European Region
Dr Hans Henri P. Kluge
WHO Regional Director for Europe
In line with the European Programme of Work (EPW), 2020–2025, which focuses on “United Action for Better Health in Europe”, the WHO Regional Office for Europe (WHO/Europe) is pleased to highlight 5 key results from the Programme Budget 2024–2025 End-of-Biennium Assessment, the last biennium of GPW 13 and conclusion of the first European Programme of Work.
This high-level assessment captures the collective achievements of the European Region across the full breadth of our mandate during a biennium marked by extraordinary complexity and sustained pressure. Against a backdrop of persistent health system stress following the COVID-19 pandemic, the continued war in Ukraine, increasing climate-related health threats, and significant financial volatility, WHO/Europe worked alongside 53 Member States to deliver tangible health impact where it was needed most.
Across the three strategic priorities of the EPW — universal health coverage, health emergencies, and healthier populations — the Region delivered results grounded in addressing country needs, backed by evidence, driven by partnerships, and supported by strong leadership, governance, and data systems.
Key achievements during the biennium include, but are not limited to:
- Strengthened primary health care and more equitable financing for universal health coverage, including concrete reforms to financing, service delivery and benefit design in multiple countries. WHO support translated into expanded access to mental health, youth-friendly and community-based services, reduced out-of-pocket payments for medicines, and the introduction of innovative PHC payment and service models, including in conflict-affected settings.
- Enhanced preparedness, prevention and response to health emergencies, with all contributing countries advancing capacities under the International Health Regulations. The Region achieved record levels of engagement in preparedness processes, strengthened laboratory and surveillance systems, expanded emergency medical team readiness, and sustained large-scale emergency response operations — most notably in Ukraine and neighbouring countries affected by displacement and cross-border risks.
- Accelerated action on noncommunicable diseases, risk factors and health determinants, supported by multisectoral policies on tobacco, alcohol, nutrition and physical activity, strengthened mental health systems, and targeted action on health inequities across the life course. WHO/Europe’s work increasingly translated evidence into legislation, regulation and implementation — addressing not only what works, but how to make it work in complex political and commercial environments.
- Leadership in data, digital health and accountability, including strengthened health information systems, expanded use of digital tools for service delivery and surveillance, and region-wide analytical initiatives such as NCD scorecards, AMR accountability mechanisms and health system maturity assessments. These efforts reinforced transparency, comparability and evidence-informed decision-making across the Region.
- Resilient governance and partnerships, even amid severe financial constraints. WHO/Europe sustained delivery despite unprecedented budgetary pressures, advanced institutional reforms aligned with the UN80 agenda, adopted the Second European Programme of Work, 2026–2030 (EPW2), and expanded collaboration with Member States, UN partners, youth, academia and civil society.
This regional assessment also brings together key lessons learned and persistent challenges in the region. These include the importance of pairing evidence with governance and financing mechanisms; the central role of community trust and frontline health workers; the need for sustained, multi-biennium engagement to translate pilot reforms into national systems; and the reality that operational volatility — financial, geopolitical and administrative — is now a structural feature of the Region’s environment.
Together, these results underscore the continued relevance and necessity of WHO’s mandate in the European Region — the Organization’s most diverse region, spanning high-, middle- and lower-income countries, fragile and conflict-affected settings, and highly decentralized health systems.
As we conclude the first European Programme of Work spanning 2020–2025, the Region is looking ahead. Climate crisis, demographic ageing, shifting disease patterns, evolving health security threats, and rapid technological change are reshaping health and well-being in Europe and Central Asia. Building on the lessons and results of this biennium, WHO/Europe, together with its Member States and partners, is shaping a transformative vision for the next phase of regional cooperation under EPW2 — one that is resilient, equity-driven and firmly anchored in country impact.
I invite you to explore the detailed results presented here, including consolidated regional narratives and country-level summaries, which together illustrate how WHO/Europe continues to deliver for health, even under the most challenging circumstances.
