REPORT FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT AND THE COUNCIL Implementation of the third Programme of Union action in the field of health in 2016
Date: 2019-08-05
Institutions: Directorate-General for Health and Food Safety, European Commission
Subjects: EU financing, EU policy, EU programme, disease prevention, health care, information system, orphan disease, patient's rights, public health

EN 

  EN 

   EUROPEAN COMMISSION  Brussels, 5.8.2019  COM(2019) 365 final  REPORT FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT AND THE COUNCIL Implementation of the third Programme of Union action in the field of health in 2016 {SWD(2019) 316 final}  
 
 
Introduction 

This report presents the implementation of the annual work programme for 2016 (2016 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 20141. 

In  accordance  with  Article 13(1)  of  the  Regulation,  the  Commission  must  report  to  the  health 

programme committee on the implementation of all actions funded under the programme and keep the 

European Parliament and the Council informed. This report provides detailed information on the 2016 

budget and how it was used. 

The Commission staff working document accompanying this report sets out examples of key actions 
co-funded under the second2 and third health programmes for which final results became available in 

2016. It includes actions on the main themes (such as rare diseases and European Reference Networks, 

care coordination, registries, health security — especially in light of the Ebola epidemic and tobacco) 

which  have  been  included  in  successive  financing  decisions.  It  also  includes  a  table  with  a  detailed 

overview of all co-funded activities and contracts. 

The 2016 AWP focused on the setting up and  supporting the European Reference Networks3 set up 
under  Directive  2011/24/EU  on  the  application  of  patients’  rights  in  cross-border  healthcare4. 

European Reference Networks are virtual networks of EU healthcare providers that tackle complex or 

rare diseases and conditions. 

In addition, the AWP 2016 had a strong focus on objective 1 – ‘Promoting health, preventing diseases 

and  fostering  supportive  environments  for  healthy  lifestyles  taking  into  account  the  health  in  all 

policies  principle’,  with  priority  topics  addressing  key  lifestyle  factors  (alcohol,  tobacco,  drugs), 

chronic  disease  prevention  and  management  and  health-related  issues  concerning  migrants’  and 

refugees’ health. 

The Commission closely monitors the implementation of the third health programme and ensures that 

its results are more widely publicised. It also encourages all Member States and non-EU countries that 

contribute  to  the  programme  to  participate  in  its  actions  and  to  create  links  with  other  relevant  EU 

funding programmes such as Horizon 2020. 

1 
2 
3 
4 

OJ L 86, 21.3.2014, p. 1. 
OJ L 301, 20.11.2007, p. 3. 
http://ec.europa.eu/health/ern/networks_en 
OJ L 88, 4.4.2011, p. 45-65. 

 
 
 
 
                                                      
TABLE OF CONTENTS 

Introduction ................................................................................................................................ 1 

Key themes of 2016 .................................................................................................................... 3 

Implementation of the health programme .................................................................................. 6 

1. 

2. 

3. 

4. 

Budget .......................................................................................................................... 6 

Priorities and financing mechanisms ........................................................................... 7 

Implementation by financing mechanism .................................................................... 9 

Beneficiaries .............................................................................................................. 10 

Improvements ........................................................................................................................... 11 

2 

 
 
 
 
 
Key themes of 2016 

The 2016 AWP aims to contribute to the Commission's health priorities as outlined in the President's 
political  guidelines5  and  the  mission  letter  of  the  Commissioner  responsible  for  health  and  food 
safety6. 

European Reference Networks 

The priority health initiative under the 2016 AWP was to set up the European Reference Networks 

(ERNs) in accordance with: (a) Directive 2011/24/EU of the European Parliament and of the Council 
of  9 March  2011  on  the  application  of  patients’  rights  in  cross-border  healthcare7;  and  (b)  the  EU 

policy on rare diseases. 

ERNs are virtual networks involving more than 900 healthcare providers across the EU. They aim to 

tackle  complex  or  rare  diseases  and  conditions  that  require  highly  specialised  treatment  and  a 

concentration of knowledge and resources. 

