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EU external relations and financial cooperation in health – focus on Russia

EU external relations and financial cooperation in health – focus on Russia. European Commission DG RELEX Unit E1 Russia and Northern Dimension 21 April 2008. Summary. Political and Legal Framework Partnership and Cooperation Agreement Common Spaces Northern Dimension

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EU external relations and financial cooperation in health – focus on Russia

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  1. EU external relations and financial cooperation in health – focus on Russia European Commission DG RELEX Unit E1 Russia and Northern Dimension 21 April 2008

  2. Summary • Political and Legal Framework • Partnership and Cooperation Agreement • Common Spaces • Northern Dimension • Political and Sector Dialogues • FinancialCooperation • TACIS 1991-2006 • National Program • Cross border cooperation: Neighbourhood Programmes • ENPI 2007-2013 • National Program, including Common Space Facility • Interregional Program: TAIEX • Cross Border Cooperation Programs • Medium Term Outlook

  3. I. Political and Legal Framework

  4. Political and Legal Foundation of EU-Russia Relationship PARTNERSHIP AND COOPERATION AGREEMENT (PCA) 1997 – ? • Founded on shared principles & objectives: promotion of international peace and security, support for democratic norms & for political & economic freedoms • Sets principle common objectives: establishes institutional framework for bilateral contacts, calls for activities & dialogue in a number of areas • Trade provisions: Most-Favoured-Nation (MFN); eventual establishment of bilateral free trade area (FTA); support Russia in its preparations for WTO accession • Provides a mechanism for dispute settlement • “Mixed” agreement covering matters falling under EU & under national competence of the Member States

  5. Health sector covered under social provisions PARTNERSHIP AND COOPERATION AGREEMENT (PCA) 1997 – ? • Negotiated in early 1990s, finalised in 1994 • Health largely a Member States competence at the time • Some provisions referring to health and safety at work • No mention of other health policy issues

  6. The EU-Russia Common Spaces • Creation of 4 Common Spaces at St Petersburg Summit, May 2003 1. Common Economic Space 2. Common Space of Freedom, Security and Justice 3. Common Space on External Security 4. Common Space of Research, Education and Culture • Adoption of Road Maps May 2005 Road Maps are short- to medium-term instruments for the implementation of the Common Spaces

  7. 1. Common Economic Space • Create open, integrated market between EU & Russia • Reduce trade and investment barriers • Strengthen cooperation on regulatory policy, investment issues, competition, financial services, telecommunications, transport, energy, space activities, etc. • Focus on environmental issues, including energy efficiency, Kyoto Protocol, nuclear safety • Based on transparency, non-discrimination, & good governance HEALTH: protection of intellectual property rights; fight against counterfeiting and piracy, notably in priority sectors such as pharmaceuticals

  8. 2. Common Space of Freedom, Security, and Justice • Implementation of Visa Facilitation and Readmission Agreements since 1 June 2007 • Cooperation on inter alia combating terrorism, money laundering, trafficking in drugs and Human Beings • Cooperation aiming at document security • Support for border management, and reform of Russian judicial system • Development of operational cooperation between FRONTEX & Federal Border Security Service of Russia HEALTH: prevention, treatment and rehabilitation of drug addiction, paying particular attention to high-risk groups to prevent the spread of HIV/AIDS and other diseases

  9. 3. Common Space on External Security • International order based on effective multilateralism, central role of UN, effectiveness of OSCE and Council of Europe • 5 priority areas: - strengthening dialogue & cooperation on international scene; - fight against terrorism; - non-proliferation; - crisis management; - civil protection • Ensure stability in the regions adjacent to the EU & Russian borders

  10. 4. Common Space on Research, Education, and Culture • Research: Capitalise on strength of EU-Russia research communities & cultural and intellectual heritage; promote joint research activities in areas of common interest • Education: TEMPUS Programme; Erasmus Mundus programme; Bologna Process (education reform); European Studies Institute in Moscow • Culture: Lay firm basis for cooperation in cultural field, and strengthen and enhance European identity on basis of common values HEALTH: promoting the development of life skills education programmes for youth (on smoking, physical exercise, drugs, alcohol, HIV/AIDS etc)

