The 11 smallest countries in the WHO European Region have jointly committed to stronger action to improve the health of their populations. Ministers and senior officials from Andorra, Cyprus, Estonia, Iceland, Latvia, Luxembourg, Malta, Monaco, Montenegro, San Marino and Slovenia signed the Cyprus Declaration at the 10th High-Level Meeting of WHO/Europe's Small Countries Initiative (SCI) in Limassol, Cyprus on 10–12 April 2024. During the meeting, North Macedonia officially became the 12th SCI Member State.
The Cyprus Declaration sets out a way forward for small countries to act jointly on a range of issues. These include the cancer care continuum, climate change, access to medicines, and the looming health workforce crisis, which are all issues that small countries have been battling with for decades. The SCI meeting also shared successes in implementing the “Roadmap for better health in smaller countries in the WHO European Region, 2022–2025”, which includes human resources for health (HRH), access to novel medicines, and health and tourism – a vital source of income for many of the SCI Member States.
“In this room, we are more than just health ministers; we are architects of change, advocates for progress, and guardians of public health,” said Cyprus Minister of Health, Michael Damianos, as he welcomed the delegates. “We have the power to transform health in our nations and lead the way for a brighter and healthier future for generations to come.”
A roadmap for better health
Since the creation of the SCI in 2013, 6 Member States have developed national strategies for HRH and the other 5 have integrated the health workforce into national health strategies. 10 countries have joined the WHO Novel Medicines Platform (NMP) to improve affordable and equitable patient access to effective, novel, high-cost medicines in the Region.
With the Cyprus Declaration, small countries reinforced their commitment to ensuring that their health systems are climate-resilient, decarbonized and environmentally sustainable, and to promoting health and well-being in national and local efforts to reduce greenhouse gas emissions and adapt to climate change. To this end, by 2026, they will develop stand-alone or integrated national health and climate action plans, according to national contexts and priorities.
Tourism, on which many of the small countries depend, is inevitably impacted by climate change and extreme weather events. Through the Coalition of Partners on Health and Tourism, coordinated by WHO/Europe and UN Tourism, the small countries are joining forces to prioritize health and well-being and strengthen health system resilience, safety, and security within tourism. Building climate-resilient health systems also means strengthening the health workforce.
“There is no way we can provide the care our populations need without our health workforce,” emphasized WHO Regional Director for Europe, Dr Hans Henri P. Kluge. “I have heard your concerns: demographic shifts; ageing populations; shrinking numbers of young students; outward migration. Yet, it was very encouraging to see the progress and good policies already implemented by SCI countries to improve the supply of the health workforce, in line with the WHO framework for action.”
The SCI expands to 12
The SCI also saw their network grow as North Macedonia officially became the 12th SCI Member State.
“I am confident that the accession of the Republic of Northern Macedonia to the WHO/Europe Small Countries Initiative will not only advance our nation's health care efforts but will also fuel a collective pursuit to achieve universal health care and better health outcomes for all,” said North Macedonia’s Deputy Minister of Health, Dr Maya Manoleva.
“Through the SCI network, small countries are able to join forces and take action with a united voice in international policy-making fora, whether it concerns climate change, access to cancer treatment and care, medicines, health workforce or tourism,” added Dr Bettina Menne, Coordinator of the SCI, who described it as a true laboratory for innovation.
This year’s annual SCI conference was co-organized by the Ministry of Health of Cyprus and WHO/ Europe and hosted by the Government of Cyprus. It was attended by ministers and delegates from 14 small countries, including Barbados and Moldova as observers. The SCI initiative, led by the WHO European Office for Investment for Health and Development in Venice, Italy, was launched in 2013. It now includes 12 countries with a total population of almost 9 million people.