In profile: cohesion policy 
improving health services
and access in the regions

The EU's cohesion policy invests in health, a key asset for regional development and competitiveness, in order to reduce economic and social disparities. The health sector and public health policy is a very important issue across the European Union. Health spending accounts for almost 10% of the GDP in Europe with those people employed in health related fields accounting for 15% of the European workforce.    
Cohesion policy investments in health are closely linked with the EU's health policy framework, including needs assessment and cost-effectiveness. Investments may address a number of different areas such as Europe’s ageing population, healthcare infrastructure and sustainable systems, e-health, health coverage and health promotion programmes. 
The Coronavirus Response Investment Initiative (CRII) was adopted on 1 April, 2020 to mobilise cohesion policy to flexibly respond to the rapidly emerging needs in the context of the COVID-19 pandemic.  The objective is to target more support to the most exposed sectors, such as healthcare, SMEs and labour markets, and help to the most affected territories in Member States and their citizens.

In relation to health, the initiative includes provisions to accelerate and enhance support to Coronavirus related expenditure including  the financing of health equipment, medicines, testing and treatment facilities, medical equipment (including ventilators and masks), training and supplementary wage support to health personnel and support to vulnerable groups (such as medical assistance or home care services).  

Accelerated procedures are also now in place to support the reallocation of EU cohesion policy financing.
It is expected that many national and regional programmes will come forward with reprogramming proposals in the coming months based on their specific needs.
Below we examine the investments planned by national and regional since 2014 under the European Regional Development Fund (ERDF) and the European Social Fund (ESF).
As programmes report on progress the data presented below will be updated (indicator values and detailed financial progress are reported annually). 


1. What are the priorities?

1.1 Which types of health improvements are prioritised? 

Many types of  interventions can be financed by the ERDF and the ESF.  The Commission's guidance for 2014-2020 highlighted the following priorities for the ERDF
  • Investment in health and social infrastructure to improve access to health and social services and reduce health inequalities, with special attention to marginalised groups such as the Roma and those at risk of poverty;
  • Infrastructure investments that contribute to the modernisation, structural transformation and sustainability of health systems, leading to measurable improvements in health outcomes, including e-health measures;
  • Targeted infrastructure investments to support the shift from institutional to community-based care, which enhances access to independent living in the community with high-quality services.
  • Support infrastructure investments in childcare, elderly care and long-term care;
  • Support for the physical and economic regeneration of deprived urban and rural communities including the Roma, which reduces the spatial concentration of poverty, including the promotion of integrated plans where social housing is accompanied notably by interventions in education, health, including sport facilities for local residents and employment.
Health investments in cross-border cooperation programmes respond to needs and challenges identified in the border regions. For example, projects focus on improving cross-border governance, important in emergency situations, as well as health and emergency services covering regions on both sides of the border. 
The main ESF priorities were the following:
  • Prolonging healthier working lives through the development and implementation of measures to promote healthy lifestyles and tackle health risk factors such as physical inactivity, smoking, harmful patterns of alcohol consumption;
  • Supporting actions improving health and safety at work, including by promoting a healthy environment and mental well-being at the workplace;
  • Enhanced access to affordable, sustainable and high-quality healthcare with a view to reducing health inequalities, supporting health prevention and promoting e-health, including through targeted actions focused on particularly vulnerable groups; 
  • Supporting the transition from institutional care to community-based care services for children without parental care, people with disabilities, the elderly, and people with mental disorders, with a focus on integration between health and social services;
  • Promoting access to services, in particular social care, social assistance services and healthcare (including preventive healthcare, health education and patient safety), especially for persons in vulnerable situations.
The Commission proposed broadening ERDF/ESF priorities in the Coronavirus Response Investment Initiative as set out above.  
Project examples from the current and recent programmes are highlighted below.

1.2 ERDF examples

Improving emergency services, BG 
The ERDF is financing better equipped, more efficient and more accessible emergency healthcare services in Bulgaria with EUR 71 million.  All 237 emergency care facilities throughout the country will have improved infrastructure and emergency rooms with state-of-the-art medical equipment and 400 new ambulances.  Benefits should especially be felt in more remote areas and for the most vulnerable groups of patients.

Cross-border cooperation of emergency services, LT, PL
Emergency services in the cross-border areas between Lithuania's Marijampolé & Alytus regions and the Podlaskie & Warmińsko-Mazurskie regions of Poland cooperate to improve their response times and to promote the EU-wide 112 emergency number.

Da Vinci Surgical System: robots in surgery, ES

The da Vinci Surgical System project is developing techniques and providing the training for using robots in minimally invasive surgeries. 
It is improving the quality of surgical interventions and reducing patient recovery times.

New diagnostic centre for cancer patients in Vilnius, LT
new centre for positron emission tomography was built at the Vilnius University Hospital Santaros Klinikos. This advanced imaging technology has improved early diagnosis of cancer and the effectiveness of treatment. The modern centre provides better access to health specialists and state-of-the-art equipment for Lithuanian citizens.

1.3 ESF Examples

Day Care Centers for People with Disabilities, GR

Day Care Centers have been set up in Greece to help people with disabilities acquire new skills and socialize, while providing substantial support to their parents. The project contributes to the transition from institutional care to community-based care services. 


