Forty-ninth Regional Committee for Europe: Florence, 13 - 17 September 1999: collaboration with agencies and organizations active in health in Europe

WORLD HEALTH ORGANIZATION R e g i o n a l O f f i c e f o r E u r o p e COPENHAGEN Provisional agenda item 2(d) EUR/RC49/Inf.Doc./2 16 July 1999 09819 ENGLISH ONLY C o l l a b o r a t i o n w i t h A g e n c i e s a n d O r g a n i z a t i o n s A c t i v e in H e a l t h in E u r o p e The European Region is one of great political, economic, social and institutional contrasts. The public health situation, too. is very variable, with profoundly unsatisfactory conditions in the eastern part of the Region. The agenda for health involves all aspects of society, and multisectoral and multilevel participation is accordingly a fundamental part of the Health for All philosophy. Partnership and collaboration are therefore strongly emphasized in the HEALTH2 I policy framework. Plainly, these functional requirements can be met only if a wide variety of health-interested organizations and actors work together with countries in a systematic, structured and coordinated way. This paper reviews the extent and content of the Regional Office for Europe’s collaborative activities during 1998-1999 in this context. REGIONAL COMMITTEE FOR EUROPE F orty -n in th session , F lo ren ce , 1 3 – 17 S e p te m b e r 1 9 9 9 CONTENTS Page European Com m ission........................................................................................................................................................ 1 Commission Communication on the development of public health po licy ..............................................1 WHO assistance to candidate countries for accession to EU membership............................................... 1 PHARE/TACIS..........................................................................................................................................................2 Information for health for Europe.........................................................................................................................2 European Monitoring Centre for Drugs and Drug Addiction (E M C D D A )..............................................2 Evaluation of integrated health promotion and innovation in a network of European cities............... 3 European Network of Health Promoting Schools (ENHPS): a joint EURO/European Commission/Council o f Europe p ro jec t .......................................................................................................... 3 WHO Healthy Cities Network.............................................................................................................................. 3 Promotion of energy-efficient transport in a network of European cities................................................. 3 Healthy public policy...............................................................................................................................................4 Meetings of Chief Medical Officers of the E U .................................................................................................4 N urs ing ........................................................................................................................................................................4 Council of E urope .................................................................................................................................................................4 Sixth Conference of European Health M inisters ............................................................................................. 4 H IV /A ID S................................................................................................................................................................... 4 Patients’ r igh ts ...........................................................................................................................................................5 Health information....................................................................................................................................................5 Programmes of the United N ations..................................................................................................................................5 United Nations reform process ............................................................................................................................. 5 Joint United Nations Programme on HIV/AIDS (UNAIDS)........................................................................ 5 United Nations Economic Commission for Europe (E C E ) .......................................................................... 6 United Nations Children’s Fund (U N IC EF)......................................................................................................6 United Nations Population Fund (UN FPA )....................................................................................................... 6 United Nations Development Programme (U N D P ) ........................................................................................6 Office of the United Nations High Commissioner for Refugees (U N H C R )............................................6 Specialized agencies of the United Nations S ys tem ....................................................................................................6 World Bank.................................................................................................................................................................6 International Monetary Fund ( IM F ).................................................................................................................... 7 Emergency humanitarian assistance................................................................................................................................7 Albania, the Federal Republic of Yugoslavia and The Former Yugoslav Republic of Macedonia....7 Bosnia and Herzegovina......................................................................................................................................... 8 Federal Republic of Y ugoslavia........................................................................................................................... 8 Tajik istan ....................................................... ............................................................................................................ 9 Regional development ban k s .............................................................................................................................................9 The European Bank for Reconstruction and Development (E B R D )..........................................................9 Introduction.............................................................................................................................................................................1 Multilateral collaborative activ it ies ................................................................................................................................ 