  11. Political Dialogue • Summits (biannual) • Permanent Partnership Councils (ministers) • Parliamentary Cooperation Committee • Sector Dialogues • >20 ongoing with latest on Regional Policy and on Investment • discussions ongoing on launching a dialogue on Public Health and another one on Social issues • Expert meetings • Human rights consultation Aim for productive and balanced political dialogue with Russia, covering all fields, at political, high official and expert level

  12. Public Heath Dialogue in the making • First EU-RU health expert meeting in Feb. 2008 in BXL • Concept paper lists the modalities of establishing a new dialogue on public health under Common Space IV • Specific areas of cooperation to include • prevention of non communicable diseases (tobacco, alcohol, healthy lifestyle etc.) with particular attention to high risk groups, such as youth as specifically foreseen in the Road Map • infectious diseases where there is a need to strengthen surveillance&monitoring of the spread of HIV/AIDS, TB, malaria • a range of cross cutting issues of health in all policies such as cooperation on health statistics, cooperation in medical and public health education, climate change effects on health etc. • Dialogue expected to be officially launched by EU-Russia Summit June 2008. Signature may take place during Health Commissioner Moscow visit May 2-5

  13. Northern Dimension

  14. Northern Dimension • Fosters relationship between Baltic Sea States, Norway, Iceland, North-West Russia, including Kaliningrad • Aim - strengthen dialogue & cooperation in the region - through subsidiarity and active participation of all stakeholders HEALTH: Northern Dimension Partnership for Public Health and Social Well-being: • Expert groups on HIV/AIDS, Primary Health Care, Prisons Health, Social Inclusion, Healthy Lifestyle and Work Ability

  15. II. Financial Cooperation

  16. TACIS - Technical Assistance Technical Assistance to the Commonwealth of Independent States (TACIS) 1991-2006 • Since 1991, EU has provided appr. 2.7 billion € to Russia under TACIS Programme • EU is Russia’s largest provider of economic & technical assistance • Programme focus: institutional, legal, & administrative reform; economic & social development; freedom, justice, & security; fight against organised crime & terrorism; migration & asylum

  17. TACIS National Indicative Program– Health Sector (1) • "Social consequences of transition" was one of the three priority areas for the EU-Russia Cooperation programme in the period 1994 – 2006 • A total of 20 large projects (each with a budget over 1 million euros) have been implemented in the field of public health (some of which are still ongoing) • The overall budget spent on supporting Russia health sector reforms and health care services totals to approximately 60 million EUR

  18. TACIS National Indicative Program– Health Sector (2) • Covered various aspects of health care: primary health care, health education at schools, communicable diseases, health care in the penitentiary system • In several geographical zones: Karelia, Vologda, Leningrad, Pskov, Belgorod, Ulyanovsk, Buryatiya, Irkutsk, Tjumen, Lipetsk, Kaliningrad etc. • Partners included the Ministry of Health and Social Development, Ministry of Justice , Federal Service for Implementation of Punishments, Moscow Medical Academy, Federal AIDS centre, ministries of health in regions such as Kaliningrad, North Caucasus republics. • Implemented through different channels: private sector consultants, international organisations, NGOs

  19. HIV/AIDS: PHASE I • Duration: January 2004 - March 2006 (completed) • The project targeted prevention of HIV and AIDS • Major activities included public awareness raising, including through the “Time to Live” telemarathon (Ulyanovsk and Buryatiya transmissions), and encouragement of HIV workplace policies • The project had two pilot regions: Buryatiya and Ulyanovsk Oblast • The main operating partner was the Federal AIDS Centre

  20. HIV/AIDS: PHASE II • Duration: September 2005 – December 2007 (completed) • The project was targeted at improving possibilities for treatment of HIV+ patients • Pilot regions: Leningrad Oblast (+SPB), Kaliningrad Oblast, Krasnoyarsky Krai, Irkutsk Oblast • The main partner was the Federal Ministry of Health and Social Development • This project was implemented through a co-financing agreement with the WHO

