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REGIONAL OFFICE FOR

<TSWorld HealthOrganizationEurope

Biennial Collaborative Agreement

between

the Ministry of Health of the Republic of Lithuania

and

the Regional Office for Europeof the World Health Organization

2018/2019

Signed by:

For The Ministry of Health of the Rep blic of Lith ania

Name Professor Aurelijus Veryga

pate

Title Minister of Health

For the WHO Regional Office for Europe

Signature

Name Dr Zsuzsanna Jakab

2 1 h c Z tPDate

Title Regional Director

Table of Contents

INTRODUCTION 1

TERMS OF COLLABORATION 3

PART 1. SETTING PRIORITIES FOR COLLABORATION FOR 2018-2019 4

1.1 Health situation analysis 4

1.2 Priorities for collaboration 51.2.1 The Health 2020 and the 2030 Agenda in the Republic of Lithuania 51.2.2 Linkage of BCA with national and international strategic frameworks for the Republic of Lithuania 51.2.3 Pro rammatic priorities for collaboration 6

PART 2. BUDGET AND COMMITMENTS FOR 2018-2019 7

2.1 Budget and fin ncing 7

2.2 Commitments 72.2.1 Co itment of the WHO Secretarial 72.2.2 Commitments of the Ministry of Health 7

LIST OF ABBREVIATIONS 8

ANNEX 9

Introduction

This document constitutes the Biennial Collaborative Agreement (BCA) between the WorldHealth Organization (WHO) Regional Office for Europe and the Ministry of Health of theRepublic of Lithuania for the biennium 2018-2019.

This 2018-2019 BCA is aligned with the WHO Twelfth General Programme of Work, for theperiod 2014-2019, which has been formulated in the light of the lessons learned during theperiod covered by the Eleventh General Programme of Work. It provides a high-levelstrategic vision for the work of WHO, establishes priorities and provides an overall directionfor the six-yea period beginning in January 2014. It reflects the three main co ponents ofWHO reform: programmes and priorities, governance and management.

The WHO Programme Budget 2018-2019, as approved by the Seventieth World HealthAssembly in resolution WHA70.5, was strongly shaped by Member States, which havereviewed and refined the priority-setting mechanisms and the five technical categories andone managerial category by which the work of the Organization is now structured.

The BCA reflects the vision of the WHO Regional Office for Europe, Better Health forEurope, as well as the concepts, principles and values underpinning the European policyframework for health and well-being, Health 2020, adopted by the WHO Regional Co mitteefor Europe at its 62nd session.

Health 2020 seeks to ma imize opportunities for promoting population health and reducinghealth inequities. It recommends that European countries address population health throughwhole-of-society and whole-of-government approaches. Health 2020 emphasizes the need toimprove overall governance for health and proposes paths and approaches for ore equitable,sustainable and accountable health development. As such, Health 2020 is the unifying policyframework for the collective effort to achieve the new 2030 Agenda for SustainableDevelo ment by promoting inclusive and participatory governance, adopting a whole-of-government/whole-of-society approach and trategically mobilizing and using resources.

Health 2020 s intersectoral approach of health in all policies means health in all theSustainable Development Goals (SDGs) of the 2030 Agenda. Contributing to all the goals ofthe 2030 Agenda by leading and steering the integration of the health objectives and priorityareas for action into the 2030 Agenda process, implementation of Health 2020 will provide aresilient and supportive environment that will enable the achievement of SDG 3 on ensuringhealthy lives and promoting well-being for all at all ages as well as the health targets in all theother SDGs.

Description of the Biennial Collaborative Agreement

This docu ent constitutes a practical framework for collaboration. It has been drawn,up in arocess of successive consultations between national health authorities and the Secretariat ofthe WHO Regional Office for Europe. '

The collaboration program e for 2018-2019 has taken its point of depa ture from the bottom-up planning process for 2018-2019 underta en with the country. This work was carried out as:part of WHO reform, in the overall context provided by the Twelfth General Programme ofWork. The objective of the bottom-up lanning exercise was to determine the priority healthoutcomes for WHO collaboration with the country during the period 2018-2019. This

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document further details the collaboration programme, including proposed outputs anddeliverables.

The WHO Secretariat has managerial responsibility and is accountable for the programmebudget outputs, while the outcomes define Member States uptake of these outputs. Achievingthe programme budget outcomes is the joint responsibility of the individual Member State andthe Secretariat. At the highest level of the results chain, the outcomes contribute to the overallimpact of the Organization, namely, sustainable changes in the health of populations, to whichthe Secretariat and the countries contribute.