9 Information for health for Europe........................................................................................................................ 9 European Environment and Health Committee (EEH C).............................................................................10 Healthy Planet Fo rum ........................................................................................................................................... 10 Interagency Immunization Coordinating Committee (IICC)..................................................................... 10 Intergovernmental and bilateral organizations........................................................................................................... 10 Organisation for Economic Co-operation and Development (O E C D )....................................................10 United Kingdom Department for International Development (D fID ).....................................................10 Special events...................................................................................................................................................................... 11 20 years of the Alma-Ata Declaration..............................................................................................................11 Collaborative networks.....................................................................................................................................................11 European Forum of Medical Associations and WHO (EFM A).................................................................11 European Forum of Nursing and Midwifery Associations and W H O .....................................................11 EuroPharm Forum.................................................................................................................................................. 11 Foundations and nongovernmental organizations..................................................................................................... 12 Soros Foundation....................................................................................................................................................12 European Society of General Practice/Family Medicine (ESGP/FM ).....................................................12 International Federation of Red Cross and Red Crescent Societies (IFR C ).......................................... 12 International Confederation of Midwives (ICM )...........................................................................................12 International Council of Nurses ( IC N ) ............................................................................................................ 12 Public Services International (PSI), Consumers International (Cl), World Medical Association (W M A )..............................................................................................................12 London School of Economics and Political Science and London School of Hygiene and Tropical M edicine ........................................................................................................................................12 Association of Schools of Public Health in the European Region (ASPHER)..................................... 12 European Public Health Association (E U PH A )............................................................................................ 13 Tipping the Balance (T T B )..................................................................................................................................13 European Union of General Practitioners (UEMO)...................................................................................... 13 International Federation of Gynaecology and Obstetrics (FIGO) and European Association of Perinatal Medicine................................................................................................13 International Diabetes Federation (Europe), European Association for the Study of Diabetes, International Diabetes Federation (G lobal)..................................................................................................13 EUR/RC49/Inf.Doc./2 page I 1. A strategic vision of how to bring about health improvements is important for engendering a sense of shared purpose, goals and objectives. The Health for All (HFA) philosophy, and now the H E A LTH 21 policy framework in the European Region, offer to all those working in partnership a practical vision of and guide to health improvement based on explicit values. 2. For WHO, this strategic objective is o f prime concern. For other partner organizations, health interests (while they are important) will not be paramount. WHO therefore has a particular responsibility to promote and coordinate the carrying out of health-related activities together with many other organizations and with all its Member States. It must do so not in a directive but in a facilitating way, respecting the many differences in organization, management and culture among those bodies that it is working with. 3. In its European Region, W H O has incorporated and fostered this theme of partnership within its organizational structure and ways of working. It accordingly conducts ongoing strategic reviews of its collaborative arrangements with those organizations that it works with most often or most extensively. E u r o p e a n C o m m i s s i o n 4. The Director-General of W HO visited Brussels in January 1999 to renew at the highest level the strategic collaboration between W HO and the European Commission (EC). Three important points were noted on that occasion: • work is proceeding on drafting a new exchange of letters between W HO and the Commission; • W HO has contributed its views on the Commission’s recent “Communication on the development o f public health policy in the European Community” (see below); • W H O is making further efforts to contribute positively to the health dimensions of the process for countries’ accession to membership of the European Union (EU). Com m ission Communication on the developm ent of public health policy 5. On 15 April 1998 the European Commission published a “Communication from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions on the development of public health policy in the European Community” (COM(98) 230 final). This paper outlines a possible new Community public health policy based on three strands of action: • improving information for the development of public health; • reacting rapidly to threats to health; and • tackling health determinants through health promotion and disease prevention. 