EUROPEAN COMMISSION Brussels, 12.12.2018 COM(2018) 818 final REPORT FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT AND THE COUNCIL Implementation of the third Programme of the Union's action in the field of health in 2015 {SWD(2018) 489 final}



INTRODUCTION This report presents the implementation of the 2015 annual work programme (2015 AWP), under the third Health Programme 2014-2020 established by Regulation (EU) No 282/2014 of the European Parliament and of the Council of 11 March 2014. Under Article 13 of the Regulation, the Commission must report to the Health Programme Committee on the implementation of all actions funded under the Programme and also to the European Parliament and the Council. This report meets the latter requirement. It provides detailed information on the 2015 budget and how it was committed. It also takes account of the amendment to the 2015 AWP to channel funding towards those Member States under particular migratory pressure that require support in their response to the related health challenges. The Commission Staff Working Document accompanying this Report sets out a number of examples of the key actions co-funded under the second and third Health Programmes, for which final results became available in 2015. It also gives examples of actions funded under the 2015 work programme in supportive fields such as evaluation and dissemination. The report also provides tables with an overview of all co-funded activities and contracts. The 2015 AWP focused on innovation in health and healthcare, with two related action streams (health technology and migrants’ health) highlighted in this report. The Commission decided to amend the 2015 AWP in response to the high influx of migrants in clear need of international protection and the need to provide financial support to organisations able to support Member States in addressing this emergency situation. The Commission ensures that the implementation of the third Health Programme is closely monitored and that results are publicised more widely. It also continues to encourage all Member States and other countries involved in the Programme to participate and continues to seek synergies with other EU funding programmes.

TABLE OF CONTENTS INTRODUCTION ACTIONS OF THE YEAR — SPECIFIC THEMATIC FOCUS OF 2015: BUDGET IMPLEMENTATION 1. Budget 2. Objectives, priorities and financing mechanisms in 2015 3. Implementation of the operational budget by financing mechanism 4. Beneficiaries OTHER MAIN FEATURES



THEMES AND ACTIONS FOR 2015:

The priority health topic for the 2015 AWP was ‘health technology assessment (HTA) and innovation’. This was addressed through several actions funded by different financing mechanisms and signed in the first quarter of 2016, most of them for 3 years, meaning that they will run until the end of 2018 and in some cases until 2020. They are: ·the new joint action on HTA, representing the highest ever EU contribution (EUR 11 999 798.74) to a single aspect of health policy under the third Health Programme; ·two projects and a joint action on integrated care (total EU contribution EUR 6 837 798.31); and, ·the preparatory work for the establishment of the European Reference Networks (EUR 381 372.23). Background: The new joint action on HTA is the scientific and technical component of EU cooperation in this area. It was launched in June 2016 and will run until 2020. It includes government appointed organisations (from EU countries, EU accession countries, EEA and EFTA countries), and a large number of relevant regional agencies and not-for-profit organisations that produce or contribute to HTA in Europe. Goal: The objective is to support voluntary scientific and technical level between HTA bodies. This cooperation should provide input for the development of a model for joint work to be continued after EU funding under the Health Programme ends. Means: There is a strong focus on the joint production of health technology assessments and early dialogues on the results and how to apply them in national settings. The early dialogues, particularly the parallel consultations, have become highly valued by companies seeking early advice. As of May 2018, 29 requests for early dialogues have been received by the joint action partners. HTA also assesses other aspects of health technology, for example its cost implications for the patient and its impact on the organisation of healthcare systems in the delivery of care and administration of treatment. It is therefore a multidisciplinary process that systematically reviews the medical, economic, organisational, social and ethical issues related to the use of a health technology. Background: On integrated care, one co-funded project brings together innovative European healthcare regions, industry and academia in a partnership that has the potential to transform ‘cure and care’ delivery services. The project includes both a pilot project phase and scaled-up, routine care practice. The project involves 13 partners from six EU countries (Denmark, Germany, Greece, Netherlands, Spain and United Kingdom). Goal: The overall objective is to identify, transfer and scale up existing and operational care coordination and good tele-health practices, with the aim of reaching 75 000 care recipients or patients across regions and programmes in multiple European countries. The project is expected to deliver two major benefits: ·a strong basis for successful twinning and coaching that facilitates shared learning; ·practical support for scaling up good practices that promote active and healthy ageing and the participation of older people in the community. This combined with a joint action, should contribute substantially to improving the organisation and implementation of integrated care concepts across the EU. Additional actions in response to the migration crisis in the summer of 2015 and following the subsequent amendment to the 2015 AWP, are: ·four projects on migrants’ and refugees’ health (EUR 6 239 154) ·one direct grant to the International Office of Migration (IOM) (EUR 1 000 000). These aimed to ‘support Member States under particular migratory pressure in their response to health related challenges, with a view to provide concrete support to organisations active in the field and help address the public health impact in the most affected EU Member States’. Background: One project, led by the Andalusian School of Public Health, brought together partners from seven countries (Belgium, Denmark, Italy, the Netherlands, Poland, Slovakia and Spain).

