COMMISSION STAFF WORKING DOCUMENT EXECUTIVE SUMMARY OF THE EVALUATION Final Evaluation of the Third Health Programme 2014-2020
Date: 2023-11-15
Institutions: Directorate-General for Health and Food Safety, European Commission
Subjects: EU programme, disease prevention, health care, health care system, health service, illness, public health

EN 

  EN 

   EUROPEAN COMMISSION  Brussels, 15.11.2023  SWD(2023) 370 final  COMMISSION STAFF WORKING DOCUMENT  EXECUTIVE SUMMARY OF THE EVALUATION  Final Evaluation of the Third Health Programme 2014-2020 {SWD(2023) 369 final}  
 
 
Purpose and scope of the evaluation 

This staff working document presents the final evaluation of the third Programme for the 
Union's action in the field of health (2014-2020) (the Programme)1.  

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. 

Emphasis  is  put  on  five  main  evaluation  criteria:  relevance,  effectiveness,  efficiency, 
coherence and EU added value of the Programme. 

Following the outbreak, in the first quarter 2020, of the COVID-19 pandemic in the EU 
territory, relevant actions funded by the Programme (2014-2020) were switched to their 
emergency mode and geared towards combatting the pandemic.  

These  actions  were  not  included  in  the  scope  of  the  external  study  supporting  the 
evaluation, since some of them were in early stage or in the middle of implementation at 
the time when the external study was launched. Nevertheless, the SWD mentions these 
actions, which were funded by the Programme in its last implementation year, as part of 
the  EU  response  to  the  COVID-19.  These  emergency  actions  were  mostly  launched  in 
the  early  stages  of  the  pandemic,  before  the  adoption  of  the  EU4Health  Programme 
(2021-2027)2, which succeeded the Third Health Programme 2014-2020. 

.The third Programme for the Union's action in the field of health (2014-2020) 

With  a  budget  of  EUR  449.43  million  over  7  years,  the  Programme  was  the 
Commission's  main  instrument  to  underpin  and  support  EU  policy  coordination  in  the 
area of health during the implementation period 2014-2020. 

The Programme had four specific objectives: 

(i)  promote  health,  prevent  diseases  and  foster  supportive  environments  for  healthy 
lifestyles,  
(ii) protect EU citizens from serious cross-border health threats,  
(iii) contribute to innovative, efficient and sustainable health systems,  
(iv) facilitate access to better and safer healthcare for EU citizens.  

1  The  Programme  was  established  by  REGULATION  (EU)  No  282/2014  OF  THE  EUROPEAN 
PARLIAMENT AND OF THE COUNCIL of 11 March 2014 on the establishment of a third Programme 
for the Union's action in the field of health (2014-2020) and repealing Decision No 1350/2007/EC, OJ L 
86, 21.3.2014, p. 1. 
2 Regulation (EU) 2021/522 of the European Parliament and of the Council of 24 March 2021 establishing 
a Programme for the Union’s action in the field of health (‘EU4Health Programme’) for the period 2021-
2027, and repealing Regulation (EU) No 282/2014 (OJ L 107, 26.3.2021, p. 1–29) 
EUR-Lex - 32021R0522 - EN - EUR-Lex (europa.eu). 
3 Budget expressed in 2014 prices; Programme budget in current prices is equal to EUR 452.3 million.  

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These specific objectives are further broken down into  23  thematic priorities4  and are 
linked  with  several  indicators  to  measure  the  extent  to  which  the  specific  objectives 
were achieved. 

The Programme was implemented through annual work programmes adopted following a 
the  Programme  Committee  consisting  of  Member  States’5 
positive  opinion  of 
representatives. The implementation made use of both grants (i.e. joint actions involving 
Member  States’  authorities,  project  grants,  operating  grants  to  NGOs,  direct  grants  to 
international  organisations,  prizes,  Presidency  conferences)  and  procurement  contracts. 
The  Consumers,  Health,  Agriculture  and  Food  Executive  Agency  (CHAFEA)  was 
entrusted with the implementation of the Programme. 

Key findings per evaluation criterion, lessons learned and recommendations 

Effectiveness 
The  evaluation  found  that  knowledge  produced  by  the  Programme  was  used  in 
policymaking  and  that  the  Programme  contributed  to  improvements  in  health  and 
healthcare policies in the EU (in areas such as antimicrobial resistance, health technology 
assessment,  health  inequalities,  alcohol,  tobacco  control  and  European  Reference 
Networks for rare diseases). 