6. W H O ’s Regional Office for Europe (EURO) has responded to the Commission with interim observations on this Communication, as part o f the Europe-wide debate sought by the Commission. The Office has also participated in several discussions, organized by EU Member States, on the future development of public health policy within the European Union. W HO assistance to candidate countries for accession to EU m em bership 7. Five WHO Member States in central and eastern Europe (Czech Republic, Estonia, Hungary, Poland and Slovenia) are negotiating to become members of EU early next century, with another five (Bulgaria, Estonia, Latvia, Romania and Slovakia) in a later wave of potential entrants. These countries are already working to bring their legislation and standards into line with the EU, so as to become equal partners with EU countries by the time they enter the Union. I n t r o d u c t i o n 8. EURO was approached by the European Commission in the spring of 1998 to contribute to this exercise, producing the following inputs to the Commission: • a sh o rt su m m ary o f th e HEALTH21 p o licy fra m ew o rk ; • an assessment of the health situation in the accession countries; • details of EURO ’s partnership with the accession countries, both programme by programme and country by country; • key health-related issues and requirements that the accession countries should tackle or meet by the time they become EU member states. The Regional Office stands ready to become a full partner with the Commission during this ongoing process. PHARE/TACIS 9. Under a contract between EURO and the EU ’s programme of action for restructuring the economy in countries of central and eastern Europe (PHARE), a sum of approximately ECU 100 000 was allocated for joint activities for the period 1997/1998. A number o f joint projects were launched, and the Baltic States, Bulgaria, Hungary and Romania have been pilot countries in this exercise. Also in the Baltic states, WHO has supported the PHARE health service and health care financing reform process, by joining forces in areas of mutual interest. 10. A third form of collaboration with the European Commission has been through its PHARE projects in countries of central and eastern Europe (CCEE) and TACIS projects in the newly independent states (NIS) of the former Soviet Union. EURO ran joint venture projects in Estonia in 1997 on primary health care (PHC), in Latvia in 1998 on human resource planning and PHC, and in Lithuania in 1998 on public health, health insurance and the primary health care interface, and on voluntary health insurance. Inform ation for health for Europe 11. EU R O ’s unit of Epidemiology. Statistics and Health Information (ESI) has a large number of joint collaborative projects with the Commission. The aim of these projects is to strengthen health information systems and promote their use at European, national and local levels for pinpointing areas for public health action and for managing and monitoring public health and health services. 12. These joint projects are either for the 15 EU member countries or for the 10 accession countries and/or CCEE/NIS. Examples of the former include the work done for the Commission’s first report on the state of health in the EU. namely the EU Highlights on Health and the Health Interview Survey (EUROHIS) project. The latter category included the development and use of national HFA databases for the CCEE (Copernicus CARE Support) and of a European public health information network for eastern Europe (EUPHIN-EAST) for 23 CCEE/NIS. For the accession countries, Highlights on Health were extended to the CCEE and health situation assessment reports were drawn up for the Commission. European M onitoring Centre for Drugs and Drug Addiction (EM CDDA) 13. EURO is represented on the management board of EMCDDA, which is situated in Lisbon. Ongoing discussions are taking place concerning the involvement of the European Commission in the preparations for the next major European ministerial conference on alcohol, which will be held in 2000, five years after the WHO European Conference on Health, Society and Alcohol (Paris, 12-14 December 1995). 14. The Commission is invited to all meetings of national counterparts of W H O ’s European Alcohol Action Plan (EAAP) and is thus involved in the planning of activities and follow-up. EUR/RC49/Inf.Doc./2 page 2 EUR/RC49/Inf.Doc./2 page 3 Evaluation of integrated health promotion and innovation in a network of European cities 15. In 1997/1998, the main contractor for this project with the Commission’s Directorate-General V was the London School of Economics. EURO’s Healthy Cities project, acting as information coordinator, was one of three associate partners, together with the University of Maastricht and Politecnico di Milano. The research carried out formed a large part of the evaluation of Phase II (1993-1997) of the Healthy Cities project. European Network o f Health Prom oting Schools (ENHPS): a jo in t EURO/European Comm ission/Council of Europe project 16. The Technical Secretariat o f ENHPS has been actively involved in drawing up a report on health promotion and health education in schools in EU member countries. This report has been submitted by the Commission to the Council o f Ministers for Health and Education. 17. A workshop on the practice and evaluation of the health promoting school, which took place in Thun, Switzerland, in November 1998, focused on the exchange of experience and information on evaluation strategies used in ENHPS, as well as on the development of communication strategies with regard to the findings from such evaluations. The scientific data will be published during 1999. W HO Healthy Cities Network 18. A series of contracts have funded W H O’s Healthy Cities activities within the EU-supported European Sustainable Cities and Towns Campaign. EURO was invited to be a core partner in the Campaign, following the two European conferences in Aalborg, Denmark in May 1994, and in Lisbon, Portugal in October 1996. 