PROGRESS ON THE TRIPLE BILLION TARGETS
Regional Aggregation
These charts illustrate the contributions of various tracer indicators driving progress toward the Triple Billion targets for universal health coverage, health emergencies and healthier populations. Each stacked bar shows the relative contribution of these indicators over time, highlighting both gains and areas where progress has reversed. The overlaid lines indicate the net impact of outcome indicators associated with each target, providing a broader view of how health impact is evolving.
WHO CONTRIBUTION TOWARDS HEALTH OUTCOMES
Regional Aggregation Of The Output Prioritization
This table provides a regional overview of the financing and implementation of prioritized outputs. It presents planned costs, available funds and utilization, alongside the number of offices (countries, territories and areas) that have identified each output as high or medium priority.
OUTPUT SCORECARDS
WHO’s Output Scorecard Measures Its Performance For Accountability
These scorecards provide an overview of progress in the delivery of outputs across the Region. Performance is assessed across six dimensions, each with specific criteria for technical and enabling outputs. Select an outcome to explore the related scorecards.
HIGHLIGHTED RESULTS
Explore WHO’s Contribution To Health Outcomes Across The Region
- Universal health coverage
- Health emergencies protection
- Healthier populations
- Effective and efficient WHO
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EU-1_Containing the Silent Threat: Addressing Antimicrobial Resistance Through Strengthened Systems and Governance
Antimicrobial resistance (AMR) kills 133 000 people in the WHO European Region each year, yet its governance demands cross-sectoral coordination that health systems have historically struggled to deliver. In 2024–2025, WHO advanced AMR action at both regional and country levels. Regionally, the WHO Regional Office for Europe (WHO/Europe) announced the AMR Accountability Index at the United Nations General Assembly and the Global Ministerial Conference in Jeddah, reframing AMR as a societal, economic and political challenge requiring cross-sectoral leadership—with a structured tracking mechanism ready for pilot in 2026. The One Health Regional Adaptation Guide was launched at the seventy-fourth session of the WHO Regional Committee for Europe (RC74), and the AMR Roadmap for the European Region 2023–2030 guided consultations across Europe and central Asia. WHO/Europe supported the launch of the Kyrgyzstan AMR Accountability Country Self-Assessment and, in Kyrgyzstan, supported the world’s first national survey on AMR prevalence—a global benchmark for evidence generation—and delivered training across bacteriological departments, with participants directly reporting improved clinical decision-making. In Slovenia, WHO developed a training package for multisectoral AMR coordination, addressing fragmented governance among ten agencies across three ministries that had hampered implementation of the national action plan.At the country level, Moldova received standardized infection prevention and control (IPC) guidance for primary health care, addressing a critical normative gap. The Czech Republic benefited from WHO provision of advanced sequencing equipment for tuberculosis (TB) drug-resistance surveillance and new thermal cyclers for human immunodeficiency virus (HIV) drug-resistance testing. North Macedonia’s health security strengthening included modernization of the communicable disease surveillance and early warning system. The Russian Federation’s three WHO collaborating centres on TB, multidrug-resistant tuberculosis (MDR-TB) and TB–HIV co-infection built national capacity and supported new MDR-TB clinical guidelines. In Cyprus, Slovakia and beyond, WHO’s normative guidance on AMR and IPC was adopted within national frameworks. Taken together, this portfolio demonstrates WHO’s catalytic role in converting political commitment into technical implementation and measurable AMR governance progress. -
EU-1_Financing Universal Health Coverage: Turning Commitments into Equitable Resource Flows
Persistent out-of-pocket expenditures, fragmented financing mechanisms and chronic underinvestment in primary health care constrained progress towards universal health coverage (UHC) across the Region in 2024–2025. WHO’s technical leadership generated concrete policy changes. In Armenia, WHO provided technical architecture for Universal Health Insurance—a landmark reform committing to reduce out-of-pocket expenditures by 40% by 2030, with immediate full subsidisation for the most vulnerable. In Georgia, WHO supported the introduction of outcome-based, age-adjusted capitation financing tied to performance indicators, with rollout beginning in 2025 for six pilot facilities ahead of national expansion. In Moldova, costing evidence generated for 41 Youth-Friendly Health Services and 40 Community Mental Health Centres informed policy on mixed payment mechanisms for 600 000 annual service users. In North Macedonia, WHO-facilitated dialogue contributed to the first revision of the Positive List of Medicines since 2014, shifting at least €1 million in household costs to public coverage through the Health Insurance Fund in 2024. In Ukraine, a WHO-developed national primary health care costing methodology directly informed a payment increase for primary health care providers in 2025, establishing tariff-setting tools for a system that reaches over five million people; over 350 specialists were trained in health financing, analytics and governance.