Several  financing  measures  were  used  to  support  ERNs  in  2016,  amounting  to  more  than 

EUR 8 million (EUR 8 012 343.47). These included: 

 

a  call  of  interest  for  ERNs  as  provided  for  in  Article 2  of  the  Implementing  Decision 
2014/287/EU8,  followed  by  the  approval  of  the  individual  healthcare  providers  and  the 

networks as a whole, by a corresponding decision of the Board of Member States as set out in 

Article 5 of the Decision; 

 

 

 

requests  for  service  for  the  independent  assessment  bodies  to  assess  candidate  ERNs  in 
the  Delegated  Decision  2014/286/EU9 

the  criteria  set  out 

accordance  with 

in 

(EUR 1 646 638.27); 

a call to fund the coordination costs of the approved networks (EUR 4 386 344.15); and 

a call in support of rare disease patient registries for the ERNs (EUR 1 979 361.05). 

Background 

Article 12(1)  of  Directive  2011/24/EU  requires  that  the  European  Commission  supports  Member 

5 

6 

7 
8 

9 

https://ec.europa.eu/commission/sites/beta-political/files/juncker-political-guidelines-speech_fr.pdf 

https://ec.europa.eu/commission/commissioners/sites/cwt/files/commissioner_mission_letters/andriukaitis_en.pdf 

OJ L 88, 4.4.2011, p. 45-65. 
OJ L 147, 17.5.2014, p. 79-87. 

OJ L 147, 17.5.2014, p. 71-78. 

3 

 
 
 
 
                                                      
States  in  developing  ERNs10.  The  Commission  Implementing  Decision  2014/287/EU  sets  out  the 

process  and  criteria for  the  networks'  entire  lifecycle,  from  the  call for  proposals  to  the  assessment, 

approval,  establishment  and  evaluation  of  ERNs.  The  Consumers,  Health,  Agriculture  and  Food 

Executive Agency (Chafea) has supported the Commission in all of these steps, for example by: 

  managing the call for networks; 

  ensuring the assessment of all candidate networks; and 

  channelling EU co-funding to support the coordination costs of the approved networks for 5 years 

(2017-2021). 

Goal 

The ERNs aim to offer people in the EU access to the best expertise and often, life-saving knowledge, 

without having to travel to another country. 

Means 

To support the sustainability of the ERNs, it was decided to award grants for long-term cooperation 

through framework partnership agreements (FPAs) between Chafea and the beneficiaries. The annual 

co-funding is then ensured by signing specific grant agreements (SGAs) that cover the scientific and 

technical coordination costs of the networks. As of June 2017, all 23 ERNs have signed FPAs and two 
rounds of annual SGAs11. 

Promotion of health and prevention of diseases 

In  addition  to  the  main  focus  of  the  year,  several  actions  supported  the  promotion  of  health  and 

prevention  of  diseases,  in  particular  focusing  on  best  practices  as  regards  the  vulnerable  groups  of 

migrants and refugees. 

Background 

Building on the financial support provided in this area during the migration crisis in 2015, the annual 

work programme 2016 promoted sustainability through capacity building and implementation of best 

practices in care provision for vulnerable migrants and refugees. 

10 
Under Article 12 of Directive 2011/24/EU on patients’ rights in cross-border healthcare and relevant implementing measures, the 
European Commission developed — through a service contract managed by Chafea — the methodology and the technical tools for assessing 
the ‘Networks and healthcare providers’ proposals. The contractor has addressed all the assessment steps from the publication of the call for 
networks to their approval, including the materials and methods to be used and the expected end products. 
11 
to EUR 13 800 000 and runs until the end of February 2022. 

The AWP 2018 provides for a multiannual grant, to cover the last 3 years of the networks' functioning. This EU funding amounts 

4 

 
 
 
 
 
 
                                                      
Goal 

The  EU  co-funding  in  this  area  aims  to  promote  best  practices  in  care  provision  for  vulnerable 

migrants and refugees. 