Funded actions helped achieve the Programme’s objectives to a large extent, in particular 
for objective 1 (promote health, prevent diseases and foster supportive environments for 
healthy lifestyles), objective 3 (contribute to innovative, efficient and sustainable health 
systems) and objective 4 (facilitate access to better and safer healthcare for EU citizens). 
This  is  demonstrated  by  the  progress  on  the  indicators  associated  with  each  of  the 
specific objectives of the Programme. Results from the quantitative analysis of indicators 
have  been  cross-checked  and  confirmed  by  the  assessment  of  the  outcome  of  funded 
actions and corroborated by surveyed stakeholders’ views. 
As regards objective 2 (protect EU citizens from serious cross-border health threats), the 
relevant  indicator  (‘number  of  Member  States  integrating  coherent  approaches  in  the 
design of their preparedness plans’) showed an increasing trend, indicating the ability of 
the  Programme  to  effectively  meet  this  objective.  Complementary  qualitative  analyses 
confirmed that funded actions contributed to strengthen the preparedness and response of 
the EU and Member States, as they contributed (in coordination with other tools set up in 
DG  SANTE  and  in  the  Commission)  to  respond  to  and  mitigate  the  moderate  health 
threats6 that frequently emerged during the implementation period. 

4 The list of 23 thematic priorities is provided in  Annex I of the Regulation (EU) No 282/2014 OF THE 
EUROPEAN PARLIAMENT AND OF THE COUNCIL of 11 March 2014 on the establishment of a third 
Programme for the Union's action in the field of health (2014-2020). 
5 For ease of reference, this document refers to ‘Member States’. However, where relevant, this shall also 
include  EFTA  countries  and  other  countries  which  participated  in  the  Programme  (i.e.  Bosnia  and 
Herzegovina Moldova, Serbia). 
6  among  which:  the  avian  influenza  H7N9  in  human  beings  (2013-2014);  resurgence  of  polio  and 
tuberculosis in certain countries; hepatitis; Ebola outbreak in west Africa and later in Democratic Republic 

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Despite  effective  contribution  of  the  Programme  funded  actions  to  combatting  the 
COVID-19  pandemic,  particularly  in  its  early  stages,  the  pandemic  uncovered 
weaknesses  in  the  preparedness  and  response  to  a  major  cross-border  health  threat  of 
such  magnitude  at  EU  and  at  Member  States  level.  These  weaknesses  and  fragilities 
mainly related to the availability of tests and testing materials; to contact tracing, public 
health  surveillance  and  rapid  response  to  avoid  further  spread  of  the  virus;  to  the 
availability  of  medical  countermeasures  (personal  protective  equipment,  medicines  and 
medical  devices);  to  healthcare  surge  capacity  (shortages  of  intensive  care  units, 
insufficient  availability  of  healthcare  staff).    Preparedness  and  planning  have  been 
exposed, at the beginning of the pandemic, as being under-funded and under-developed, 
implying  the  need  for  preparedness  and  response  systems  and  cultures  to  be 
strengthened.  
It can therefore be concluded that the objective 2 was only met to a moderate extent by 
the Programme. 

Finally, the participation of countries with low gross national income (low-GNI Member 
States) in the Programme did not increase significantly, despite the implementation of the 
exceptional utility criteria which was designed to boost their participation.  

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,  decreasing  over  time  and  comparable  with  those  of 
other EU programmes of similar size. 

An  analysis  of  the  total  implementation  costs7  of  actions  funded  under  the  4  specific 
objectives  and  on  cross-cutting  issues,  against  the  qualitative  outcome  of  these  actions 
enables to conclude that the total costs were proportionate to the results and outcomes of 
the funded-actions, even if the latter are not expressed in monetary terms. The benefits of 
the funded actions potentially outweigh, to a significant extent, their total implementation 
costs.  This  potential  is  further  enhanced  if  longer-term  effects8  of  the  actions  are  taken 
into account. 

