EN
COMMISSION OF THE EUROPEAN COMMUNITIES
Brussels, 14.10.1999
COM(1999) 463 final
INTERIM REPORT FROM THE COMMISSION TO THE EUROPEAN
PARLIAMENT, THE COUNCIL, THE ECONOMIC AND SOCIAL COMMITTEE
AND THE COMMITTEE OF THE REGIONS
on theimplementation oftheprogrammes ofCommunity action ontheprevention of
cancer, AIDS and certain othercommunicable diseases, and drug dependence withinthe
frameworkforaction inthe field ofpublic health (1996-2000)(DecisionsN°646/96/EC,
647/96/EC and 102/97/EC ofthe European Parliament and ofthe Council)
2TABLE OF CONTENTS
Introduction................................................................................................................... ...3
Consistencyand complementarity....................................................................................3Effectivenessand theachievement ofobjectives...............................................................3Monitoring..................................................................................................................... ..4
Adjustments.................................................................................................................... .4
Excerpt fromtheexperts’report onthethreeprogrammes................................................5
Thecancer programme...........................................................................................5TheAIDS and communicablediseasesprogramme................................................6Thedrugsprogramme............................................................................................8The management oftheprogrammes......................................................................9LinkswithMember Statespoliciesand programmes............................................10
Budget......................................................................................................................... ...11
3Introduction
Following the adoption of three programmes of Community action for prevention of cancer,
AIDS and other communicable diseases, and drug dependence by the European Parliament
and the Council, the Commission presents hereunder an interim report concerning mainly the
implementation period 1996 and 1997. The inclusion of the first half of the budgetary period
1998 has beenavoided as it would have undulydelayed a timelypresentationofthis report.
In this report, the Commission highlights the degree of consistency and complementarity
reached between these plans and the other relevant Community policies, programmes and
initiatives and to increase the value and impact ofthe three plans, has performed an evaluation
ofthe actions undertaken. Onthe latter point, particular regard has been given to effectiveness
and the achievement of the objectives of the measures undertaken. For this purpose, the
Commission has drawn on the opinions of a group of external experts, and from
representatives of the Member States serving on the three management committees. The
Commission also reports onthe adjustments which are deemed necessaryas a consequence of
theinformationgathered.
Consistency andcomplementarity
The Commissionsought consistencyand complementarity between its public health and other
Community policies, programmes and initiatives by a multitude of efforts on different
operationallevels, inparticular:
The implementation of the 4thFramework programme for research, technological
development and demonstration (1994 – 1998) of the European Communities was closely
followed by means ofthe inter-service consultations on publications ofcalls for proposals and
onadoptionofprojectsforfinancing.
The preparation of the 5thFramework programme for research, technological development
and demonstration (1998 – 2002) of the European Union was actively followed by means of
the inter-service consultations onthe draft proposal, and consultations on project proposals, in
ordertoensureconsistencyandcomplementarity.
Further, officials of the public health directorate were invited to all meetings of the
programme committees for the specific research programmes; likewise, officials from the
researchdirectorates wereinvited tothe meetings ofthe public healthprogramme committees.
Inthe courseofthe implementationofthe programmes, applicants seemed also to have better
understood the difference between health and health services research as foreseen under the
framework programmes for research and the preventive measures for cancer, AIDS and other
communicable diseases, and drug dependence covered under the relevant actionplans.
Effectivenessandtheachievementofobjectives
Given the kind of objectives laid down in the three action plans, the actual coverage byspecific actions following the first calls for proposals within the period of 1996 and 1997
were generallyquite sufficient. A balance between the various areas of each programme was
4made easier bythe adoptionofannualwork programmes allowing proposals for projects to be
invited in areas not yet sufficiently covered. There was one reservation that initially the
European added value of projects was in many instances under developed, but stress has been
placed onthe development ofnetworkprojects inorderto resolve this shortcoming.
To ensure subsidiarity, the opinion of Member States was invited through the programme
committees as laid down in the specific action programmes. Thus, the necessary support of
Member States for implementation of the actions selected in their countries was encouraged.