19. The Campaign arose out of Chapter 28 of Agenda 21, as agreed by the 1992 United Nations Conference on Environment and Development, and the European Commission’s Fifth Environmental Action Programme “Towards Sustainability” . It forms part of the Sustainable Cities Project, which is the overall title for cooperation between the Campaign, the EC Expert Group on the Urban Environment and the Commission’s Directorate-General XI. 20. W H O 's Healthy Cities Network has proposed the following programme of action within the framework of the European Sustainable Towns and Cities Campaign for 1999-2001: • to promote commitment and to accelerate implementation of local plans for environment and health, based on Healthy Cities and Local Agenda 21 frameworks, with emphasis on the needs of accession countries; • to develop and test guidance and planning tools on key aspects of health and sustainable development, promoting change and implementation; and • to network strategically and strengthen cooperation between partners at the international level. Promotion of energy-efficient transport in a network of European cities 21. The aim of this project, for which approval is awaited, would be to increase the use of energy- efficient personal transport. The objectives are: • to identify factors and mechanisms within municipalities that have led to pro-cycling policies; • to develop or further develop cycling policies in municipalities through twinning and technology transfer; and • to disseminate the process and lessons learned across European countries through W H O ’s Healthy Cities Network. Healthy public policy 22. An expert meeting on Healthy public policies in the European Community, was organized by the Finnish National Research and Development Centre for Welfare and Health (STAKES), as part o f an EU- funded project to examine the process for assessing the impact of EU policies on health. The meeting discussed the Commission’s Communication and emphasized that new instruments and methodologies needed to be developed to meet the obligations set out there. M eetings of Chief M edical O fficers of the EU 23. The Regional Director participates as an observer in meetings of Chief Medical Officers of the EU. At their meeting in Vienna on 24 and 25 September 1998, discussion focused on the safety of blood and blood products, and participants discussed ways of making use of E U R O ’s quality control programme in this area. At the meeting in Bonn on 25 and 26 March 1999, the Regional Director raised the issue of a potential cooperative project between Finland and EURO for the development of clinical quality guidelines, based on a study to be carried out in British, French and Swedish centres. Nursing 24. The EC-sponsored Conference “Building a European nursing research strategy”, which took place in Salamanca, Spain, from 13 to 17 March 1999. was attended by a Regional Office representative who gave a keynote address and chaired a round table about nursing practice in the twenty-first century. 25. The EU Midwifery Liaison Committee is an official observer at the annual meetings of the European Forum of National Nursing and Midwifery Associations and WHO, as is the EU Standing Committee of Nurses (PCN). C o u n c i l o f E u r o p e Sixth Conference of European Health M inisters 26. The theme of the sixth Conference of European Health Ministers, which was held in Greece from 22 to 23 April 1999, was “Ageing in the 21st century - the need for a balanced approach towards healthy ageing". The Regional Director addressed the Conference, pointing out that the situation of elderly people and the services provided for them could be improved if Member States strove to attain target 5 in the H E A L T H 2 1 policy framework, which reads “By the year 2020, people over 65 years should have the opportunity of enjoying their full health potential and playing an active social role”. 27. The Regional Director also noted that two major issues needed to be addressed: • how to strengthen the maintenance of health throughout life; • how to improve services for the elderly who have disease or disability that needs support. H E A L T H 2 1 outlines a wide range of strategies for reaching these objectives. The Regional Director concluded that what was actually needed was a “Bill of rights for older people” , in order to ensure a clear concept in society of the values and principles that should guide relations with this population group. HIV/AIDS 28. The Regional Office’s important publication Principles fo r preventing HIV infection among drug users' was co-sponsored and distributed by the Council o f Europe’s Pompidou Group. EUR/RC49/Inf.Doc./2 page 4 1 Principles fo r preventing H IV infection among drug users. Copenhagen, W HO Regional Office for Europe, 1998 (docum ent EUR/1CP/LVNG 02 06 01). Patients’ rights 29. Since 1994, when EURO together with the Council o f Europe organized a consultation on patients’ rights at which the Amsterdam Declaration was adopted, the Regional Office has collaborated closely with the Council o f Europe in this area; for example, the Council participated in the European Conference on Health Care Reforms (Ljubljana, 1996), while W HO was intimately involved in work on drawing up the 1997 Convention on Human Rights and Biomedicine (Council of Europe, European Treaties, ETS no. 164). 30. The Council of Europe has been EU RO ’s counterpart in the Patients’ Rights and Citizens’ Empowerment network since it was launched in 1997. The Regional Office is currently consolidating and streamlining the work of this network and hopes to combine its clearing house function with the Council o f Europe’s Web site on this subject. The Region has also benefited from the assessments that the Council has made of citizens’ participation and waiting lists. Health information 31. EU R O ’s Epidemiology, Statistics and Health Information unit is a participating member of the Council o f Europe’s project on “Trends in mortality” . P r o g r a m m e s o f t h e U n i t e d N a t i o n s United Nations reform process 32. The Regional Office has supported the role of UN resident coordinators, endorsed the concept o f an integrated UN presence and participated in the United Nations Development Assistance Framework (UNDAF) exercises within the context o f the UN reform process. In the European Region, two pilot countries for UNDAF exercises are Romania and Turkey, and the Regional Director has asked WHO representatives and liaison officers in the European Region to participate in the process. W H O ’s philosophy and its HFA polices, programmes, database and documents have been well received in this context. Joint United Nations Programme on HIV/AIDS (UNAIDS) 33. The Regional Office's programme on Sexually Transmitted Infections (STIs) and HIV/AIDS works in close consultation and collaboration with UNAIDS and its other co-sponsors. A UNAIDS intercountry technical adviser is based in the Regional Office, and a Medical Officer post has been established for STIs, the costs of which are shared with UNAIDS. UNAIDS is providing financial support for E U R O ’s activities (a total o f US $130 000 for this biennium), and a series of joint activities have been carried out with UNAIDS and other co-sponsors. 