Goal: to support Member States in establishing or strengthening a health sector coordination mechanism for a coherent and consolidated national and cross-country response to address the health-related issues of arriving migrants (refugees, asylum seekers and other migrant populations) while preventing and addressing possible communicable diseases and cross border health threats. This was achieved through an assessment of the coordination mechanism in place and by improving coordination and health professionals' capacities and skills. Background: Another project involved eight partners to support health authorities in 11 Member States. Goal: The project focused on health assessments of incoming migrants via a common instrument allowing Member States to detect and assess potential threats, distribute health promotion materials and raise awareness among stakeholders. The detailed overview of all actions funded under the 2015 is provided in the Commission Staff Working Document accompanying this report. BUDGET IMPLEMENTATION 1.Budget The overall budget for the third Health Programme 2014-2020 is EUR 449.4 million. This includes EUR 30 million for the functioning of the Consumer, Health, Food and Agriculture Executive Agency (Chafea) which the Commission has mandated to manage the Health Programme 2014-2020. Chafea has been providing the Commission with technical, scientific and administrative assistance in implementing the Health Programme since 2005. It organises annual calls for proposals, coordinates the evaluation of submissions, negotiates, signs and manages related grant agreements, and disseminates the results of actions. It is also responsible for many procurement procedures. The budget set out in the work plan for the 2015 AWP was EUR 59 750 000, broken down as follows: ·operational expenditure: EUR 54 041 000, corresponding to the third programme for EU action in the field of health (2014-2020) budget line 17 03 01 (‘Encouraging innovation in health, increasing the sustainability of health systems and protecting Union citizens from serious cross-border health threats’); ·administrative expenditure: EUR 1 500 000, corresponding to the support expenditure for the third Programme for EU action in the field of health (2014-2020) budget line 17 01 04 02. The total operational budget was EUR 55 629 805 and the total administrative budget was EUR 1 551 822, 66. This included EFTA/EEA credits and recovery credits from previous budget years.



2.Objectives, priorities and financing mechanisms in 2015 In 2015, the total operational budget was divided among the four specific programme objectives as follows. 1.Health promotion: EUR 15 669 170.92 (29 % of the operational budget in 2015) for promoting health, preventing diseases and fostering supportive environments for healthy lifestyles taking into account the ‘health in all policies’ principle. 2.Health threats: EUR 5 016 028.59 (9 % of the operational budget in 2015) for protecting EU citizens from serious cross-border health threats. 3.Health systems: EUR 25 106 924.35 (46 % of the operational budget in 2015) for contributing to innovative, efficient and sustainable health systems. 4.Better and safer healthcare: EUR 6 127 923.17 (11 % of the operational budget in 2015) for helping EU citizens access better and safer healthcare.

The specific call to ‘support Member States under particular migratory pressure in their response to health related challenges’ was a horizontal action related to Objectives 1 (health promotion) and 2 (health threats). The corresponding amount of EUR 7 234 199.58 (13 % of the operational budget in 2015) was divided evenly between Objective 1 and Objective 2 and resulted to the calculations above. In addition, horizontal activities (IT, communication) amounted to EUR 2 857 971.72 (5 % of the operational budget in 2015). Figure 1: Operational budget by third Health Programme objective in 2015 The figure below provides information on the Health Programme credits invested as EU contribution under the different thematic priorities in year 2015. Figure 2: Operational budget by thematic priority in 2015 The Programme is implemented through a wide range of funding instruments. These are: ·actions co-financed with Member State authorities (joint actions); ·project grants; ·operating grants in support of non-governmental organisations; ·direct agreements with international organisations; ·public procurement; ·other actions, such as the scientific committees, administrative agreements with the Joint Research Centre and grants for Council presidency conferences. Competitive selection and award procedures were used to select initiatives for funding. However, they are not used for joint actions, direct grant agreements and conferences organised by Council presidencies because in those cases competitive procedures are either not allowed under the specific rules or are not used in practice, for example, due to a monopoly situation. Administrative credits covered expenditure for studies, meetings of experts, information and publication costs, and technical and administrative assistance for IT systems. 3.Implementation of the operational budget by financing mechanism Type of financing mechanism Implementation (EUR)

Commitments Share of mechanism in total implemented budget (commitments) Calls for proposals: Project grants 14 944 000.04 27.3 % Operating grants 5 005 520.00 9.1 % Grants for joint actions 17 791 725.60 32.5 % Conference grants to the Member States holding the presidency of the EU 120 434.90 0.2 % Direct grant agreements Managed by CHAFEA 3 715 000.00 6.8 % Managed by DG SANTE 120 747.29 0.2 % Procurement (service contracts) Managed by CHAFEA 5 890 424.70 10.8 % Managed by DG SANTE 5 744 988.82 10.5 % Other actions Managed by CHAFEA 500 000.00 0.9 % Managed by DG SANTE 945 177.40 1.7 % Budget implemented in 2015 54 778 018.75 100 % Total available budget 55 629 805.00 Credits not used by CHAFEA 218 478.65 by DG SANTE 633 307.60