Achieving the priority outcomes as identified in this BCA is therefore the responsibility ofboth the WHO Secretariat and the Ministry of Health of the Republic of Lithuania.

The document is tructured as follows:

1. PART 1 covers brief health situation analysis and agreed priorities for collaboration in2018-2019, which will be the focus of the joint efforts of the Ministry of Health andthe WHO Secretariat.

2. PART 2 includes sections on the budget for the BCA, its financing and the mutualcommitments of the WHO Secretariat and the Ministry of Health.

3. The Annex provides su mary by programme budget c tegory, outcomes, programmebudget outputs and deliverables. Two modes of delivery a e foreseen:

Intercountry (IC), addressing countries’ common needs using Region-wideapproaches. It i expected that an increasing proportion of the work will bedelivered in this way.countr -specific (CS), for outputs that are highly specific to the needs andcircumstances of individual countries. This will continue to be important and thechosen mode of delivery in many cases.

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Terms of collaboration

The priorities (PART 1) provide a fr mework for collaboration for 2018-2019. Thecollaborative programme may be evised or adjusted during the course of the biennium bymutual agreement, where prevailing circumstances indicate a need for change.

The BCA is signed in English, and it comes into force from the date of the last signature andends with the end of the year 2019. The biennial programme budget outputs and greeddeliverables for 2018-2019 may be amended by mutual agreement in writing between theWHO Regional Office for Europe and the Ministry of Health as a result of, for example,changes in the country s health situation, changes in the country capacity to implement theagreed activities, specific needs emerging during the biennium, changes in the RegionalOffice’s capacity to provide the agreed out uts, or in the light of changes in funding. Eitherparty may initiate amendments.

After the BCA is signed, the Ministry of Health will reconfirm/nominate WHO nationalcounterpart and national technical focal points. The national counterpart will be responsiblefor the overall implementation of the BCA on the part of the Ministry and liaise with allnational technical focal points on a regular basis. The Head of WHO Country Office (HWO)will be responsible for implementation of the BCA on behalf of WHO. The BCA workplan,including the planned programme budget outputs, deliverables and implementation schedule!will be agreed accordingly. Implementation will start at the beginning of the biennium 2018-2019. The Regional Office will provide the highest possible level of technical assistance tothe country, facilitated and supported by the Country Office or other modalities present in thecountry. The overall coordination and management of the BCA workplan is the responsibilityof the HWO.

The WHO budget allocation for the biennium indicates the estimated costs of providing thelanned outputs and deliverables, predominantly at the country level. On the basis of the

outcome of the WHO financing dialogue, the funding will come from both WHO coi orateresources and any other resources obilized through WHO. These funds should not be usedto subsidize or fill financing gaps in the health sector, to supplement sala ies or to purchasesupplies. Purchases of supplies and donations within crisis respon e operations or as part ofdemonstration projects will continue to be funded through additional mechanisms, in line withWHO rules and regulations.

The value of WHO technical and management staff based in the Regional Office and ingeographically dispersed offices (GDOs), and the input of the Country Office to the deliveryof planned outputs and deliverables are not eflected in the indicated budget; the figurestherefore greatly understate the eal value of the sup ort to be provided to the country. Thissupport goes beyond the indicated budget and includes technical assistance and other inputsfrom WHO headquarters, the Regional Office, GDOs and unfunded inputs, from countryoffices. The budget and eventual funding included in this Ag eement are the Organization sfunds allocated for Regional Office cooperation within the country workplan.

The value of Government input - other than that channelled through the WHO Secretariat - is not estimated in the BCA.It should lso be noted that this BCA is open to further developmentand contributions from other sources, in order to supplement the existing programme or tointroduce ctivities that have not been included at this stage.

In particular, the WHO Regional Office for Europe will facilitate coordination with WHOheadquarters in order to maximize the effectiveness of country interventions in the spirit ofthe One WHO principle.