Means 

Within this overall framework, the 2016 AWP co-funded: 

 

three  projects  on  ‘Migrants’  health:  Best  practices  in  care  provision for  vulnerable  migrants 

and refugees’ (EUR 2 484 164.99); 

 

two 

tenders  on 

‘Training 

for  health  professionals  with  migrants  and 

refugees' 

(EUR 4 107 214); 

 

a  direct  grant  agreement  with  the  World  Health  Organization  (WHO)  focusing  on  the 

development  and  uptake  of  technical  guidance    in  view  of  supporting  access  of  the  migrant 

population in national health care systems (EUR 500 000); and 

 

an operating grant to the ‘Vulnerability network’ (EUR 326 808.00). 

The three projects on migrants’ health are: 

  MigHealthCare,  in  which  14  partners  from  10  Member  States  (Austria,  Bulgaria,  Cyprus, 

France, Germany, Greece, Italy, Malta, Spain and Sweden) are developing and pilot testing a 

comprehensive  toolbox  to  put  in  practice  community-based  care  models  for  vulnerable 

migrants  and  refugees,  including  predictive  models,  best  practice  examples,  algorithms  and 

tailor-made health materials. 

  MyHealth, in  which  11  partners from  seven  Member  States  (the  Czech  Republic,  Germany, 

Greece,  Ireland,  Italy,  Spain  and  the  United  Kingdom)  are  developing  health  intervention 

strategies for mental health and communicable and non-communicable diseases. The project 

will  also  put  in  place  an  ICT-based  platform  (including  an  interactive  map  of  EU  health 

systems) to support tools and health information applications for both patients and healthcare 

professionals.  

  ORAMMA,  in  which  eight  partners  from  four  Member  States  (Greece,  the  Netherlands, 

Sweden and the United Kingdom) promote safe motherhood and improve access to maternal 

healthcare.  The  project  pilots  and  evaluates  integrated  and  cost-effective  initiatives  for  safe 

motherhood  focusing  on  women  with  particular  risks.  It  also  aims  to  extend  good  practices 

across EU healthcare systems to ensure equity among Member States. 

The  two  tenders  on  ‘Training  for  health professionals  with  migrants  and refugees’ (EUR 4 107 214) 

financed  the  development  of  an  advanced  training  package  on  mental  health,  post-traumatic  stress 

detection and screening for communicable diseases in migrants and refugees and the training courses 

5 

 
 
 
 
themselves in 10 European countries (Bulgaria, Croatia, France, Greece, Italy, Malta, Norway, Serbia, 

Slovenia and Spain). 

The project addresses health professionals, law enforcement officers and trainers of trainers. It should 

lead  to  a  better  understanding  of  the  needs  of  the  migrant  population,  reinforced  skills  for  those 

involved in their care and a positive public health impact both in the selected countries and in the EU 

as a whole. 

The  direct  grant  agreement  with  the  WHO  focuses  on  the  development  and  uptake  of  technical 

guidance,  including  checklists,  Standard  Operating  Procedures  (SOPs),  good  practice  indicators  and 

fact  sheets  in  6  priority  issues  of  migrant  health  [Mental  Health,  Health  Promotion,  Non 

Communicable Diseases, Mother and New Born, Child Health (including immunization) and Elderly 

Health],with a view to supporting access of the migrant population to national health care systems. 

Finally,  the  AWP  2016  provided  financial  support  to  the  European  network  for  reducing 
vulnerabilities in health12. This network produced the 2016 Observatory report on access to healthcare 

for people facing multiple vulnerabilities in health (which covered 31 cities in 12 countries) and the 

2016 legal report on access to healthcare (which covered 17 countries). 

A detailed overview of all actions funded under the AWP 2016 is provided in the Commission staff 

working document accompanying this report. 

Implementation of the health programme 

1. 

Budget 

The  overall  budget  for  the  third  health  programme  2014-2020  is  EUR 449.4  million.  This  includes 

EUR 30  million  for  the  operating  costs  of  the  Consumer,  Health,  Food  and  Agriculture  Executive 

Agency (Chafea), mandated by the Commission to manage the programme. Chafea has been providing 

the  Commission  with  technical,  scientific  and  administrative  assistance  in  implementing  the  health 
programme  since  200513.  It  organises  annual  calls  for  proposals,  coordinates  the  evaluation  of 

submissions, and negotiates, signs and manages related grant agreements, and disseminates results of 

the actions. It is also responsible for many procurement procedures. 

