According to the midterm evaluation of 2017, the third health programme has been performing well and has been implemented effectively, contributing to better health protection through its policies and activities. The programme has efficiently addressed the Commission’s priorities on the implementation of best practices for health promotion and disease prevention, crisis preparedness and risk management, the production and communication of relevant information within the framework of the EU semester, the fostering of mental health, and health and innovation.
In the 2014-2020 period, the European Court of Auditors published several reports assessing the implementation of the health programme. In EU Actions for Cross-border Healthcare– Special report 07/2019, the Court found that ‘EU actions in cross-border healthcare enhanced cooperation between Member States. The Commission has overseen the implementation of the Cross-border Healthcare Directive well.’ The special report also identified certain shortcomings and improvements that were necessary in terms of reducing administrative burden and the long-term financial sustainability of the European reference networks. In Addressing Antimicrobial Resistance– Special report 21/2019 the Court emphasised: ‘Fighting against antimicrobial resistance is complicated. The Commission and [European Centre for Disease Prevention and Control] support to strengthen Member States One Health approach to [antimicrobial resistance] was valuable’. However, it also pointed out some challenges, particularly with regard to the sustainable implementation of the results in the Member States. These were addressed in the new EU4Health programme.
While reorienting and gearing a proportion of its resources towards fighting the COVID-19 pandemic, the third health programme continued to implement its main actions with a view to enhancing and further consolidating key achievements over the 2014-2020 implementation period.
With regard to objective 1 ‘promote health, prevent diseases and foster supportive environments for healthy lifestyles’, the targets were reached in all respects except the number of Member States involved in the European accreditation scheme for breast cancer.
With regard to objective 2 ‘protect EU citizens from serious cross-border health threats’, the target of 28 Member States integrating coherent approaches in the design of their preparedness plans was achieved in 2020.
With regard to objective 3 ‘support public health capacity-building and contribute to innovative, efficient and sustainable health systems’, 41 notices of advice were produced and 23 Member States used the tools and mechanisms identified in order to contribute to effective results in their health systems.
With regard to objective 4 ‘facilitate access to better and safer healthcare for EU citizens’, 24 European reference networks were established in accordance with Directive 2011/24/EU, more than 1500 healthcare providers and centres of expertise joined European reference networks and all 28 Member States used the tools developed.
The final evaluation of the third programme for the EU's action in the field of health (2014-2020) (the programme) has been completed. It assesses the performance of the programme, its main outcomes and achieved results and identifies the main problems and solutions with regard to its implementation.
The main achievements of the programme are the following.
- The establishment of a portal for the exchange and implementation of best practices in health promotion and disease prevention.
- An ‘EU compass for action on mental health and wellbeing’, a web-based mechanism used to collect best practices and analyse information on policy and stakeholder activities in mental health.
- On cancer, the European quality assurance scheme, a harmonised and evidence-based way to grant equal and quality-benchmarked treatment to patients, and the European network of cancer registries coordinated by the Joint Research Centre (128 cancer registries from 29 European countries, with more than more than 25900000 records).
- A feasibility study was carried out for the development of a common EU vaccination card. The resulting template was tested by a sample of 10000 citizens in 10 Member States.
- In 2018, the joint action on efficient response to highly dangerous and emerging pathogens at EU level(EMERGE joint action) delivered on its work for the improvement of capabilities for rapid laboratory diagnosis of new or emerging pathogens (e.g. sample sharing). The joint action also contributed to combating the outbreaks of ZIKA and Ebola.
- During the Ebola and Zika outbreaks, part of the funds of the programme were used to support interventions to limit the spread of these threats by strengthening Member States preparedness and response through the actions of the Health Security Committee.
- The European health data space joint action, with 25 participating countries, facilitated the establishment of a European health data space, by developing principles for the cross-border secondary use of health data. The Commission published its proposal for the establishment of the European health data space in 2022.
- The joint actions for EU cooperation on health technology assessment (EUnetHTA) enabled to produce 41 joint reports (joint assessment and early dialogues). These led to the adoption of legislation, securing EU cooperation on health technology assessment in the long-term.
- In 2019, the joint action on market surveillance of medical devices enabled the reinforcement of the market surveillance system for medical devices and the improvement of coordination and cooperation among all Member States.
- A total of 24 European reference networks– virtual networks involving healthcare providers across Europe– were established. They aim to tackle complex or rare medical diseases or conditions that require highly specialised treatment and a concentration of knowledge and resources. More than 1500 healthcare providers are a part of European reference networks across the EU.
Key findings per evaluation criterion, lessons learned and recommendations
Effectiveness
The evaluation found that knowledge produced by the programme was used in policy making and the programme contributed to the improvement of health and healthcare policy developments in the EU (e.g. in the areas such as anti-microbial resistance, health technology assessment, health inequalities, alcohol, tobacco control, European reference networks for rare diseases).
Funded actions helped achieve the programme’s objectives to a good extent, in particular for objective 1 (promote health, prevent diseases, and foster supportive environments for healthy lifestyles) and objective 4 (facilitate access to better and safer healthcare for EU citizens). This is demonstrated by the positive trend of the quantitative indicators associated with each of the 4 specific objectives of the programme.
However, the participation of countries with low gross national income (low-GNI Member States) in the programme did not increase significantly, despite the exceptional utility criteria designed to do so.
Efficiency
The programme was relatively cost-effective. In particular, its functioning costs (administrative costs plus the costs allocated to the functioning of the executive agency CHAFEA) were found reasonable, moreover on decreasing trend and comparable with those of other EU programmes of similar size.
The introduction of electronic tools, SYGMA-COMPASS for the submission of proposals, management of grants, monitoring and reporting mechanisms (also used by the Horizon 2020 Framework Programme for Research and Innovation), enabled, along with other simplifications measures (e.g. the introduction of framework partnership agreements for operating grants), to improve the efficiency of the programme implementation. However, according to some beneficiaries, there was some scope to further simplify the processes, especially in relation to funding applications, monitoring and reporting.
Administrative costs were found heavy by some stakeholders involved in actions, increasing workload and potentially putting countries with low GDP or smaller organisations off becoming involved, or being involved in future work.
Cost-effectiveness of actions could have been improved with a more centralised information system (either using existing systems in place within the programme portal; or a new addition) dedicated to disseminating information about EU funding, ensuring synergies across projects, and further communicating on the results of the implemented actions.