34. EURO hosts the secretariat of the Task Force for the Urgent Response to the Epidemics of Sexually Transmitted Diseases in Eastern Europe and Central Asia which was established in February 1998. The Task Force includes representatives of the United Nations Children’s Fund (UNICEF), UNAIDS, the United Nations Population Fund (UNFPA), the World Bank, the International Federation of Red Cross and Red Crescent Societies, Medecins sans frontieres, the Danish International Development Agency (DANIDA), the Know How Fund at the United Kingdom’s Department for International Development, the German Association for Technical Cooperation (GTZ), the United States Agency for International Development (USAID), the American International Health Alliance, the International Planned Parenthood Federation, the Open Society Institute, the United State Centers for Disease Control (CDC), the International Union against Sexually Transmitted Infections, and a number of national research institutions. 35. As members of the UNAIDS Task Force on HIV Prevention among Injecting Drug Users, the Council of Europe and WHO have collaborated on the English and Russian versions of the publication Principles for preventing HIV infection among drug users, which is in high demand in eastern Europe (see also para. 28). EUR/RC49/Inf.Doc./2 page 5 36. The statutory four-yearly joint ECE/WHO meeting on health statistics took place in Rome from 14 to 16 October 1998 (see para. 45). Staff from the Regional Office (and WHO headquarters) also participated in the Conference of European Statisticians from 14 to 16 June 1999. United Nations Children’s Fund (UNICEF) 37. UNICEF participated in, and financially supported CCEE/NIS delegates to, the joint ECE/WHO meeting on health statistics (see above). UNICEF continues to be a key collaborating partner in all W H O ’s humanitarian fields of operations. United Nations Population Fund (UNFPA) 38. The Regional Office’s W omen’s and Reproductive Health unit is collaborating with UNFPA on reproductive health projects in Albania, Armenia, Bosnia and Herzegovina, Georgia, Romania, Russian Federation, Tajikistan, Turkmenistan and the Ukraine. Furthermore, Entre Nous, the European magazine for reproductive and sexual health, is produced and distributed in 6 languages: English, French, Hungarian, Portuguese, Russian and Spanish. All the projects mentioned are financed by UNFPA. United Nations Development Programme (UNDP) 39. UNDP is a key partner in all EURO’s country operations, both humanitarian and development- oriented. EURO evaluated the UNDP-funded health care reform support project in Lithuania in 1997. Collaboration between EURO and UNDP (exchange of information and participation in national workshops) has also taken place in Georgia and the Republic of Moldova. Office of the United Nations High Commissioner for Refugees (UNHCR) 40. There has been strong cooperation with UNHCR in all EURO ’s fields of humanitarian assistance. A specific current joint operation is in the south Balkans, where WHO has been acting as public health adviser to UNHCR, with particular reference to the public health needs of the refugees within camps. WHO has also worked with UNHCR on carrying out specific public health programmes, for example in the fields of water, sanitation and solid waste. E U R /R C 49/In f .D oc ./2 page 6 United Nations Economic Commission for Europe (ECE) SPECIALIZED AGENCIES OF THE UNITED NATIONS SYSTEM World Bank 41. The V/orkl Health Report 19992 identifies six major functions for the new WHO, among them the establishment of partnerships with international financing organizations. Based on the experience gained from technical cooperation with the World Bank in the European Region. EURO is trying to help draw up a global agreement between WHO and the World Bank, and to clarify the various levels and content of contacts between the World Bank. WHO and its regional bodies. Comprehensive Development Frameworks 42. The President o f the World Bank has proposed setting up comprehensive frameworks for development assistance to countries, involving all relevant sectors and actors. The overall aim is to bring together social and economic development objectives within a framework which assigns due importance to social objectives. This proposal is strongly supported by EURO. European Observatory on Health Care Systems 43. The World Bank is a founding partner o f the European Observatory on Health Care Systems, together with EURO, the governments of Norway and Spain, the European Investment Bank, the London School of Economics and Political Science, and the London School of Hygiene and Tropical Medicine. 2 The world health report 1999. M aking a difference. G eneva, W orld Health Oranization, 1999. EUR/RC49/I n f. Doc ./2 page 7 44. The Regional Office took part in the World Bank’s “Health Development Week” and in a series of meetings concerning health promotion. The aim was to explore the work and future priorities of the Bank, the American University and EURO. Leadership training was a particular issue for discussion, with the Bank interested in exploring ways in which CCEEs which already have a World Bank loan with a health promotion component could be involved. The Bank has also expressed its interest in joining forces with WHO to update EU RO ’s document Resourcing health prom otion ,3 45. The World Bank participated in the joint ECE/W HO meeting on health statistics, hosted by 1STAT (Italy) and held in Rome from 14 to 16 October 1998. This event also served as the forum for the second “Information for Health for Europe” meeting. Participants from CCEE/NIS received financial support from the World Bank, UNICEF and UNFPA. The meeting was also attended by representatives of EC, the Statistical Office of the European Communities (Eurostat), the Organisation for Economic Co­ operation and Development (OECD) and the Statistical Office of the United Nations. 46. EURO staff also took part in a meeting on a major study conducted by the Bank, which resulted in a report entitled Curbing the epidemic: Governments ancl the economics o f tobacco control.4 Lastly, EURO staff participated in regional planning and evaluation meetings organized by the World Bank (Budapest 1997, Tallinn 1998). At country level, EURO has many contacts with the Bank, for instance in Armenia, Estonia, Georgia, the Republic of Moldova and the Russian Federation. International Monetary Fund (IMF) 47. W H O ’s Director-General has recently discussed new forms of more intensive collaboration between WHO, IMF and the World Bank. Joint areas of cooperation which have been identified include safeguarding essential health and social functions in some or all o f the six Expanded Structural Adjustment Facility (ESAF) pilot countries, and the development of benchmarks for monitoring trends in health sector performance as related elements of collaboration. E m e r g e n c y h u m a n it a r ia n a s s is t a n c e A lbania, the Federal Republic of Yugoslavia and The Former Yugoslav Republic of Macedonia 48. At the beginning of the Kosovo crisis. EURO strengthened the structure of its existing humanitarian aid office in Tirana, opened offices in Kukes and Skopje and maintained its offices in Belgrade and Podgorica. As soon as the security situation allowed, WHO re-established its presence in Pristina, and it is expected that the staffing of this office will be increased by up to 10-12 international health professionals dealing with various health areas. Urgently needed WHO kits (new emergency kits and those for use in surgery, mental health and tuberculosis, and insulin) have been procured and sent to Pristina for distribution. 