At the same time, the programme committees guaranteed the required transparency of the
European Commission’s actions towards the Member States. The transparency towards the
European Parliament was ensured by the prior transmission to that Institution of reports and
documents intended for each of the programme Committees as well as an annual list of
projects financed.
To ensure the highest possible standards for the quality of the actions selected, each
committee not only gave a favourable opinion on the annual work plans, but was also
consulted on the preparation of the calls for proposals, the selection of projects and the
follow-up of their implementation. In addition, for the Cancer Programme, the Commission
has formalised the existence of an Advisory Committee for Cancer prevention, formerly
known as the High Level Cancer Experts Committee, composed of independent scientific
experts who provide opinions to the Commission on projects to be financed and on cancer
preventionissues ingeneral.
Monitoring
Monitoring ofthe specific actions has been performed mainlythrough a continuous follow-up
bythe CommissionServices ofthe contractualobligations ofthe projects financed.
Adjustments
To improve the European added value as an important general objective, the Commission
Services have embarked on a strategy to ask for enhanced networking of applicants to ensure
better cross-border co-operation, e.g., as a means ofdisseminationof best practice inEurope.
To cover areas of Community interest, which were not covered byspecific actions selected to
date, following a thorough analysis of the active portfolio, the Commission adapted each
annual work plan respectively. In turn, the annual work plans aided in establishing priorities
for the next calls for proposals as wellas inthe selectionofthe newlyproposed actions.
For the Cancer Programme, a document was agreed by the management committee and
adopted bythe Commissionconcerning simplificationofprocedures.
5To further improve transparency and simplify dissemination at the same time annual reports
have been produced for 19961and 19972by the Commission’s Services jointly for the three
programmes, which give a comprehensive picture of the work of the respective unit of the
Commission’sservices.
Following external suggestions and internal review of shortcomings the linkages between the
three programmes and other public healthprogrammes have been improved.
Excerptfromthe experts’reportonthe three programmes
Finally, excerpts from the findings of a group of independent experts who, under contract to
the Commission, analysed each individualprogramme, are presented below:
THE CANCERPROGRAMME
With few exceptions, the projects have been evaluated as appropriate or very
appropriate and relevant in relation to the objectives ofthe programme. Mostly, they
properly address the various actions in terms of aims, specific objectives, design and
achievements. However, in some cases such as health education projects, the targets
and methods are quite oftenbadlyspecified.
Nevertheless, the projects in general appear to be competently implemented and
managed. In addition, the timing of outputs in comparison with the proposed
schedule has generallybeen maintained, withsome exceptions.
However, the dissemination of results has basically followed quite traditional
pathways, such as scientific conferences and publications within scientific journals.
Although these means of dissemination are certainly appropriate, they are
undoubtedly not sufficient to ensure involvement of the general public or even of a
majorityofhealthprofessionals.
Positive results of noteinclude:
– The expansion and development of European networks, especially in the fields of:
nutrition and cancer (mainlythrough the EPIC project), breast and cervical cancer
screening, fight against tobacco and cancer registration;
– The production and diffusion of consensus documents, guidelines, appropriate
software for increasing comparability and uniform quality of data registration and
anti-cancer activities over Europe;
1Directorate Public Health and Safety at Work, Unit V/F/2, Implementation of action programmes
targeted on diseases, Annual report 1996, Implementation of the actions: - Europe against cancer -, -AIDS and other communicable diseases -, - drug addiction prevention -, Internal document CE-V/3-97-002-EN-C.
2Directorate Public Health and Safety at Work, Unit V/F/2, Implementation of action programmestargeted on diseases, Annual report 1997, Implementation of the programmes - Europe against cancer, -AIDS and other communicable diseases, - Drug addiction prevention, Internal document CE-V/3-98-009-EN-C.
6– The implementation of prevention and early detection programmes of appropriate
qualityin Europeanareas previouslyuncovered or with little coverage;and,
– The diffusion of quality control practices in the fields of data registration and
cancer health services, according to common criteria and aiming to obtain a more
uniformqualityofthese activities across Europe.