Screening Centre for Early Detection of Infective Diseases, CZ
National Screening Centre for early Detection of Infective Diseases was created in Czechia. Several working teams worked together to complete a study on collective COVID-19 immunity across the Czech population. Currently, another study on the presence of the antibodies in recovered COVID-19 patients is under preparation.
Support to the Elderly and Nursing Homes, PL
The project supports nursing homes, facilities providing 24-hour care for the elderly, disabled and chronically ill, and health care entities. It allows the employment of new employees, as well as the purchase of hygiene and personal protection for the staff (i.e. masks, helmets, gloves, aprons). It also allows the retrofitting of facilities with the equipment necessary to combat COVID-19 (i.e. locks, isolation rooms, beds, oxygen concentrators).
Developing digital skills to improve healthcare, FI
Digital technologies have revolutionised the health and social care industry over recent years, so it's vital that health workers understand how to use and make the most of them. The project, developed by the Kajaani University of Applied Sciences (KAMK) in Finland, helps teachers, managers and staff who work in the industry to develop their digital health skills. 


2. Tracking EU finances

2.1 What health investments were planned? How is it changing? 

Four "intervention fields" are used to track direct EU investments in health improving services. 
  • Code 053: Health infrastructure; (NB this includes systems and equipment)
  • Code 081: ICT solutions addressing the healthy active ageing challenge and e-health services and applications (including e-Care and ambient assisted living);
  • Code 107: Active and healthy ageing; 
  • Code 112: Enhancing access to affordable, sustainable and high-quality services, including health care and social services of general interest.
The first two fields cover the bulk of ERDF support, while the last two fields are predominantly financed by the ESF. 
Allocations can change over time with changing needs.  The changes in allocations since 2016 and particularly since early 2020 (linked to the COVID-19 pandemic) can be seen by comparing the two charts below.   
  • The fist chart below shows the progression in the EU amounts planned year on year 2016-2019;
  • The second chart shows the changes to the total planned amount during 2020; 
  • Use the filters in the top right of each chart to filter by fund and country allocations. 
With the legal changes adopted in the CRII in early April 2020 it is expected that health actions will continue to be increased.  

2.2 Explore progress with EU financing

Use the chart below to track the annual progress with the four intervention fields and, clicking on the bars, see the national investment efforts and programme effort, using the filters you can filter by fund. 
Not all countries planned significant EU investment in these health objectives initially. In general, ERDF health investments tend to be concentrated in the less developed countries and regions. As for the ESF, investments in access to health care tend to be concentrated in countries facing particular challenges.
There are also variations in the rate of implementation, both in deciding on the projects to finance and in the rate of investment spending by those projects - see the chart below. At a first glance, the data below raises question on how EU investment in health services and access is allocated and mobilised.
  • Why are only some of the countries focusing on improving health infrastructure and access? 
    It tends to be less developed regions and countries that mobilise ERDF funding for health service modernisation.  Under the ESF, access to affordable, sustainable and high-quality services, including health care has been co-financed in countries facing particular challenges or addressing a country-specific recommendation in that field. The richer countries have significant national budgets and, in any event, lower per capita EU funding, which is prioritised in areas such as research and SME competitiveness. The  two intervention fields do not capture research and innovation investments linked to human health and medical equipment made under the research and small and medium enterprise's high level themes.
  • Why are some of the decided amounts higher than the planned?
    This question has a simple explanation: overbooking of projects in the programme portfolios. In order to ensure that they will be able to spend as much as possible of the EU funding available, Member States often select more projects than strictly required under the plans. If some projects later fail, they programmes can still use the funding for other projects. In case all projects are completed, the national budget covers the overbooked costs that are not covered by the programme.

3. Tracking the benefits of EU support

3.1 Explore progress with delivering ERDF investment outputs

One common indicator was defined for the period 2014-2020 to measure the "population covered by improved health services":  
Common Indicator CO36 is defined as: "Population of a certain area expected to benefit from the health services supported by the project. It includes new or improved buildings, or new equipment for various type of health service (prevention, outpatient or inpatient care, aftercare)."
This indicator was designed to track in an aggregate way the population benefiting from EU funded health service improvements.  The graph below compares the progress in tracking the European  combined improvement in health services measured by the common indicator.
  • By clicking on one of the bars a new graph appears showing the specific year across member states.
  • By further clicking, the information becomes even more specific by looking at within country information of the different programmes that use this indicator.
Comparing the common indicator targets and progress under the planned investments it appears that not all programmes investing in health are reporting on the common indicator. Indeed the common indicator does not capture all eligible actions, which have many other outputs captured by programme-specific indicators, which cannot be aggregated.
The common indicator has thrown up challenges.  It was challenging for the programmes to set accurate targets initially without knowing the projects that would be selected (that is why the programmes targets have been increasing year on year).  The values of the population benefiting are collected from each project. Where there are multiple projects there can be overlapping of the population covered, which can lead to over counting at programme level. This is being treated by some programmes by setting limits on the population covered. The robust of the values reported are alos likely to be addressed in impact evaluation).

3.2 Tracking participants of ESF support to health care

The best way to see how ESF investments in health have benefited individuals across the EU in the 2014-2020 programming period is by looking at the number of participants supported under two main priorities:

  • Active and healthy ageing (investment priority 8vi); 
  • Enhancing access to affordable, sustainable and high-quality services, including health care and social services of general interest (investment priority 9iv)
In the chart below, click on the bar for a given year and a new graph appears showing the participants for each country. By further clicking, the information becomes even more specific by looking at within country information of the different programmes. 
It is worth noting that the concept of "participants” refers to persons benefiting directly from an ESF intervention and does not include persons benefiting indirectly.  As a consequence, this monitoring data does not capture the full impact of ESF investments in public health systems and services on broader groups of society beyond the participants directly benefiting from the support.

4. More information:

Find more #ESIFOpenData stories here.

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Date of text:  v1 March 2020 / v2 May 2020 / V3 June 2020
Authors: Petra Goran / Giulia Rossi Hernandez / Mita Talenti