12 

Operating grant to the Vulnerability Network, 2015-2017 FPA. 

13 
Decision 2004/858/EC of 15 December 2004 (OJ L 369, 16.12.2004, p. 73) amended by Decision 2008/544/EC of 20 June 2008 
(OJ  L  173,  3.7.2008,  p. 27);  from  December  2014  CHAFEA  has  replaced  the  Executive  Agency  for  Health  and  Consumers  (EAHC) 
Commission Implementing Decision 2014/927/EU. 

6 

 
 
 
 
 
                                                      
The budget set out in the work plan for 2016 AWP14 was EUR 62 160 000, broken down as follows: 

  Operational expenditure: EUR 56 451 000, corresponding to the third EU health programme 

(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 expenditure to support the 

third EU health programme (2014-2020) budget line 17 01 04 02. 

  Contribution of the health programme to Chafea's budget: EUR 4 209 000. 

The total operational budget came to EUR 57 992 112 as it included an additional EUR 1 541 112 of 

EFTA/EEA credits and recovery credits from previous budget years. 

A 

total  of  EUR 56 695 888.83  was  committed  under 

the  2016  AWP:  Chafea  covered 

EUR 48 248 609.99  of  this  amount,  while  DG  SANTE  committed  an  additional  EUR 8 447  278.84 

covering part of procurement and other actions. 

2. 

Priorities and financing mechanisms 

In  2016,  the  total  operational  budget  committed  (EUR 56 695  888.83)  was  divided  among  the 

programme's four specific objectives as follows: 

1.  Health  promotion:  EUR 25 622  317.07  (45%  of  the  operational  budget  in  2016)  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 3 947 709.3 (7%) for protecting EU citizens from serious cross-border 

health threats 

3.  Health  systems:  EUR 8 655  656.8  (15%)  for  contributing  to  innovative,  efficient  and 

sustainable health systems 

4.  Better and safer healthcare: EUR 14 892 153.25 (26%) for facilitating access to better and 

safer healthcare for EU citizens 

Horizontal activities (IT, communication) amounted to EUR 3 578 052.41 (7%). 

14 

Commission implementing decision of 1/3/2016 C(2016) 1158 final. 

7 

 
 
 
 
                                                      
Figure 1: Operational budget by third health programme objective in 2016 

The figure below provides information about the health programme credits invested as EU 

contribution through the different thematic priorities in year 2016. 

Figure 2: Operational budget per priority theme in 2016 

8 

 
 
 
 
 
To meet these objectives, the programme comprises a wide range of funding instruments. These are: 

  project grants, including the SGAs for the ERNs; 

  operating grants in support of non-governmental organisations; 

 

actions co-financed with Member State authorities (joint actions); 

  direct agreements with international organisations; 

  public procurement; and 

  other actions, such as the support to the scientific committees, administrative agreements with 

the Joint Research Centre and grants for Presidency conferences. 

Competitive selection and award procedures were used to select initiatives for funding. Competitive 

selection and award procedures 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 adequate (for example, due to a monopoly situation). 

Administrative  credits  covered  expenditure  such  as  studies,  meetings  of  experts,  information  and 

publication costs, and technical and administrative assistance for IT systems. 

3. 

Implementation by financing mechanism 

Type of financing mechanism 

Implementation (EUR) 

Share of mechanism in 

total implemented budget  

Calls for proposals: 

Project grants 

European  Reference  Network  (ERN)  SGAs  under 

FPA by objective 

Operating grants 

Grants for joint actions 

Conference grants to the Member States holding 

the Presidency of the EU 

Direct grant agreements 

Procurement (service contracts) 

Managed by CHAFEA 

Managed by DG SANTE 

Other actions  

18 323 884.19 

8 795 212.04 

4 386 344.15 

5 142 328.00 

14 376 881.83 

141 780.43 

4 450 000.00 

16 089 842.38 

10 456 063.54 

5 633 778.84 

3 313 500 

32.3% 

15.5%  

7.7% 

9.1% 

25.4% 

0.3% 

7.8% 

28.3% 

18.4% 

9.9% 

5.9% 

9 

 
 