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EU-1_Transforming People-Centred Health Services: Reaching Every Patient Across the Region
Across the WHO European Region, persistent gaps in quality, accessibility and integration of health services drove a concentrated programme of reform support in 2024–2025. In countries at different stages of health system development—from high-income settings navigating ageing populations and post-pandemic backlogs to lower-middle-income countries facing fragmentation, underfunding and displacement—WHO’s technical leadership, delivered through 25 country offices and 4 regional divisions, produced documented, country-specific results. Key contributions included guiding the Ministries of Health of Bosnia and Herzegovina through structural primary health care (PHC) assessments and a cross-country study visit; equipping 60 rural ambulatories in Georgia with telemedicine infrastructure; supporting Georgia’s PHC reform with the introduction of outcome-based capitation financing for six pilot facilities ahead of national expansion; integrating WHO Caregiver Skills Training into Latvia’s national system for children with developmental delays; supporting Moldova’s costing evidence for financing 41 Youth-Friendly Services and 40 Community Mental Health Centres serving over 600 000 users annually; backing Slovenia’s multi-stakeholder PHC strategy adopted in September 2024; installing 28 modular PHC facilities in conflict-affected areas of Ukraine to restore services for approximately 170 000 people; and enabling nearly 62 000 outreach consultations for 42 000 patients through WHO-supported mobile teams in Ukraine.WHO also drove disease-specific service delivery improvements: expanding mental health services through QualityRights initiatives in Albania, Armenia, Croatia, Slovenia and Türkiye; supporting HPV vaccine introduction in Belarus, Kazakhstan, Tajikistan and Ukraine; strengthening emergency care systems in Moldova; advancing the National Medicines Access Platform in North Macedonia, shifting over €1 million in household costs to public coverage; and modernizing TB care pathways in Poland and Slovakia. These contributions—from 25 country offices and 4 regional divisions—collectively advanced primary health care reform, disease-specific service strengthening and equity-oriented delivery across the European Region, with documented results in countries representing the full spectrum of health system development stages. -
EU-2_Building Emergency Preparedness Across the Region: Strengthening Readiness in Contributing Countries
The WHO European Region’s health security landscape in 2024–2025 was shaped by the ongoing conflict in Ukraine, cross-border displacement, climate-sensitive disease threats, and the legacy of coronavirus disease (COVID-19) preparedness gaps. The WHO Regional Office for Europe (WHO/Europe) addressed persistent underperformance in the International Health Regulations (IHR) on risk communication, community engagement and infodemic management: training was provided to Member States to reverse these documented deficits. Involving over 25 countries and over 100 Emergency Medical Teams (EMTs), WHO/Europe advanced the EMT Regional Action Plan 2024–2030. Kazakhstan secured US$ 19 million in WHO-brokered emergency preparedness investment. Moldova received a comprehensive chemical, biological, radiological and nuclear (CBRN) preparedness package in response to its proximity to the conflict in Ukraine, including simulation exercises, multisectoral coordination tools and legal framework development. Bosnia and Herzegovina advanced health security legislation following WHO assessments identifying gaps in emergency coordination. Romania strengthened CBRN and polio preparedness through hazards exercises and multisectoral coordination.At country level, Albania and Tajikistan completed Joint External Evaluation (JEE) processes; Bosnia and Herzegovina advanced health security legislation following WHO assessments identifying gaps in emergency coordination; Croatia conducted WHO-supported risk assessment workshops using the Strategic Toolkit for Assessing Risks (STAR); North Macedonia modernized its disease surveillance and early warning system; Serbia upgraded laboratory quality management systems across 24 microbiology laboratories through WHO-delivered intensive training, mentorship and site visits; Türkiye received WHO technical support for laboratory preparedness; and Ukraine’s hospitals received 26 heating units and water, sanitation and hygiene (WASH) improvements under WHO infrastructure support to 660 frontline health facilities. The aggregate result is a Region substantially better positioned to detect, prevent and respond to health emergencies than at the biennium’s outset.All 22 contributing offices advanced emergency preparedness capacities; the examples above reflect the range of approaches and documented results across the contributing base. -