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PART 1. Setting priorities for collaboration for 2018-2019

1.1 Health situation anal sis

The average life expectancy in Lithuania has increased to 74.6 years in 2015, but is still thelowest in the EU, and the country has the widest gender related gap of life expectancy at birthamong EU countries (69.2 years for males, and 79.7 years for females). Cardiovasculardiseases, cancer, external causes and dise ses of the digestive system are the leading fourcauses of death. The mortality rate from ische ic heart disease and stroke are the two maincauses of death in Lithuania. According to the European Health Interview Survey nearly threeout of ten inhabitants a e suffering from hypertension.Unhealthy lifestyles are the ain national health challenge. Alcohol consumption remains amajor health threat and, according the WHO estimates, is the highest in Europe and the world.Prevalence of daily smoking among adults has decreased in the last years and is currentlylower than the EU average, while the prevalence of smoking among men and boys up to 15years old is higher than the EU average. The majority of inhabitants have a diet low invegetables, fruits, and wholegrain and fish products. About one in si adults in Lithuania is

/» obese. Though obesity in adolescents up to 15 years old is still relatively low (13% in 2013-2014) it had increa ed nearly three times fro 4% in 2001-2002.For a number of years Lithuania has had the highest rate of suicides in the EU. Though from2000 the suicide rate was decreasing, it is still very high (31.5 per 100 000 inhabitants in2015) co pared with other countries.Studies show a high level of child maltreatment in Lithuania. The issue requires bettercoordination of services between sectors, stronger involvement of the health sector, provisionof free of charge complex services for abused children and their families, adoption of relevantlegislation, strengthened surveillance and pilot and implement prevention programs.Lithuania is one of the high priority countries of the WHO European Region for TB and fo the high MDR-TB burden. The defaulting rate is particularly high among MDR-TB patients,and treatment outcome monitoring of MDR-TB cases needs to be improved. TB and HIV co-infection is one of the priority issues.WHO estimates that the yearly environmental burden of diseases for Lithuania is 19%. Majorchallenges remain with the creation of health promoting environments and the use of toolssuch as environmental health impact assessment.Health care expenditures per inhabitant in Lithuania are half of the EU average. Cost formedicines constitutes the major part of out-of-pocket payments. Prevent ble mortality inLithuania is one of the highest in the EU and provides a high potential in improving healthsystem performance.Lithuania is one of the EU countries with the highest health inequalities. Mortality inequalitieshave been identified by all socio-economic indicators, but a e especially high when assessedby the mode of work and status of economic activity. Investigations have shown highinequalities between population groups with different education levels.

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1.2 Priorities for collaboration

1.2.1 The Health 2020 and the 2030 Agenda in the Republic of Lithuania

In 2014 the Parliament of the Republic of Lithuania has adopted the Lithuanian HealthStrategy (LHS) 2014 2025 which was inspired by and followed the values, principles andstrategic directions of Health 2020 and focused on four strategic priorities: 1) safe socialenvironment, reduced health inequities; 2) healthy environment at work and favourable livingconditions; 3) promotion of healthy lifestyle; 4) effective and high quality health careaccording to the needs of population. The LHS has been implemented through a wide range ofother strategic documents and programs, including interinstitutional ones. For allocation ofthe EU structural funds (2014-2023) two action plans have been adopted by the Ministry ofHealth, one, on reducing health inequalities (focused on problematic regions of the country inthe areas of cerebrovascular diseases, circul tory diseases, TB, addictions, traumas, peoplewith disabilities and children health), and another - on healthy ageing (healthy lifestyle andprophylactics, prevention of falls, improvement of mental health, creation of healthierworking conditions, optimisation of complex nursing and geriatric services, prevention ofinflammatory and degenerative rheumatic diseases and related disabilities).In 2016, the Government of Lithuania carried out a comprehensive evaluation of nationalpolicies conformity with the SDGs. An inter-ministerial working group together withrepresentatives from the NGOs and other soci l partners concluded that Lithuania has a widerange of policy instruments and legislation in place. However, main challenges to ensureeffective implementation remain.The Lithuanian Government’s Action Plan for 2017-2020 foresees priority measures for theimplementation of the 2030 Agenda. With a view to shape sustainable development policyafter 2020, the Lithuanian Government is going to update the National Progress Strategy„Lithuania 2030 .Lithuania has already started data collection and analysis for sustainable developmentindicators. More than 50% of the indicators have already been made publicly available.Lithuania announced that it will carry out a Voluntary National Review of its 2030 agendaimplementation in 2018.Health 2020 and the 2030 Agenda implementation in Lithuania will further benefit frombuilding and strengthening strategic partnerships on municipal and regional levels, throughsuch initiatives as the Regions for Health Network (Health Promoting Kaunas Region is the

ember from Lithuania), the International Healthy Cities Network (Klaipeda and Kaunascities), the National Health Promoting Schools Network, the National Health PromotingHospitals Network (including primary health care institutions), and the Health PromotingUniversities Network.