  21. Preventive Health Clinics: “POLYCLINICS”PROJECT • Duration: January 2006 - June 2009 • Cardiovascular, diabetes, mental health, elderly • In cooperation with the MHSD (Moscow), as well as in two pilot regions: Tjumen, Lipetsk • Implemented by GTZ • The first year of implementation focused on analysis of current situation. Study tours to other regions of Russia and abroad have also been organised. • During 2007 and 2008, the project introduced new working methods at pilot polyclinics, and is making recommendations to federal MHSD.

  22. KALININGRADHEALTH • Duration: September 2006 – March 2009 • The project targets different aspects of health sector needs including public awareness on healthy life styles, primary health care, maternity care services, TB and HIV/AIDS, health care in penitentiary system (in particular the Ozerki prison hospital) • Equipment provision • The main operating partner is the Ministry of Health of Kaliningrad

  23. NORTH CAUCASUS HEALTH • Duration: September 2006 – September 2009 • Equipment procurement for two hospitals: Roddom n. 2, Republican Children’s hospital • Capacity building, training for medical personnel and personnel of the Ministry of Health of Chechnya • Establishment of Health Learning Resource Centres • Major operating partner: Ministry of Health of Chechnya • Implemented through direct agreements with WHO and UNICEF

  24. TACIS Cross-Border Indicative Program- Neighbourhood Programs • Under TACIS Cross Border Cooperation Indicative Program 2004-2006 • EURO 35 million allocated to six programs benefiting Russian regions (incl. Kaliningrad from NIP) • Jointly funded under EU structural funds (INTERREG under European Regional Development Fund) and TACIS • Joint selection of projects but regulations/procedures still separate • Small scale projects for regional and national administrations; micro-projects for very local initiatives

  25. TACIS Neighbourhood Programs- Health Sector • 6 regions: • South East Finland-Russia • Kareila • Kolarctic • Lithuania-Poland-Russia (Kaliningrad) • Estonia-Latvia-Russia • Baltic Sea Region • >200 projects across sectors, all funds committed • Examples of health and social projects: • Establishment of rehabilitation centre for children with disabilities (Kaliningrad) • Challenges to wellbeing – violence against women, prostitution and risk behaviour as challenges for cross border cooperation (Murmansk) • Artic children cross border training supporting education to promote psychosocial well being in Barents region (Murmansk) • Cross border network for disabled people (Pskov)

  26. Changing approach TACIS • National and • Neighbourhood Programmes are still ongoing but in 2007 we moved to a new type of financial cooperation...

  27. European Neighbourhood and Partnership Instrument (ENPI) • Policy driven – it supports the implementation of the roadmaps for the Four Common Spaces (thematic priority) and Kaliningrad Oblast (geographic priority). These roadmaps have been agreed by the Russian Government. • It is not about technical assistance for transition. There is a distinct move from past donor-recipient relationship, clearly no longer appropriate, to emphasise the consolidation of a partnership. • More focus on programming - National Indicative Programme 2007-2010 is our joint document setting out priorities for financial cooperation (€ 30 million per annum).The NIP is agreed by the Russian Government. • The ENPI regulation is a much more “enabling” regulation as it allows for co-financing. ENPI projects could become truly joint projects where Russian funds match EU funds.