EU-2_Preventing the Next Pandemic: Mitigating the Emergence and Re-Emergence of High-Threat Pathogens
The risk of pathogen emergence and re-emergence requires a proactive, systems-level approach that integrates human, animal and environmental health surveillance and response. In 2024–2025, the WHO Regional Office for Europe (WHO/Europe) advanced this agenda through multiple complementary strategies. WHO/Europe launched the Regional Adaptation Guide on One Health at the seventy-fourth session of the WHO Regional Committee for Europe (RC74), providing a practical country-level implementation framework for the One Health approach, and established the first WHO collaborating centre on One Health—a research and capacity-building hub for the integration of human, animal and environmental health surveillance across the Region. The antimicrobial resistance (AMR) Accountability Index was positioned explicitly as a mechanism to address AMR as a driver of future pandemic risk. WHO supported the development of One Health literacy modules in partnership with the Ministry of Health of Italy, including programmes for secondary schools, investing in the next generation’s awareness of pandemic risk. In Kazakhstan, WHO co-funded a US$ 19 million preparedness investment package addressing deficiencies in laboratory systems and emergency response—two capacities critical for early pathogen detection.At country level, Georgia’s cold chain infrastructure upgrade—881 refrigerators, 100 fridge tags, 112 voltage stabilizers, two cold rooms and two ultra-low temperature freezers deployed across 62 districts—improved the operational readiness of the national vaccination system as a first line of pandemic prevention. In Poland, health security strengthening developed International Health Regulations (IHR)-aligned capacities for AMR response and cross-border threat management. In Slovenia, multisectoral AMR governance was advanced, reducing the structural fragmentation that hampers coordinated One Health response. In all these countries, WHO’s contribution was to embed preparedness for emergence not as a crisis response but as a sustained system function. -
EU-2_Responding When It Matters Most: WHO's Acute Emergency Response Across the Region
Acute health emergencies in 2024–2025 spanned infectious disease outbreaks, conflict-related disruption, mental health crises, radiological threats and a devastating Escherichia coli (E. coli) outbreak affecting children. The WHO Regional Office for Europe (WHO/Europe) responded with timeliness, technical expertise and coordinated surge capacity. In response to Latvia’s enterohaemorrhagic E. coli outbreak (March–April 2025)—affecting 53 children, 31 hospitalized and 22 developing haemolytic uraemic syndrome—the WHO Regional Office for Europe provided direct clinical advisory support to the Clinical Hospital; this was formally acknowledged by the Ministry of Health of Latvia. With over 100 teams from more than 25 countries, WHO/Europe sustained the Region’s largest emergency medical surge capacity pool under the Emergency Medical Teams (EMT) Regional Action Plan 2024–2030. In Ukraine, WHO supported 660 frontline health facilities with medicines, trauma supplies and rehabilitation materials, reaching 3.8 million people in conflict-affected oblasts. In Türkiye’s Gaziantep cross-border operation, WHO sustained health services for populations across more than 13 years of crisis in north-west Syrian Arab Republic.At country level, Armenia maintained continuity of essential services during severe regional flooding in 2025; Bosnia and Herzegovina received WHO emergency coordination support for measles and pertussis outbreak response, enabling 10 000 catch-up vaccinations and risk communication to 200 000 people; Georgia, Kazakhstan and Tajikistan contributed through infrastructure, capacity-building and Joint External Evaluation (JEE)-informed operational readiness improvements; Moldova’s Safe and Scalable Care project strengthened emergency department standards and trauma care pathways; Poland advanced community-based crisis response capacity as part of its mental health scale-up; Romania’s chemical, biological, radiological and nuclear (CBRN) preparedness included multi-hazard simulation exercises and poliovirus response planning; Serbia upgraded 24 laboratory diagnostic units for outbreak response; and Slovakia developed standardized crisis psychosocial support standards and de-escalation protocols applicable to mental health emergencies. -
EU-3_Tackling Risk Factors Through Multisectoral Action: Tobacco, Alcohol, Obesity and Beyond