 
Managed by CHAFEA 

Managed by DG SANTE 

Budget implemented of AWP 2016 

Total available budget of AWP 2016 
Credits not used15  

500 000.00 

2 813 500.00 

56 695 888.83 

57 992 112.00 

by CHAFEA 

1 282 128.59 

by DG SANTE 

14 094.58 

0.9% 

5% 

97.76% 

2.22% 

0.02% 

Beneficiaries 

4. 
In  2016,  more  than  20016  different  grants  and  contracts  were  signed  with  diverse  beneficiaries  and 

service  providers  ranging  from  governmental  and  non-governmental  organisations  to  academic 

institutions and private companies. 

The  category  ‘other’  includes  beneficiaries  such  as  health  care  providers  and  international 

organisations. Figure 3 provides an overview of the different groups of beneficiaries. 

Figure 3: Types of beneficiaries of the third health programme in 2016 

15 
16 

Differences between the credits available for use only in 2016 and the amounts actually contracted. 
This excludes contracts with single experts e.g. those participating in the scientific committees. 

10 

 
 
 
 
 
 
 
 
                                                      
Improvements 

The  programme's  support  for  ERNs  has  stimulated  innovation  in  health  care  delivery  and  increased 

access to quality care across the EU. 

Chafea used all simplification  tools at its disposal to streamline the EU financial contribution to the 

ERNs. Awarding FPAs and subsequent specific grants will make implementation and reporting easier 

and will provide the ERNs with a stable operating framework. 

Key actions under the health promotion and disease prevention programme objective were co-funded 

with competent authorities in the Member States (joint actions). The number of participants in these 
joint actions17 reflects the interest of Member States to actively engage in joint initiatives in the areas 

of tobacco control, prevention of HIV/AIDs, Tuberculosis and viral hepatitis and chronic diseases. 

Following  the  work  done  in  2015,  Chafea  continued  to  invest  significantly  in  information  and 

dissemination activities in close collaboration with DG SANTE and the health programme's network 

of  National  Focal  Points.  Chafea  organised  several  workshops,  collaborated  in  major  national  and 

international conferences, and organised stand-alone events with national authorities in EU countries. 

It  also  produced  a  series  of  brochures and info-sheets  on  the  health  programme's  key  priority  areas. 

Further  details  on  the  2016  dissemination  activities  are  provided  in  the  Commission  staff  working 

document. 

To  monitor  the  health  programme’s  implementation,  the  progress  made  according  to  the  CORDA 
system18 will be followed by an analysis of the feedback on the programme's outcomes and potential 

impact. 

As  most  actions are still in  their early  stages, concrete  results  are  not  yet  available.  Deeper  insights 

into  the  programme's  overall  impact  will  only  be  available  once  the  first  generation  of  co-funded 

actions  has  been  completed.  Nevertheless,  the  multiannual  plan  developed  at  the  outset  of  the  third 

health  programme  ensures  continuity  and  coherence  between  the  different  types  of  financing 

instruments  available.  ERNs  are  a  clear  example  as  their  support  has  been  optimised  by  aligning 

procurement  (assessment  of  health  care  providers  and  ERNs),  project  grants  (for  patient  registries’ 

work),  joint  actions  (on  rare  diseases  and  ORPHANET)  and  specific  grants  under  a  FPA  for 
coordinating the networks. 

In  2016  there  were  between  27  and  44  partners  (beneficiaries,  affiliated  entities  not  included)  per  joint  action  which  was  a 

17 
challenge for their overall management and coordination as all partners had to sign the grant agreement. 
18 
tools. Implemented by the Common Support Centre of the Research and Innovation it is the key source of information and provides feedback 
on the attainment of the programme's objectives and priorities, the types of actions and the types of organisations co-funded. 

CORDA centralises the data collected for all actions managed by Chafea and monitored through the use of the H2020 electronic 

11