WHO country cooperation strategy at a glance: Malta

HEALTH SITUATION Maltese citizens enjoy one of the highest life expectancies in Europe. NCDs are a major issue. Despite health gains, there are increased risk factors associated with NCDs. One preventable contributing factor is obesity, which is increasingly prevalent among both adults and children. Diseases of the circulatory system are the leading causes of death, accounting for 40.1% of all deaths in 2013. Neoplasms are the second major causes of deaths, accounting of 27% of all deaths, followed by diseases of respiratory systems (10.6%) and external causes of morbidity and mortality (3.3%). Ischaemic heart disease mortality rates are higher than European average. Diabetes mellitus as an underlying cause of deaths accounts for 3.2% of all deaths, which is also higher than the European average. The free syringe distribution program for intravenous drug users, started in late 1980s, has resulted in low rates of HIV infection. An upward trend in the incidence of HIV in same-sex sexual encounters has been observed. HIV infections has been identified as a priority area for action in the field and a strategy is currently being developed. A free childhood immunization programme for all children has resulted in lower morbidity and mortality from vaccine preventable infectious diseases. Substantial work has also been done in the development of emergency response plan for microbial emergencies and pandemic crises. HEALTH POLICIES AND SYSTEMS The ministry for Energy and Health is responsible for the provision of health services, health services regulations and standards, environmental health, health and safety, health promotion and diseases prevention. The ministry for Family and Social Solidarity is responsible for social policy and policy relating to the child, the family and persons with disability, elderly people and community care, social housing, social security, pensions and solidarity services. The publicly financed health system provides a comprehensive basket of health services to all persons residing in Malta who are covered by Maltese social security legislation. Particular attention is being given to the use of information technology due to the creation of the Integrated Health Information System and the introduction of new electronic medical records system alongside the opening of Mater Dei Hospital in 2007. The ministry is currently in the process of drawing up an e-health strategy. Other actors include other government ministries, the Foundation for Medical Services, government commissions, agencies, board of committees, professional regulatory bodies and professional groups, private and voluntary sectors, the Church and the general public. The private sector complements the provision of health services, in particular in the area of primary health care. In addition, some services (especially for long-term and chronic-care) are also provided by the private sector, religious bodies and other international organizations. The Maltese Health System provides a comprehensive basket of health services available universally for all its citizens. According to the European Union Statistics on Income and Living Conditions, self-reported unmet need due to financial constraints in 2010 was as low as 0.8%, reflecting Malta’s major focus on providing equal access to health services for all. Indeed, socioeconomic inequalities are more evident among health determinants such as obesity and health literacy than for health care access. A major challenge for the health system is ensuring sustainability as Malta faces increasing demands from its citizens, an ageing population and the rising cost of medicines and technology. COOPERATION FOR HEALTH The past cooperation between WHO and Malta includes the following areas: addressing policy development for health promotion and disease prevention; strengthening national environment and health; health system strengthening, and increasing capacity for policies that address social determinants of health. In 2017, Malta held the rotating presidency of the Council of European Union, with a focus on obesity and overweight - a public health problem that affects most European countries. In addition to its relation to WHO, Malta has also a number of bilateral cooperation agreements with other EU and non-EU Member States, such as Italy, UK, China, Israel and Qatar. Such bilateral agreements provide for technical cooperation between the two countries, clinical support, training as well as exchange of expertise in the field of health. Malta has provided critical support in the field of health during the crises in Lybia and Tunisia in 2012. It served as the transit point for 21000 foreigh workers and expatriates, who fled Lybia to return their homeland. The country also provided, within its resource limitations, acute hospital care to civilians and served as a shipping base for medical supplies to be sent in most affected areas. During this time, there was a significant coordination among the various entities locally and collaboration with UN agencies and other Member States, as well as voluntary NGOs. Malta http:// www.who.int/countries/en/ WHO region Europe World Bank income group High-income Child health Infants exclusively breastfed for the first six months of life (%) () Diphtheria tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) (2016) 97 Demographic and socioeconomic statistics Life expectancy at birth (years) (2015) 83.7 (Female) 79.7 (Male) 81.7 (Both sexes) Population (in thousands) total (2015) 418.7 % Population under 15 (2015) 14.4 % Population over 60 (2015) 25.6 Poverty headcount ratio at $1.25 a day (PPP) (% of population) () Literacy rate among adults aged >= 15 years (%) () Gender Inequality Index rank (2014) 46 Human Development Index rank (2014) 37 Health systems Total expenditure on health as a percentage of gross domestic product (2014) 9.75 Private expenditure on health as a percentage of total expenditure on health (2014) 30.84 General government expenditure on health as a percentage of total government expenditure (2014) 15.64 Physicians density (per 1000 population) (2015) 3.908 Nursing and midwifery personnel density (per 1000 population) (2015) 9.141 Mortality and global health estimates Neonatal mortality rate (per 1000 live births) (2016) 4.6 [3.8-5.5] Under-five mortality rate (probability of dying by age 5 per 1000 live births) (2016) 6.8 [5.7-8.1] Maternal mortality ratio (per 100 000 live births) (2015) 9 [ 6 - 15] Births attended by skilled health personnel (%) (2013) 99.9 Public health and environment Population using safely managed sanitation services (%) (2015) 93 (Urban) 93 (Rural) 93 (Total) Population using safely managed drinking water services (%) (2015) 100 (Total) Sources of data: Global Health Observatory May 2017 http://apps.who.int/gho/data/node.cco WHO COUNTRY COOPERATION STRATEGIC AGENDA (2016–2021) Strategic Priorities Main Focus Areas for WHO Cooperation STRATEGIC PRIORITY 1: Collaborating on promoting the Health 2020 policy framework, including intersectoral action, towards people- centred health systems  Further enhancement and strengthening of quality strategic purchasing;  Further development of regulatory arrangements, with special emphasis on evaluation of performance and the quality of services provided;  Exploring innovative methods to improve sustainability of the health system and financing. STRATEGIC PRIORITY 2: Addressing the increasing burden of NCDs, in particular obesity and mental health, through intersectoral and life- course approaches Addressing NCDs and Child Obesity  Strategic analysis of the results of comprehensive national food consumption survey initiated in 2015;  Development of policies and/or actions to address dietary and physical activity issues;  Implementation of the whole school approach to a healthy lifestyle to combat child obesity;  Development of a regulatory mechanism for marketing foods high in fat, salt and sugar to children;  Development of an intersectoral approach for enhancing physical activity. Addressing Mental Health Service Provision.  Drawing up on an updated mental health strategy and action plan;  Development of public mental health services with emphasis on community supported living, early detection and intervention, and integration of crisis response services;  Elaboration of a national policy or action plan to address alcohol use, followed by relevant regulations. STRATEGIC PRIORITY 3: Promoting cross border collaboration on health with an emphasis on emergency preparedness and response, including refugee and migrant health  Development of capacity to deal with health needs in the situation of a massive influx of refugees and migrants;  Development of capacity to respond to health threats, including those arising from social determinants of health, in particular with regard to extreme weather events, chemical pollution and improving resilience of water supply and sanitation systems. STRATEGIC PRIORITY 4: Further promoting the role of Malta in International health and its global and regional contribution  Development of a supporting network for Small Member States;  Capacity building in global and regional health diplomacy Please note that the 3rd generation CCS 2014-20g finalize © W orld Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. 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 WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. This publication does not necessarily represent the decisions or policies of WHO. WHO/CCU/18.02/Malta Updated May 2018