1.2.2 Linkage of BCA with national and international strate ic frame orks forthe Republic of Lithuania

This BCA for the Republic of Lithuania supports the realization of Lithuania s national healthpolicies and plans such as the National Development Strategy: Lithuania 2030; the NationalDevelopment Programme 2014-2020 and its interinstitutional action plans for horizontalpriorities on Health for All and regional development; the Lithuanian Health Strategy 2014-2025, the Lithuanian Health System Development Framework document 2011-2020; theNational Public Health Care Development Programme 2016-2023; the National Cancerprevention and control program (2014-2025); the Mental Health Strategy and its implementationplan and suicides prevention action plan; the Interinstitutional action plans on drugs, tobaccoand alcohol prevention; the National Security Strategy; the National Sustainable DevelopmentStrategy; the National Environmental Protection Strategy;the State Programme on Violence

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Prevention in the Close Environment 2014-2020; and the Child Wellbeing Progra e for2013-2018. This BCA has already identified the related key Sustainable Development Goalstargets and indicators.

1.2.3 Programmatic priorities for collaboration

The following collaboration programme for 2018-2019 as detailed in the Annex is based onthe country-specific needs and WHO regional and global initiatives and perspectives and was

utually agreed and selected in response to public health concerns and on oing efforts toimprove the health status of the population of the Republic of Lithuania. It seeks, to facilitatestrategic collaboration enabling WHO to make a unique contribution.

Implementation of the BCA will focus on building partne ships with state and non-state actorsstakeholders; strengthening monitoring, surveillance and governance fo health by findingjoint intersectoral solutions through the life-course for priority health issues (HIV, TB, NCDs,mental health, tobacco and alcohol control, nutrition, child maltreatment prevention, childrenand adolescents health and ageing); building capacities fo leadership and intersectoral work;building on the work on environment and social determinants Of health; improving healthsyste performance through integrated services delivery and strengthened human resources,improving rationale use of edicines; developing national mechanism for evidence-informedpolicy-making and e-health application; pro oting policy dialogues on social determinants ofhealth and health equity and promoting evidence, tools, best practice and expe ience sharingwithin the Baltic, Baltic-Nordic and other cooperation frameworks.

The progra me budget outputs and deliverables are subject to further amendments asstipulated in the Terms of Collaboration of the BCA.

A linkage to the related SDG target and Health 2020 targets is provided for eve y programmebudget output.

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PART 2. Budget and commitments for 2018-2019

2.1 Budget and financing

The total budget of the Republic of Lithuania BCA is US$ 170 000.00. All sources of fundswill be employed to fund this budget.

In accordance with World Health Assembly resolution WHA70.5, following the financingdialogue the Director-General will ake known the distribution of available funding, afterwhich the Regional Director can consider the Regional Office s allocations to the biennialcollabo ative agreements.

The value of the WHO contribution goes beyond the indicated onetary figu es in thisdocument, since it includes technical assistance and other inputs fro WHO headqua ters, theRegion l Office, GDOs and count y offices (COs). The WHO Secretariat will, as part of itsannual and biennial prog amme budget implementation report to the Regional Committee,include an estimate of the actual costs of the country programme, including, in quantitativeterms, the full support provided to countries by the Regional Office, in addition to amountsdirectly budgeted in the country workplans. V

2.2 Commitments

The Ministry of Health and the WHO Secretariat jointly commit to working together tomobilize the additional funds required to achieve the outcomes, progra me budget outputsand deliverables defined in this BCA.

2.2.1 Commitments of the WHO Secretariat

WHO agrees to provide, subject to the availability of funds and its rules and regulations, theoutputs and deliverables defined in this BCA. Separate agreements will be concluded for anylocal cost subsidy o direct financial cooperation inputs at the time of execution.

2.2.2 Commitments of the Ministry of Health

The Ministry of Health shall engage in the policy and strategy formulation andimplementation processes required and provide available personnel, materials, upplies,equipment and local expenses necessary for the achievement of the outcomes identified in theBCA.

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LIST OF ABBREVIATIONS

General abbreviations

BCA - Biennial Collaborative AgreementCS - Country-specificEU - European Union

GDO - Geographically dispersed officeHWO - Head of the WHO Country OfficeIC - Intercountry

LHS - Lithuanian Health StrategySDGs - Sustainable Development GoalsWHA - World Health AssemblyWHO - World Health Organization

Technical abbreviations

HIV - Human Immunodeficiency virus

M/XDR-TB - Multidrug- and extensively drug-resistant tuberculosisNCDs - Noncommunicable diseasesNGO - Nongovernmental organizationTB - Tuberculosis

Annex

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