  28. Nationalprogramme Content agreed annually with the Russian Government (National Coordination Unit in Min. of Economic Development and Trade) Budget: EUR30 mill/year Contains programmes such as IBPP, Common Spaces Facility Priorities: four Common Spaces, Kaliningrad Regionalprogramme Contents developed centrally in Brussels Multi-country projects in Eastern Europe Central Asia region (e.g. FLEG) Priorities: defined on an ad hoc basis ENPI Cross-borderCooperation(CBC) programme Highly innovative program EU structural funds and external cooperation budget pooled with single procedures Russia benefits from 7 programmes: Kolactic, Karelia, SE Finland, Est-Lat- Rus, Lit-Pol-Rus, Baltic and Black Sea Priorities: Common Spaces, Northern Dimension Interregionalprogramme Contains: Erasmus Mundus External Cooperation Window Tempus TAIEX and SIGMA Priorities: the fourth Common Space (education)for Erasmus and Tempus, four Common Spaces for TACIS Key elements of ENPI in Russia

  29. ENPI National Indicative Program Process: • Annual Program 2007 completed and approved by the European Commission, awaiting Russian signature. • Projects for the AP2008 have already been identified, program being finalised. • Project identification for the national AP2009 will start at the end of 2008 year and continue until March 2009. Content: • In view of changing policy context, focus shifting to programmes and facilities that make it possible to make financing available for "lighter" policy dialogue related needs on an ad hoc basis. • New instrument: Common Space Facility (already under TACIS AP2006, expected to be continued under ENPI)

  30. Common Space Facility (1) • Aiming to support policy dialogues under Common Spaces • The fist budget of EUR5.5 million available under the AP 2006 • Eligible activities include • Policy studies • Seminars • Workshops • Expert mobilisations • Study tours • Publicity actions • Policy and legal advice • Research papers • Procedure for applications is being discussed with Russian Ministry of Economic Development and Trade and Ministry for Foreign Affaires

  31. Common Space Facility • It is likely that applications will be submitted by Russian line ministries (including the Ministry of Health and Social Development) and by European line DGs (including SANCO and Relex) using a standard questionnaire aiming to identify the Common Space and policy dialogue relevance • Once a proposed action is approved by all parties procurement will be through call for proposals to EC member states administrations (for MS expertise) or through framework contract procedure (for private sector consultants), possibly also through international organisations in specific cases • Due to external cooperation programme deadlines, all funds must be committed to specific activities by July 2009

  32. ENPI Interregional Program - TAIEX • The ENPI interregional programme contains, among other instruments, the programme "TAIEX“ • Seminars, study visits, expert mobilisation • Demand Driven instrument. There is no budget allocation per country. Instead the funds are utilised for events on a first come first served basis. The available budget covers all countries of ENPI/east • TAIEX is administered in a specific TAIEX unit in DG Enlargement. Applications can be put forward by line DGs (e.g. SANCO) or Russian line ministries (including Ministry of Health and Social Development) • Events implemented in Russia or for Russians should ideally be related to the four common spaces

  33. ENPI Cross Border Coop. Program (CBC) • The ENPI/CBC programme is an innovative region-to-region cooperation between EU and the North West of Russia • In line with the new EU-Russia Regional Policy Dialogue • The priorities under the CBC programme include: • promote economic and social development in regions on both sides of common borders • address common challenges, in fields such as environment, public health and the prevention of and fight against organised crime • ensure efficient and secure borders • promote local cross-border “people-to-people” actions • Bottom up approach: Joint Operational Programs prepared by Joint Management Authorities (JMA) representing the countries and regions concerned. Decentralised management: JMA will launch calls for proposals, evaluate offers and sign contracts

  34. ENPI CBC - Russia • Russia can benefit from 7 CBC programmes: • Kolarctic (Finland-Russia) • Karelia (Finland-Russia) • South-East Finland-Russia • Estonia-Latvia-Russia • Lithuania-Poland-Russia • Baltic Sea • Black Sea • The indicative EU contribution in the 2007-2013 period is EUR308 million for the 7 programmes concerning Russia • Russia has indicated it will provide EUR 122 million (an exact mechanism for this co-financing is being discussed) • Baltic Sea Program already approved by Commission Decision December 2007, awaiting Russian signature (Deadline end 2008) • Other 6 Joint Operational Program Documents must be finalised, approved by participating states and sent to Commission in June 2008 the latest or funds will be lost