However, a greater amount of innovation would be welcome, especially in some
actions. For example, more innovation is recommended in the fields of health
education techniques; fight against tobacco; teaching methods for health
professionals; application of new techniques for improving the performance and the
effectiveness of public health programmes such as in breast and cervical cancer
screening, of screening for cancers other than breast and cervix, and of methods for
quitting smoking in highrisk groups.
In general, from a review of the reports it is clear that all the listed projects greatly
benefited and indeed were often made possible bythe financial support ofthe Europe
Against Cancer programme. For many of them, the Community financial support
allowed a high intensity of inter-country exchanges, the agreement on methods, the
achievement of a uniform quality and the production of common documents and
statements.
It is quite remarkable that in no case do the projects’ activities, given the programme
framework, appear to conflict or even overlap with national programmes. On the
contrary, some project documents claim synergy and beneficial effects on national
health activities. However, the relation with other agencies active in the field is not
always clear. For some clusters and actions, it was difficult to evaluate if there is an
overlap with other activities supported by the European Community, such as
BIOMED.
Finally, in terms of European added value, the evaluation identified some
contributions and some room for improvement. A significant majority of the projects
is multinational. The tendency to finance multinational projects should be maintained
and encouraged. However, multi-nationality does not automatically guarantee an
acceptable level of European added value, for which a rigorous methodology, a
sufficient degree of innovation and a good dissemination of results are also needed.
These features characterise many, but not allthe projects and actions.
THEAIDSANDCOMMUNICABLEDISEASESPROGRAMME
With few exceptions, the projects have been evaluated as appropriate and relevant in
relation with the objectives of the programme. In general, these projects delivered a
range of effective and appropriate studies and interventions. Unfortunately, action 10
was not addressed by any project in 1996 and 1997 (Member States vaccination
policies and programmes).
Funded projects provided a mix of innovative approaches and expansion of pre-
existing effective projects. In general, these properly address the various actions in
terms of aims, specific objectives, design and achievements. In a few cases, such as
the EchinoEuroReg project (about echinococcosis), activities do not really fit into the
7annual priorities defined for the programme, but this relates to only a very small part
ofthe cluster’s budget.
Populations targeted bythe projects were generallyappropriate. However, sometimes
projects excluded high priority sub-populations, which should be redressed in the
future.Forexample,greaterattentionwithintheclusteroncombating transmissionof
AIDS should be allocated to projects targeting the range of men who have sex with
men, and also to intravenous drug users whether or not they are ‘marginalised young
people’.
Projects were usuallywell managed, and resources used cost-effectively.
The results from a number of projects are quite impressive. Many of the
multinational networks supported by the programme seem at first sight to be a cost-
effective way of creating Community added value. However, the project reports of
the networks quite often fail to give a convincing picture of actual capacity to gather
expertise and experience from all the Member States and from all the relevant
agencies in the Member States, as well as to disseminate information provided by
these networks.
It will be important to pay substantially greater attention to the issue of
discrimination, which is seldom dealt with adequately in the projects, and which
should be integrated into the framework of the response at all levels to AIDS,
sexuallytransmitted and other communicable diseases.
Positive results of noteinclude:
– Improvement of the co-ordination of communicable disease surveillance systems
and the co-ordination of the Community response, with initial efforts focused on
HIV/AIDS, tuberculosis, drug resistance;
– The regular production of the monthly bulletin ‘Eurosurveillance’ and a weekly
electronic bulletin.
– Building of a network (EARSS), standardisation and validation of antibiotic
resistance susceptibilitytesting and reporting;
– Creation and development of a European network for HIV/STD (Sexually
transmitted diseases) prevention for prostitutes resulting from the merging of two
existing networks:EUROPAP and TAMPEP;
– Analysis of border issues with regard to HIV/AIDS, STDs and development of
co-operative, border crossing methods ofprevention;
– Maintenance and enhancement of the European network on HIV/AIDS and
hepatitis prevention in prisons; expansion and further development of the
European public policy network on HIV/ AIDS (EPPNA); creation of a European
AIDS and enterprise network(EAEN);
– Creationoftwo Europeancentres for AIDS prevention, information and education
(addressing youthand mobilityrespectively).