Behavioural and metabolic risk factors—tobacco, harmful alcohol use, unhealthy diet, physical inactivity and obesity—drive the Region’s noncommunicable disease (NCD) burden, accounting for 90% of mortality. In 2024–2025, WHO’s multisectoral risk factor action generated legislative changes, evidence breakthroughs and institutional innovations. In Estonia, WHO’s alcohol policy evaluation documented measurable mortality and life expectancy improvements while identifying remaining implementation gaps, and supported a voluntary food reformulation plan addressing child obesity (31% of schoolchildren overweight or obese). In Kazakhstan, WHO-supported advocacy produced two landmark pieces of legislation: a ban on electronic cigarettes signed by the President in April 2024, and a law banning energy drink sales to those aged under 21 years adopted in July 2024. In Latvia, WHO-supported legal reform produced a 15–20% reduction in prescription medicine costs and contributed to alcohol policy reform in a country where alcohol accounts for 18% of deaths—3.5 times the European Union (EU)-27 average.Work by the WHO Regional Office for Europe (WHO/Europe) was decisive in scale and reach: scaling the Childhood Obesity Surveillance Initiative (COSI) to compile the most comprehensive regional childhood obesity dataset; mobilizing 2 million health professionals across Europe on alcohol policy ahead of the United Nations High-level Meeting (UNHLM); launching the 20-year EU tobacco control evaluation report; developing NCD scorecards for all 53 Member States; and delivering the Data for Impact initiative quantifying the east–west NCD mortality gap. In Armenia, WHO supported enforcement of the 2020 tobacco control law through a mobile application enabling real-time violation reporting. In Belarus, WHO supported NCD prevention training and the Sustainable Development Goals (SDG) localization framework. In Croatia, COSI data directly influenced national policy on child nutrition and physical activity. In Georgia, trans-fat elimination dialogues addressed a modifiable driver of the country’s cardiovascular disease burden. In Türkiye, WHO supported urban health and tobacco control initiatives, and in the Russian Federation, WHO advanced a new screening and brief intervention model for hazardous alcohol use within primary health care. -
EU-3_Tackling Root Causes: Addressing Social Determinants of Health Across the Life Course
The social determinants of health—income, housing, education, employment, environment and access to services—generate the conditions that make disease more likely and recovery harder. In 2024–2025, WHO’s contributions addressed these structural drivers across the life course. In Estonia, WHO’s evaluation of the national alcohol policy identified positive mortality and life expectancy trends while documenting the gap to the < 8 litres per capita target. In Georgia, WHO led high-level policy dialogues on trans-fat elimination and obesity prevention, with the national noncommunicable diseases (NCD) investment case and first national obesity policy dialogue (2024) providing the evidence base for intersectoral action on cardiovascular disease—responsible for one in three deaths in a country where NCDs cost 6.16% of gross domestic product (GDP) annually. In Kazakhstan, WHO-supported advocacy led to landmark legislation banning the sale of energy drinks to those under 21, addressing data showing 40% of school-aged children consuming these products regularly. In the Russian Federation, WHO advanced healthy ageing through the WHO Global Network of Age-friendly Cities and facilitated coordination of a new national project targeting life expectancy of 78 years by 2030.For displaced populations, WHO contributed to the social determinants of migrant health through refugee health system reviews in Poland and Romania and support to long-term health inclusion in Poland. Public health work from the WHO Regional Office for Europe (WHO/Europe) advanced healthy settings and addressed commercial and environmental determinants of obesity, tobacco and alcohol harm. The WHO/Europe Data for Impact initiative quantified the social determinants dimension of NCD inequality—excess premature male mortality and the east–west disparity—through NCD scorecards for all 53 Member States. In Türkiye, WHO addressed urban health inequalities linked to air pollution, green space access and infrastructure disparities. Albania, Belarus, Bosnia and Herzegovina, Moldova, North Macedonia, Serbia, Slovakia, Slovenia and Tajikistan reported country-specific results on social determinant domains including immunization inequities, disability services, NCD burden management and conflict-related social disruption, collectively broadening the regional evidence base for social determinants action. -
