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Using SF for health

Within the Lisbon Treaty (EU, 2007), the goal of the EU is to foster economic development while maintaining social cohesion. The Structural Fund (ERDF and ESF), the Cohesion Fund and Rural Development Fund, are funds allocated by the EU as part of its regional policy. They aim to reduce regional disparities in terms of income, wealth and opportunities. Europe's poorer regions receive most of the support, but all European regions are eligible for funding under the policy's various funds and programmes.

The EC Communication Solidarity in Health (2009) and Council conclusions on health and equity in all policies (Council of the European Union, 2010); current Cohesion Policy (2006), Together for Health (2007), the Europe 2020 Strategy (2010) require cross cutting action by all EU Directorates to reduce health inequities. For the first time, Cohesion Policy for 2007–2013 included a health priority. Three main areas of health-related SF investment were identified for 2007–2013: direct, indirect and non-health sector investment (Watson, 2009). These built on limited health investment available to Objective 1 regions in the 2000–2006 period.

There are a number of characteristic categories of need within the health sector relevant to targeted SF investment:

  • Urgent and immediate investment to overcome serious deficiencies in the safety and quality of direct provision of healthcare, in the main resulting from poor and inadequate range and quality of health infrastructure and clinical technologies;
  • Investment to reshape and reconfigure hospitals and health facilities to improve their responsiveness to changing need. This for example includes changes in the patterns of patient demand, advances in clinical technologies, adoption of new models of care and providing improved workforce facilities. Underpinning these factors is the constant need to improve operational efficiency and effectiveness;
  • Investment to develop workforce competencies, efficiency and effectiveness, this notably also includes investment in eHealth and similar ICT technologies;
  • Measures to engage and help citizens look after their own health; including the patient as co-producer of care;
  • Investment to support transformational change in health service systems and structures; whole systems redevelopment to modernize and reshape healthcare services.


The Prague declaration on Structural Funds

By signing the Prague Declaration in April 2004 Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland and Slovakia together with Ireland, Italy, the Netherlands, Austria and Greece expressed their commitment to the objective of encouraging health related investments via the Structural Funds.


The funding framework

EU funding to improve healthcare standards, whether through investments in infrastructure, equipment or training, is currently possible through the EU’s relevant Structural Funds: the European Regional Development Fund (ERDF) and the European Social Fund (ESF). Among the various funds, the ERDF constitutes the major funding opportunity. Out of a total of €24.4 billion allocated to the Ten, €14.95 billion will be available for Objective 1 regions and therefore eligible for funding health projects. Of these, the ERDF Mobilising EU Funding for Health will provide 61 % so that approximately €9.15 billion will in fact be available for health projects financed by the EU.


Absorption capacity

Concern has been expressed about the Ten’s “absorption capacity” for Structural Funds. Failure to spend the allocated funds under this financial framework or failure by a Member State to adequately police spending will undermine that Member State’s right to funding under the framework beyond 2007- 2013. The Structural Funds allow for the co-financing of projects up to 75 % for most of the accession countries, and up to 90% in some cases. The required financial contribution of 25 % or even 10 % of the total budget in the case of Cohesion Fund projects may be a challenge for the Ten, particularly where public debt is high.

 New Member States intending to benefit from Structural Funds for health improvements therefore need to ensure that they maintain healthcare as a priority for funding and expand the range of health-related projects in line with the extended scope of eligibility. 

 The new Structural Funds for the period 2007-2013 extend the scope and eligibility for health-related projects, notably to include technical assistance, IT systems for medical services, productive investment including medical equipment, and exchange of best practice. Although the EU has set up a framework for funding health improvements, it will still be up to national governments to take advantage of this funding potential by identifying healthcare improvements as a key priority in their national programmes, and by allocating sufficient budgetary means to secure the necessary co-financing requested from the Member States under the EU structural fund rules.



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