Some critical issues were identified, inparticular:
8– Dissemination of results often occurs only through traditional pathways, such as
scientific conferences and publication within scientific journals. These approaches
need to be enhanced to ensure that a much wider audience is aware of the results
and conclusions offunded projects;
– Vaccination policies and programmes with respect to HIV/AIDS are assuming
greater significance, and projects investigating this area should be encouraged in
the future.
For many projects, Community financial support allowed a high intensity of inter-
country exchanges, agreement on methods, the achievement of a uniform and
enhanced quality, and the production of common documents and statements. In most
cases, projects appeared to clearlydemonstrate synergismwithnationalactions.
The assessment in terms of European added value is quite complex. However, the
project results in the majority of cases have significant practical relevance, and
theoretically, should better inform the HIV/STD policy framework and the design
and delivery of programmes in the Member States. At present, there is only limited
evidence that project results are actually being disseminated widely and influencing
keypolicy-makers regarding future direction on HIV/STD issues within the Member
States and inthe EuropeanCommunityas a whole.
THE DRUGSPROGRAMME
Implementationofmost ofthe actions ofthe programme commenced during the first
two years of the 5-year programme. However, much remains to be achieved in areas
such as: relapse prevention and rehabilitation; evaluating the effectiveness of
information and health education campaigns; tools with polysubstance dependence;
the extension of European network of ‘test towns’ and promoting initiatives to
improve the drug preventionaspect of vocationaltraining ofteachers;and, health and
socialcare professions and other professionals responsible for young people .
Much also depends on the follow up of the projects and on opportunities for theEuropean Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and other
European institutions to disseminate results, because dissemination by the project
contractors often remains quite restricted. In the same vein, funding of European
networks in the field of public health action related to drug dependence should be a
priority, withthe aimofdisseminating project results.
There are quite impressive results from a number of projects. Many of the
multinational networks and teams supported by the programme seem to be a quite
cost-effective wayof creating Community added value. However, the project reports
of the networks quite often fail in giving a convincing picture of their actual capacity
to gather expertise and experience from all the Member States and from all the
relevant agencies in the Member States, as well as to disseminate information when
provided throughthese networks. A positive development is the number of networks
that have proceeded in providing electronic information channels such as websites,
electronic databases and other uses ofthe Internet.
The projects funded seem to emphasise approaches targeted directly to individuals,
contrasted with a lack of projects with a broader public policy approach towards
9public health problems related to drugs. Such projects would be needed to increase
knowledge about the impact of the larger public policy context on the drug
phenomenon and on the feasibility of specific intervention models in different public
policy contexts.
As there are large political debates, both at international and European level as well
as at national and municipal level, on future public policy strategies with regard to
drug problems, there is a great need for research-based evidence to help policy
makers to choose betweendifferent strategic alternatives.
The linkages between the programme and other public health programmes managed
by Directorate GeneralV seemweak. The projects that are funded seldomuse, to the
maximum extent, experience in policy development outside the field of drugs, such
as with addictions to chemical substances (drugs, nicotine, alcohol) or with the
generaltraining ofprofessionals or peertraining programmes.
The decision to adopt the programme placed a significant emphasis on co-operation
with other international and intergovernmental organisations as well as with other
Community programmes and initiatives and the EMCDDA. The projects’
documentation indicates that there have been quite a few links to the EMCDDA,
while the indications ofco-operationwithother internationalagencies are rather few.
THE MANAGEMENT OF THEPROGRAMMES
Programme management since the first years of the implementation of these
programmes has improved, but there are stillopportunities for further improvement.
The cancer and AIDS and communicable diseases programmes were adopted in
1996, with the drugs programme not being finalised until January 1997. Thus, the
creation of the formal management infrastructure, including the setting up of the
programme committees and their rules of procedure and working practices, only
occurred after the formal commencement of the programmes at the beginning of
1996.
There has been some continuity in the management of public health actions by the
Commission, from the period prior to the establishment of the programmes, to the
development of management practices of the new programmes in its first years.
Those responsible for managing the programmes were the same until mid-1998, but
several changes among the collaborators took place, affecting continuity of
knowledge.