The  introduction  of  the  SYGMA9-COMPASS10  IT  tools  for  submitting  proposals, 
managing  grants  and  monitoring  and  reporting  (also  used  by  the  Horizon  2020 
Framework  Programme  for  Research  and  Innovation),  enabled,  together  with  other 
simplification  measures  (e.g.  the  introduction  of  framework  partnership  agreements  for 

of  Congo  –  DRC;  Zika  virus  outbreak;  influenza;  measles;  dengue;  yellow  fever,  West  Nile  fever, 
chikungunya viruses. 
7  i.e.  the  total  costs  incurred  by  the  Commission,  Programme  beneficiaries,  Member  States  and  relevant 
stakeholders. 
8 e.g. establishment of lasting knowledge/expertise sharing networks; contribution to progressive changes 
in population behaviour, through the implementation of health promotion and disease prevention actions  
9 European Commission’ IT-based grant management system 
10  European  Commission’s  IT-based  workflow  system  for  the  Horizon  2020  Framework  Programme  for 
Research and Innovation and for other EU Programmes of the research family, including the Third Health 
Programme 2014-2020 

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operating  grants)  to  improve  the  efficiency  of  the  Programme.  However,  according  to 
some  beneficiaries,  there  was  scope  to  further  simplify  the  processes,  especially  in 
relation to funding applications, monitoring and reporting. 

Administrative  costs  were  found  heavy  by  some  stakeholders,  increasing  the  workload 
and  potentially  deterring  countries  with  a  low-GNI  or  smaller  organisations  from 
participating in the Programme or getting involved in future work. 

The  cost-effectiveness  of  actions  could  have  been  improved  by  introducing  a  more 
centralised information system (either using systems already in place in the Programme 
portal  or  adding  a  new  one)  dedicated  to  disseminating  information  about  EU  funding, 
ensuring  synergies  across  projects,  and  further  communicating  on  the  results  of  the 
implemented actions. 

Coherence 
The actions funded by the Programme were aligned with its objectives and coherent with 
each other.  
The  Programme  also  encouraged  cooperation  and  was  aligned  with  other  instruments 
financing  health-related  activities,  in  particular  the  European  Structural  and  Investment 
Funds and Horizon 202011 . Moreover, actions funded by the Programme contributed to 
wider EU policies and priorities (i.e. the Europe 2020 strategy for smart, sustainable and 
inclusive  growth  in  2014-2015,  the  Juncker  Commission’s  priorities  in  2016-2019  and 
the  von  der  Leyen  Commission’s  priorities  in  2020),  and  were  aligned  with  wider 
international  obligations,  in  particular  the  WHO  common  policy  framework  ‘Health 
2020’, as reflected in the Commission Communication on EU Global Health Strategy12. 

EU added value 
The  Programme  provided  added  value  in  comparison  with  what  could  have  been 
achieved  by  the  EU  without  the  Programme  and  by  Member  States  acting  alone.  In 
particular,  it  funded  multiple  actions  which  demonstrated  strong  EU  added  value  by 
encouraging Member States to exchange best practices, to cooperate and coordinate with 
each other on pertinent policy issues.  

Furthermore, it enabled mutual learning and knowledge exchange in areas such as health 
promotion  (nutrition,  physical  activity,  prevention  of  non-communicable  diseases), 
health  technology  assessment,  rare  diseases,  antimicrobial  resistance,  alcohol  and 
tobacco policy. 

11  Regulation  (EU)  No 1291/2013  of  the  European  Parliament  and  of  the  Council  of  11 December  2013 
establishing  Horizon  2020  -  the  Framework  Programme  for  Research  and  Innovation  (2014-2020)  and 
repealing Decision No 1982/2006/EC (OJ L 347, 20.12.2013, p. 104–173) 
12  COMMUNICATION  FROM  THE  COMMISSION  TO  THE  EUROPEAN  PARLIAMENT,  THE 
COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF 
THE  REGIONS  EU  Global Health  Strategy  Better  Health  for  All  in  a  Changing  World,  COM/2022/675 
final.  

https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52022DC0675&from=EN 

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The seven EU added value criteria designed for the assessment and selection of project 
the  surveyed 
proposals  and  funding  applications  were  positively  reviewed  by 
stakeholders who did not recommend updating them. 

Relevance 
An  analysis  of  participating  countries’  priorities  and  action  plans  established  at  the 
beginning of the Programme implementation,  indicates that the Programme was largely 
relevant  in  that  it  addressed  national  health  needs.  This  was  particularly  the  case  for 
objectives  1  (promote  health,  prevent  diseases,  and  foster  supportive  environments  for 
healthy lifestyles) and 4 (facilitate access to better and safer healthcare for EU citizens). 
The involvement of Member States in the design phase was instrumental in ensuring the 
Programme’s relevance. 