EU-4_Data as a Foundation for Impact: Strengthening Health Information Systems Across the Region
Health information systems (HIS)—the infrastructure that collects, analyses and communicates health data—underpin every aspect of evidence-informed health governance. In 2024–2025, WHO supported HIS strengthening across 39 countries and divisions. In Kazakhstan, where 98.5% of providers have adopted digital solutions and 87% of government health services are electronically accessible, WHO supported a national HIS assessment and developed a strategic plan to address remaining gaps, directly informing health financing reforms and universal health coverage (UHC) monitoring. In Kyrgyzstan, WHO supported the iEmdoo immunization management system—integrated into the Tunduk national e-government platform—generating digital vaccination cards for newborns, personalized reminders and real-time data for programme managers across Bishkek’s maternity hospitals. In Romania, WHO led deployment of the Electronic Medical Record Adoption Model (EMRAM) digital maturity model across more than 200 public hospitals, establishing a national baseline for electronic medical record adoption and generating actionable digitization recommendations. In Uzbekistan, WHO supported the first country in central Asia to translate the International Classification of Diseases, Eleventh Revision (ICD-11) into its national language, enabling standardized data coding integrated with national digital systems; WHO also conducted a joint assessment of the human resources for health information system and developed an implementation plan for interoperability and governance.The WHO Regional Office for Europe (WHO/Europe) Data for Impact initiative generated noncommunicable diseases (NCD) scorecards for all 53 Member States, enabling monitoring of progress towards global NCD targets. The antimicrobial resistance (AMR) Accountability Index provided a structured data framework for tracking implementation of the AMR Roadmap in the Region. In North Macedonia, WHO strengthened interoperability between health care facilities and the national tuberculosis (TB) registry. WHO/Europe’s 24/7 surveillance function processed 224 000 pieces of information in 2025. These contributions collectively advanced the data architecture that enables WHO and Member States to make evidence-informed decisions and demonstrate accountability for health results. -
EU-4_Leading with Authority: Enhancing WHO's Governance, Partnerships and Country-Level Impact
Effective WHO leadership in the European Region requires not only technical expertise but also the political authority, institutional credibility and partnership architecture to translate normative guidance into country-level change. In 2024–2025, this leadership function was tested by a US$ 28.1 million regional salary gap—triggered by the withdrawal of the United States of America from WHO in January 2025—which compelled the WHO Regional Office for Europe (WHO/Europe) to demonstrate that it could deliver its mandate “differently with less”. Under the leadership of the Regional Director’s Division (RDD), WHO/Europe adopted the Second European Programme of Work 2026–2030—a unanimous, Member State-driven governance framework—and pursued the UN80 Initiative’s reform agenda. The Region advanced the institutional partnership model: implementing the WHO Collaborating Centre Action Plan and Knowledge Community Platform; launching the Pan-European Leadership Academy (ELA) with 14 participants from ministries of health and WHO offices; completing the independent evaluation of the Central Asia and Russian-speaking countries strategy (CARM 2022–2025); and organizing two regional Knowledge Forums on refugee health in Malta and Greece. These investments built the regional partnership architecture that is WHO/Europe’s comparative advantage.At country level, WHO offices demonstrated strong governance partnerships: in Georgia, a multi-partner European Union (EU)–WHO–United Nations Children’s Fund (UNICEF)–United Nations Population Fund (UNFPA)–United Nations Office for Project Services (UNOPS) telemedicine programme reached 60 rural ambulatories; in North Macedonia, the Ministry of Health institutional strengthening package included an action plan for organizational efficiency, new standard operating procedures (SOPs) and interoperability mapping; in Slovenia, a WHO-supported artificial intelligence (AI)-assisted national health plan assessment provided the Ministry of Health with an independent evidence base for the 2026–2036 national health plan (NHP); and in the Russian Federation, WHO maintained high-level governance engagement through the High-Level Working Group (HLWG) on human immunodeficiency virus (HIV) and strategic health communication despite a complex geopolitical environment.