Due to the late setting up of the formal management structure for the programmes, a
proper evaluation of the management can only be done in the second phase of the
evaluation. However, it is possible to make some preliminary comments at this stage
of the implementation. A more detailed evaluation of management will be
undertakenduring the second phase ofthe evaluation.
A number of suggestions for further improving the timing and procedures for
processing and deciding on project applications need to be carefully considered.
Among the points emerging, the most important were: the institution of an
10independent evaluation of all project proposals by external experts3; the need for
some means of stable funding for the various European networks that were being
established and that should function as a key mechanism in the accumulation and
disseminationofknowledge; improved documentation through better specification of
what was required both in applicants’ proposals and in contractors’ reports; a need
for better links within and between programmes, with other Commission activities
and with other bodies involved in public health in Europe. Various recommendations
are made to address these concerns.
In summary, there does not appear to be any obvious mismanagement of any aspect
of the European public health programmes, but there are many opportunities for
refinement ofprocedures and practices.
LINKSWITH MEMBERSTATESPOLICIESANDPROGRAMMES
A questionnaire was dispatched to members of the programme committees for each
of the three public health programmes on 30 October 1998. The information
requested focused on a description of national prevention policies, links between it
and Community policy, and how these links had developed. Further questions asked
for informationonthemanagementoftheprogrammes.
This attempt to canvass responses fromMember States should be seen, at least, as an
important step forward in the larger task of creating coherence and synergy between
Community level, national and local initiatives in tackling public health problems,
the seriousness of which is recognised throughout the European Community.
Although unsuccessful in achieving a comprehensive picture of the specific impact
of these three programmes in all Member States, these responses from a third of the
Member States, nevertheless give some indications of the complexity of what is
needed (21 clusters in 15 Member States, not mentioning the regionalisation of
public healthprogrammes in most ofthese).
It is proposedthat before the end ofthe programmes, an independent, comprehensive
and comparative study be commissioned to investigate the relevant policies and
practices in all Member States and to review the contribution of Community policy
and initiatives to the nationaland locallevel inthe Member States.
3NB. Commission Services: this role is already carried out by the Advisory Committee for Cancer
Prevention in the case of project proposals submitted to theEurope Against Cancer Programme.
11Budget
Anoverview ofthe budget allocation for the years 1996 and 1997 for the three programmes is
presented as follows
Budgetallocation forthe Europe against cancerprogramme :
1996 1997 1996 & 1997
Area Number
ofprojectsBudget
(~MECU)Number
ofprojectsBudget
(~MECU)Number
ofprojectsBudget
(~MECU)
A-Data collection
and research15 4.191 9 3.901 24 8.092
B-Informationand
healtheducation29 2.746 16 2.532 45 5.278
C-Earlydetection
and screening32 1.721 27 1.591 59 3.312
D-Training and
qualitycontrol24 1.757 14 1.339 38 3.097
TOTAL 100 ~10.416 66 ~9.363 166 ~19.779
12Budget allocation for the Europe against AIDS and other communicable diseases
programme:
1996 1997 1996 & 1997
Area Numberof
projectsBudget
(~MECU)Numberof
projectsBudget
(~MECU)Numberof
projectsBudget
(~MECU)
A- Surveillance
and monitoring6 3.246 9 3.316 15 6.562
B-C om b a ti n g
transmission15 2.190 17 2.351 32 4.541
C– Information,
educationand
Training18 2.757 16 2.148 34 4.905
D–Supportfor
persons with
HIV/AIDS and
combating
discrimination10 1.329 10 1.348 20 2.677
TOTAL 49 ~9.522 52 ~9.163 101 ~18.685
13Budgetallocation forthe Europe against drug dependence programme:
1996 199741996 & 1997
Area Numberof
projectsBudget
(~MECU)Numberof
projectsBudget
(~MECU)Numberof
projectsBudget
(~MECU)
A- data research
and evaluation16 3.080
B- Information,
healtheducation
and training18 3.420
TOTAL 34 ~6.500 33 ~4.908 67 ~11.408
4NB. For 1997 a breakdown into rubrics A and B was not done. Instead the summary figures have been
used.