However, surveyed stakeholders felt that higher budgets could have helped address other 
or additional  problems  better (e.g. child and infant  health, including  paediatric cancers, 
health inequalities and mental health). 

The Programme has for the most part remained relevant to changes in health needs over 
time  and  was  flexible  enough  to  respond  to  emerging  health  needs  such  as  the 
migrant/refugee crisis  in  2015 and  to  undertake  and fund emergency actions to  combat 
the COVID-19 pandemic in 2020, in its early stages. 

During  the  Programme  implementation  period,  the  relevance  of  preparedness  and 
response to  health threats significantly increased  because of  infectious  diseases and  the 
moderate (or less severe) outbreaks13 that originated either within the EU territory or in 
third countries.  With the COVID-19 outbreak at  the beginning of 2020 and the lessons 
learned  from  this  pandemic,  the  protection  of  EU  citizens  from  serious  cross-border 
health threats became the highest health priority at EU level and in Member States and 
this has been reflected in the design of the successor EU health programme on the period 
2021-2027. 

Lessons learned and recommendations 
Despite the overall achievements of the Programme through the effective implementation 
of  its  funded  actions,  the  analysis  showed  that  there  have  been  limitations  to  what  the 
Programme  could  have  achieved.  These  can  be  addressed  through  the  following 
recommendations: 

-  Continued  focus  should  be  placed  on  areas  with  high  EU  added  value,  notably 
preparedness  and  response  to  cross-border  health  threats,  exchange  and 
implementation  of best practices;,  cooperation and coordination among  Member 
States on health technology assessment, rare diseases and cancer. 

-  The  flexibility  and  adaptability  were  two  of  the  Programme  key  strengths.  This 
aspect  should  continue  in  order  to  help  face  sudden  emergencies  or  changes  in 
health needs. 

13  e.g.  avian  influenza  H7N9  in  human  beings;  resurgence  of  polio  and  tuberculosis;  measles;  hepatitis; 
Ebola outbreak in west Africa and in Democratic Republic of Congo; Zika virus; influenza; dengue; 
yellow fever, West Nile fever, chikungunya viruses. 

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-  Having  all  Member  States  participate  in  the  Programme  can  only  strengthen  its 
outputs and outcomes. Full participation also increases the added value of funded 
actions.  Measures  should  therefore  be  introduced  to  remove  barriers  (e.g. 
financial and administrative barriers in relation with the complexity of application 
processes) to participation by Member States with fewer resources. 

-  The sustainability of funded actions can have a profoundly positive effect on EU 
and  national  health  policies  and  systems.  Guiding  and  actively  supporting 
beneficiaries in conceptualising and implementing actions to foster sustainability 
is a key element to consider during future planning. 

Lessons  learned  from  the  Programme  and  from  the  COVID-19  pandemic  in  terms  of 
unforeseen challenges, as well as new health needs, were taken into account in the design 
of the EU4Health programme (2021-2027) which succeeded the third health programme 
(2014-2020).  They  also  led,  notably,  to  the  Commission  proposals  for  establishing  a 
Health  Emergency  and  Response  Authority14  (HERA)  and  for  building  the  European 
Health Union15, a set of key actions and legal instruments which help16: 

•  better protecting the health of EU citizens, 
• 

equipping the EU and its Member States to better prevent and address future 
pandemics, 
improving the resilience of Europe’s health systems. 

• 

14 Proposal for a Regulation of the European Parliament and of the Council establishing a European Health 
Emergency Response Authority (HERA) 
15  COMMUNICATION  FROM  THE  COMMISSION  TO  THE  EUROPEAN  PARLIAMENT,  THE 
COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF 
THE  REGIONS:  Building  a  European  Health  Union:  Reinforcing  the  EU’s  resilience  for  cross-border 
health threats 
16 The European Health Union comprises a set of key actions, notably in the areas of: Crisis preparedness, 
reform  of  the  EU  pharmaceutical  legislation,  Europe’s  Beating  Cancer  Plan,  A  comprehensive  approach 
mental health, the European Health Data Space, Global Health Security, together with accompanying legal 
acts. See European Health Union (europa.eu) 

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