49. The immediate priority for WHO in the province of Kosovo is to make a proper assessment of the public health situation and to plan the necessary interventions for reconstruction of the whole health sector. These plans will be forwarded to the international community, to ensure compatibility and continuity in their activities to this end. Furthermore, a W HO special representative for the Balkans has been appointed and is based in Pristina. He will act as senior health policy adviser to the Regional Coordinator for United Nations Assistance in the Balkans and the UNHCR Special Envoy for Albania and the Former Yugoslavia. World Bank's "Health Development Week" and other meetings 1 Verfo, H & Catford, J. Resourcing health promotion — suggestions on ways to win more resources fo r health promotion. Helsinki, Cancer Society of Finland, 1995 (European Health Prom otion series, No. 3). 4 Curbing the epidemic: Governments and the econmics o f tobacco control. W ashington, W orld Bank, 1999 (W orld Bank Development in Practice Series). 50. Throughout the crisis, EURO has been active in a range of high-priority areas related to public health programmes for refugees and the internally displaced population in the affected countries. The Regional Office has implemented common systems of epidemiological surveillance in both Albania and The Former Yugoslav Republic of Macedonia, supporting effective coordination of humanitarian assistance from international actors. Other examples of EU R O ’s work in the area are as follows: • With UNICEF, large-scale immunization programmes have been carried out in both Albania and The Former Yugoslav Republic of Macedonia, and a vaccination campaign is planned for the Republic of Montenegro. • There are considerable problems related to water supply and sanitation in both Albania and The Former Yugoslav Republic of Macedonia, and the Regional Office is therefore looking at the placement of waste treatment plants for the disposal of organic waste and infectious materials. • The reproductive health of the refugee population is a matter o f significant concern. UNFPA has so far concentrated on providing urgently needed emergency supplies, but there is a need for coordination of humanitarian efforts in reproductive health and for increased training to ensure that supplies are properly used and that humanitarian efforts have developmental effects. • In the field of drugs, medical supplies and equipment, E U R O ’s primary goal is to provide support to primary health care facilities, hospitals, camps and host communities. Every effort is being made to bring the problems of drug donations to the attention of donors, so as to avoid the situation experienced in Bosnia and Herzegovina. A press notice has been released to this effect, and a press conference for the international media has been held in Copenhagen. • Mental health is high on the list o f priority areas, and a survey of the activities of national and international nongovernmental organizations (NGOs) in Albania is ongoing. EURO is active in coordinating mental health activities in refugee camps both in Albania and in The Former Yugoslav Republic of Macedonia, and W HO mental health teams are working in the camps in the Republic of Montenegro. • As the recognized lead agency for all health-related issues, WHO field staff chair regular meetings of the humanitarian aid agencies and work closely with the ministries of health, providing technical advice and assistance as required. Bosnia and Herzegovina 51. The programme of humanitarian assistance has continued during 1998-1999; targeted activities have been carried out in a number of programme areas. In 1998 its management was merged with that of the country’s medium-term programme, which for 1998-1999 has components that include health policy development; pharmaceuticals; medical waste; communicable diseases; health promoting schools; countrywide integrated noncommunicable diseases intervention (CINDI); and nursing. Federal Republic of Yugoslavia 52. Within the framework of the United Nations consolidated interagency appeal for humanitarian assistance in the Federal Republic of Yugoslavia, WHO began work in the country in October 1992 and has been operational there since. As of 1998, WHO continues to play an essential role as health sector coordinator in the framework of humanitarian assistance, ensuring that those at most risk and in greatest need receive aid throughout the country. As already mentioned, the humanitarian offices in Belgrade (Republic of Serbia) and Podgorica (Republic of Montenegro) have been maintained during the present crisis. 53. At the request o f the Secretary-General of the United Nations, and following acceptance by the Government of the Federal Republic of Yugoslavia, a United Nations interagency emergency needs assessment mission took place in the Federal Republic of Yugoslavia (Serbia and Montenegro) from 16 to 27 May 1999. The agencies participating in the mission were the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), UNHCR, UNICEF, UNDP, the World Food Programme (WFP), WHO, the Office of the United Nations High Commissioner for Human Rights, the United EUR/RC49/Inf.Doc./2 page 8 EUR/RC49/Inf.Doc./2 page 9 Nations Mine Action Services, the International Labour Organization, the Food and Agriculture Organization of the United Nations, the United Nations Environment Programme (United Nations Centre for Human Settlements), the International Organization for Migration and the United Kingdom’s Save the Children Fund. 54. The objectives of the mission were: • to assess the needs for humanitarian assistance in each technical sector; • to assess the impact of the conflict in the country, including the province of Kosovo, on the civilian population; and • to assess the protection of refugees and internally displaced persons (IDPs) and the conditions for repatriation and return of refugees and IDPs, including rehabilitation needs. Given the short time frame and various security and political constraints, this was intended as a preliminary fact-finding mission, which would be followed by more in-depth sectoral evaluation by relevant agencies. Tajikistan 55. An operational contract was signed with the European Community Humanitarian Office (ECHO) on health care reform, managing supplies of essential drugs and coordination of humanitarian medical assistance. The first meeting of the country’s Health Care Reform Working Group was held on 17 February 1999 with the participation of various international agencies, including Pharmaciens sans frontieres. Medical Emergency Relief International, the United Nations Office for Project Services, the International Committee of the Red Cross, the International Federation of Red Cross and Red Crescent Societies and the Aga Khan Foundation. 