tailored communication plans for the scale-up of HPV vaccination, communication training for health-care workers on human papillomavirus and COVID-19 vaccination and COVID-19 vaccination monitoring, with a focus on reporting and use of data for action. These activities are aligned to the principles of the European Immunization Agenda 2030 towards building resilient immunization systems. CONCLUSION Multiple, simultaneous, complex emergencies and consequent responses impacting our Region, and their consequent responses, characterize the 2022–2023 period. WHO/Europe mobilized and sought to respond to each emergency while focusing on the three core priorities and flagship initiatives of the EPW. WHO/Europe’s work is driven by these priorities and substantial advancements have been made within each of these over the past two years that have benefited WBs. This has included delivering workshops and training; setting up critical new initiatives; providing invaluable data and evidence to inform policy and decision-making; leading the health response amid major overlapping emergencies; and more. WHO/Europe has also provided specific and tailored technical support to the subregion in various health areas scoped by WBRM. This support under the WBRM technical objective has allowed the WB to focus their visionary efforts in 2022–2023 on PHC, digital health, mental health, childhood obesity and emergencies, as well as continuing to work on empowering the health workforce and increasing fiscal space for health. In all, WHO/Europe contributed to progress across WBRM objectives through high-level promotion, technical contribution, investments and significant efforts to facilitate WB leadership in their joint endeavors with partners towards full delivery on WBRM. The WB countries/area’s growing integration in the subregion and with the EU and solid subregional collaboration has contributed to the realization of their political objective under WBRM and facilitated the increased investment of partners and of the WBs in health, as central to developing economic well-being. 4 All references to Kosovo in this document should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). 11 Bibliography5 1. Thirteenth General Programme of Work, 2019−2023. In: World Health Organization [website]; Geneva: World Health Organization; 2023 (https://www.who.int/about/what-we-do/thirteenth-general-programme-of-work-2019---2023). 2. The European Programme of Work, 2020–2025: United Action for Better Health. Copenhagen: WHO Regional Office for Europe; 2021(https://apps.who.int/iris/handle/10665/339209). 3. Roadmap for Health and Well-being in the Western Balkans (2021-2025): European Programme of Work (2020– 2025) - United Action for Better Health. Copenhagen: WHO Regional Office for Europe; 2021 (https://apps.who.int/iris/ handle/10665/345932). 4. Compendium of the Roadmap for Health and Well-being in the Western Balkans (2021–2025): European Programme of Work (2020–2025) – United Action for Better Health. Copenhagen: WHO Regional Office for Europe; 2021 (https://apps.who. int/iris/handle/10665/345936). 5. Seventy-second Regional Committee for Europe: Tel Aviv, 12–14 September 2022: report of the Regional Director: the work of WHO/Europe in 2021–2022. Copenhagen: WHO Regional Office for Europe; 2022 (https://apps.who.int/iris/ handle/10665/361900). 6. Seventy-second Regional Committee for Europe: Tel Aviv, 12–14 September 2022: delivering United Action for Better Health – a strategy for collaboration between the WHO Regional Office for Europe and member states in the WHO European Region (https://apps.who.int/iris/handle/10665/361848). 5 All references were accessed on 18 May 2022. World Health Organization Regional Office for Europe UN City, Marmorvej 51 DK-2100, Copenhagen Ø, Denmark Tel: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eurocontact@who.int Website: www.who.int/europe 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. 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