  35. Global Fund • In addition to national and regional programs, the Commission channels substantial support to health sector through the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria • We have contributed more than € 600 million over a period of 6 years. The Commission, together with the Member States, account for over half of the total financial contributions to the Fund • Russia benefits considerably from the Fund, for iinstance providing support to two programs aiming to fight tuberculosis: • The Tomsk Oblast Comprehensive Strategy to Contain and Control Tuberculosis (2004-09, approved funding USD10,766,486) is aiming to address the currently high rates of tuberculosis and multi-drug resistant tuberculosis in the general and the prison populations • ThePromoting a Strategic Response to TB Treatment and Care for Vulnerable Populations in the Russian Federation (2005-2010 , approved funding USD49,436,016) program directly benefits TB patients from these groups, particularly the homeless, disabled and unemployed, former and current prisoners, people living with HIV and people diagnosed with multi drug-resistant TB.

  36. ENPI CBC - Health • Public health mentioned as area for cooperation in the Cross Border Cooperation Strategy Paper 2007-2013 and Indicative Program 2007-2010 • The strategy stresses that activities in the health sector must take into account specifically the cross-border context for instance for communicable diseases (Tuberculosis, HIV/AIDS) or possible epidemic or pandemic diseases • Consumer protection, food safety and quality assurance and surveillance system likewise mentioned as relevant in cross-border context • If health is included in the Joint Operational Programs as a priority, projects can be later developed in this area

  37. III. Medium Term Outlook

  38. Medium-term Outlook • Continued implementation of Road Maps • New EU-Russia Agreement replacing the PCA, taking into consideration Russia’s WTO accession • Energy security and investment will play a key role in relationship • Reinforcing sector dialogues • Work together to promote solutions for regional conflicts and global challenges HEALTH: • A new EU-RU public health dialogue under preparation • A specific article on public health in New Agreement could be envisaged

  39. Conclusions • EU & Russia are inextricably linked through geography, history, culture, joint interests and challenges • Two largest entities on the European continent, but with an economic and trade asymmetry • European security is inseparable from Russian security and unthinkable without Russia • Large number of shared challenges and opportunities reflected in growing number of dialogues HEALTH: • Move away from financial assistance to dialogue based partnership and co-financing • Exchange of statistics, best practices in areas of mutual interest, common initiatives along the Road Map

  40. Contacts and Further Information (1) • European Commission Russia Unit website: http://ec.europa.eu/comm/external_relations/russia/intro/index.htm • European Commission Delegation to Moscow website: http://www.eur.ru/en/index.htm • EC Russia Unit Secretariat email: Relex-e1@ec.europa.eu • On EU-Russia relations and Northern Dimension: • Michael Webb, Deputy Head of Unit, DG RELEX Russia Unit • On EU-Russia economic, social and health cooperation: • Monika Hencsey, Desk Officer responsible for health sector, DG RELEX Russia Unit

  41. Contacts and Further Information (2) • ENPI National Program • EC: Mr. Jyrki TORNI, geo-coordinator for Russia, AIDCO • Russia: coordinated by the National Coordination Unit: Mr. Dmitry LEVCHENKOV, Head of Department of Investment policy, Ministry of Economic Development and Trade • ENPI Common Space Facility • EC: Ms. Outa HERMALAHTI, programme coordinator for EU-Russia cooperation programme, EC Delegation Moscow • Russia: coordinated by the NCU: Mr. Dmitry LEVCHENKOV, Head of Department of Investment policy, Ministry of Economic Development and Trade • ENPI Interregional Program: TAIEX • EC: Ms. Miriam TOPLANSKA, DG Elarg, coordinator for TAIEX in Russia • Russia: coordinated by the NCU: Ms. Elena KOLEROVA, TAIEX contact point, Department of Investment policy, Ministry of Economic Development and Trade • ENPI Cross Border Programs • EC: Ms. Bodil PERSSON, project manager for ENPI / CBC programme, AidCo • Russia: coordinated by the Ministry of Foreign Affairs: Mr. Dmitry BUKIN, Counsellor, Department of Common European Cooperation, Ministry of Foreign Affairs

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