56. The pilot project on health care reforms, which is part of the EUROHEALTH programme, was launched in February 1999 as requested by the Government of Tajikistan. The project, sponsored by ECHO, is in the development stages. Local facilities such as “medical houses” and rural outpatient clinics in three districts were selected as pilot primary health care facilities for implementation of health care reforms. 57. Other ongoing projects are on the development of a national environmental health action plan (NEHAP) for the country; immunization; the CARAK project (on helping women and children in the central Asian republics, Azerbaijan and Kazakhstan) and violence against women; support for the national programme on hepatitis B control; and improving reproductive health. R e g io n a l d e v e l o p m e n t b a n k s The European Bank for Reconstruction and Development (EBRD) 58. The Regional Office’s Department of Environment and Health is represented as an observer on the E BRD ’s Project Preparation Committee (PPC). The PPC ’s role is to liaise between international financial institutions and donor countries, in order to facilitate environmental investment projects in the NIS and CCEE. Its secretariat is currently with EBRD. M u l t il a t e r a l c o l l a b o r a t iv e a c t iv it ie s Information for health for Europe 59. In pursuance of resolution EUR/RC43/R8 on “Monitoring of progress towards Health for All in 1993”, the Regional Office’s Epidemiology, Statistics and Health Information unit continues its efforts to improve coordination and collaboration with regard to statistical reporting in Europe. 60. EEHC has acted as the steering committee for the Environment and Health process of ministerial conferences, reporting annually both to W HO and to ECE, and was actively involved in preparing the Third Ministerial Conference on Environment and Health, which was held in London from 16 to 18 June 1999. 61 Through their membership of EEHC, ECE and the United Nations Environment Programme (UNEP) took part in the work of the steering committee. They played major roles in drawing up the Protocol on Water and Health (a joint ECE/WHO initiative) and the Charter on Transport, Environment and Health (partly funded by UNEP), and in developing a new programme to coordinate activities related to economic perspectives on environment and health (in cooperation with the World Bank, also a member of the EEHC). UNICEF, the Food and Agriculture Organization (FAO) and the World Meteorological Organization (WMO) were also involved in specific elements of the Conference. 62. The Conference commended EEHC on its achievements and noted its continuing potential to stimulate intersectoral action. EEHC’s remit was renewed for a further five years and its membership will be broadened to include six representatives of major groups, including NGOs, local government, business, trade unions, and environmental health professionals. EURO has both been a member of and provided the secretariat function for EEHC. Healthy Planet Forum 63. The theme of the Third Ministerial Conference on Environment and Health was “Action in partnership” , and efforts were therefore made to involve actively all of the nine “major groups” identified at the United Nations Conference on Environment and Development (Rio de Janeiro, June 1992). NGOs and other major groups were involved in preparations for the Environment and Health Conference and held their own parallel event, the “Healthy Planet Forum”. Interagency Immunization Coordinating Committee (UCC) 64. In March 1999, the Regional Office hosted IICC’s ninth meeting, to provide information about the current situation and future direction of the immunization programmes in eastern Europe, with emphasis on the NIS; to decide on the future role of IICC and its Secretariat (situated in Copenhagen); to review the poliomyelitis eradication situation and certification activities in the European Region, including the budget; and to review the diphtheria situation in selected NIS and plans for control measures in 1999-2000. INTERGOVERNMENTAL AND BILATERAL ORGANIZATIONS Organisation for Economic Co-operation and Development (OECD) 65. WHO and OECD continue to have informal agreements for the mutual exchange of data of common interest, and attempts are also being made to harmonize definitions of common indicators. OECD attended the joint ECE/WHO meeting on health statistics (Rome. 14—16 October 1998) (see para 45). United Kingdom Department for International Development (DfID) 66. DfID is providing a voluntary donation to underwrite production of “Health Care Systems in Transition” (HiT) country profiles for the central Asian republics, as well as to help fund a cross-country subregional comparison of health care in those countries. DfID recently committed £1 million for a pharmaceutical project in the NIS in 1999-2001; this is a continuation of the support they have given since 1994 and is in addition to the two existing projects for support to pharmaceutical sector reform in the Russian Federation. The NIS project addresses national drug policies, rational use of drugs, and reimbursement of drug costs. Furthermore, it provides direct country support as well as stimulating intercountry developments EUR/RC49/lnf. Doc./2 page 10 European Environm ent and Health Committee (EEHC) E U R/RC 49/1 n f. Doc .12 page 11 20 years of the Alma-Ata Declaration 67. The UN Resident Coordinator, the UNDP Representative and UNICEF were actively involved with WHO in “PHC21 - Everybody’s business”, which took place in Almaty, Kazakhstan in November 1998. The Conference celebrated the 20 years of the Alma-Ata Declaration on Primary Health Care and was attended by a large number o f senior health advisers, from both within and outside the European Region, as well as by representatives of other international organizations such as UNFPA and the World Bank. NGOs (e.g. the International Confederation of Midwives) were also represented. COLLA BO RATIV E N ETW O RKS European Forum of Medical Associations and WHO (EFMA) 68. The EFMA meeting in Tel Aviv from 7 to 9 March 1999 was hosted by the Israeli Medical Association. The main agenda items were educational needs for medical risk management; the changing meaning of medically necessary services; the tuberculosis programme at EURO and implementation of the directly observed treatment, short-course (DOTS) strategy; the concepts of medical accountability and responsibility; and health care resources and their allocation and use. European Forum of Nursing and Midwifery Associations and WHO 69. Membership of this Forum, established by EURO in 1997, has grown to 40 national nursing associations and five national midwifery associations (the latter selected as official representatives of the International Confederation of Midwives). 