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Health governance in Europe

The politics, policy and governance of health in the EU


Health in the National Recovery and Resilience Plans: State of Play

In order to receive their allocated portions of the EU’s Recovery and Resilience Facility (RRF) funds, member states are required to submit their national recovery and resilience programmes (NRRPs) to the Commission for assessment. Despite various delays, 12 NRRPs had been assessed as of the end of June 2021, and were adopted by the Council on 13 July (Austria, Belgium, Denmark, France, Germany, Greece, Italy, Latvia, Luxembourg, Portugal, Slovakia, Spain). This post gives a short overview of the health-related content of these 12 plans, offering some initial indication of how member states proposed to make use of the RRF to support health system reforms and investments. 

Plans outline a series of “components” and list specific investments and reforms under each component. The scale and ambition of the plans ranges from three components proposed in the Luxembourgish plan to 30 proposed in the Spanish NRRP. Among these, the vast majority dedicate a specific component or sub-component to health (Slovakia, in fact, dedicates 3 of its 18 components to health). Austria and Belgium are the exceptions to this trend, instead identifying health-related reforms and investments only under other components (such as those on “a just recovery”, “public administration” and “training and labour market”). 

A notable feature of the plans submitted to date is how few of them frame their investments and reforms in the context of COVID-19 or weaknesses exposed by the pandemic. The Danish plan targets stocks and supply of critical medicines, the Spanish plan addresses vulnerabilities vis-a-vis global health crises and the German plan includes investments in R&D targeting COVID-19. But the rest make little or no mention of the pandemic in relation to the investments and reforms that they propose, focusing instead on wider, more fundamental and pre-existing issues. These include the creation of infrastructure for health data, eHealth, telemedicine and digitalisation, the building and renovation of hospitals, clinics and research institutes, and the development of national strategies for primary care, prevention services, mental health care, health research and governance of the system. 

Examples of specific investments and reforms proposed:

  • Development of the electronic mother child pass platform (Austria, investment 4.A.3)
  • Implementation of the proposed law on differentiation, decentralisation, deconcentration and on measures to simplify local political action in areas including health (France, reform C7.R1)
  • Establishment and operation of Community Health Houses to improve territorial health assistance (Italy, investment M6C1-2, 1.1)
  • Plan to rationalise the consumption of pharmaceuticals and promote sustainability (Spain, investment C18.I5). 

Many of the investments and reforms proposed in these initial plans were already foreseen, or even underway, a situation necessitated largely by the speed at which NRRPs had to be devised and the complexity of the kind of project eligible for funding. In spite of this, the challenge will now be implementation, as Member States seek to overcome domestic opposition – Spain’s plan, for instance, is already proving contentious at the national level – and the EU institutions seek to monitor the application of the funds. 

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