70. The second annual meeting of the Forum took place in Copenhagen in October 1998. The technical discussion focused on the concept of the family nurse as set out in the HEALTH21 policy framework. A statement was adopted on the nursing and midwifery contribution to HEALTH21. 71. The third annual meeting of the Forum took place in Budapest in March 1999. Members were informed about the initial steps taken by the Forum’s task forces on care of the elderly, chronic disease, maternal and child health, and smoking cessation. The technical discussion focused on chronic disease, and a draft statement on the nursing contribution in this area was agreed on. The Forum also adopted a special statement in support of nurses and midwives involved in the care of refugees and internally displaced persons from Kosovo. 72. EFMA and the European Forum of National Nursing and Midwifery Associations and WHO exchange information and attend each other’s meetings as observers. EuroPharm Forum 73. The seventh annual meeting of the Forum took place in Copenhagen in November 1998. The theme of the professional session was the pharmaceutical service, looked at from both the educational and the practice sides. 74. The EuroPharm Forum is currently running five projects, conducted through community pharmacies, to promote good health. Two of these projects (on asthma services and on pharmacy-based management of hypertension under the CINDI programme) were established at the fifth annual meeting, and project protocols have been developed. Work on the other three projects (diabetes care, smoking cessation and “Questions to ask about your medicines” has been consolidated and strengthened during the past year, with attention focused on identifying simple ways of measuring the outcome of all the projects. 75. A brochure giving an overview of the Forum and its activities was published in 1998. S p e c i a l e v e n t s EUR/RC49/Inf.Doc./2 page 12 F o u n d a t i o n s a n d n o n g o v e r n m e n t a l o r g a n iz a t io n s Soros Foundation 76. The Medical Board of the Soros Foundation in Hungary has provided US $107 000 for three projects to be developed jointly with WHO in 1998-1999: on research in health economics, investment in the health of older people, and education of chronic patients. 77. The Open Society Institute is making a voluntary donation to help underwrite the cost of the European Observatory on Health Care Systems’ summer school for policy-makers in Dubrovnik, as well as for translation and distribution of Euro Observer, the quarterly newsletter of the Observatory. European Society of General Practice/Family Medicine (ESGP/FM) 78. The ESGP/FM, the European region of the World Organization of Family Doctors (WONCA), was represented at PHC network meetings in 1998 (SOUTHNET) and in the St Petersburg Initiative and expert network. ESGP/FM will also be invited to participate in PHC network meetings to be held during the autumn of 1999. International Federation of Red Cross and Red Crescent Societies (IFRC) 79. A joint project is underway with IFRC regarding the development o f an infectious diseases module for nurses who are predominantly located in the CCEE/NIS. IFRC is a key partner in W H O ’s humanitarian operations activities. International Confederation of Midwives (ICM) 80. There is continuing collaboration with ICM in view of its central role in the European Forum of National Nursing and Midwifery Associations and WHO. ICM coordinates the midwifery constituency of the Forum and was represented at both the second and third annual meetings (see paras. 69-71). International Council of Nurses (ICN) 81. ICN. having endorsed the idea of the family health nurse, will be working closely with the Regional Office’s Nursing unit on further developing the concept. ICN attended the sixth WHO Meeting of Government Chief Nurses in Stockholm in November 1998 as an observer. Furthermore, collaboration is taking place on an ICN project on infectious disease control in CCEE. Public Services International (PSI), Consumers International (Cl), World Medical Association (WMA) 82. PSI. Cl and WMA have all been represented at meetings organized by the Regional Office on patients’ rights, and the Regional Office’s representative has been invited to be a keynote speaker at annual meetings of PSI. London School of Economics and Political Science and London School of Hygiene and Tropical Medicine 83. These two establishments are founding partners in the European Observatory on Health Care Systems. Other partners include EURO, the governments of Norway and Spain, the European Investment Bank and the World Bank. Association of Schools of Public Health in the European Region (ASPHER) 84. ASPHER and the Regional Office have an agreement for collaboration on a broad spectrum of activities, including support for the development and dissemination of W H O policies and training in public health. 85. EUPHA has invited speakers from the European Observatory on Health Care Systems to make presentations, including keynote addresses, at its annual meetings. Tipping the Balance (TTB) 86. The Coordinator of TTB visited EURO in May 1999 and discussed how to give effect to the Memorandum of Understanding which was signed in March 1998. The aim is to further develop collaboration between EURO and the Tipping the Balance network, especially with regard to supporting implementation of the HEALTH21 policy framework. European Union of General Practitioners (UEMO) 87. As it has done in the past, EURO contributed an article to the sixth edition of U EM O ’s 1 9 9 9 -2 0 0 0 reference book. The text of the framework for professional and administrative development of general practice/family medicine in Europe, as well as a reference to its location on the World Wide Web, will also be included. International Federation of Gynaecology and Obstetrics (FIGO) and European Association of Perinatal Medicine 88. These organizations are working together with EURO on developing basic information sheets for perinatal and obstetric care, in order to collect case-based and aggregate data through the Obstetrical Quality Development through the Integrated Use of Telematics (OBSQID) project. International Diabetes Federation (Europe), European Association for the Study of Diabetes, International Diabetes Federation (Global) 89. These organizations are partners in the St Vincent Declaration Action Programme on Diabetes. EUR/RC49/I n f. Doc .12 page 13 European Public Health Association (EUPHA)