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WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ WELTGESUNDHEITSORGANISATION Date: 1 July 2025 ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ REGIONAL OFFICE FOR EUROPE Ms Helen Sõber BUREAU RÉGIONAL DE L’EUROPE REGIONALBÜRO FÜR EUROPA Adviser ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО European Union Affairs and International Co- Head office: operation Department UN City, Marmorvej 51, Ministry of Social Affairs DK-2100 Copenhagen Ø, Denmark Suur-Ameerika 1 Tel.: +45 45 33 70 00; Fax: +45 45 33 70 01 Email: [email protected] 10122 Tallinn Website: https://www.who.int/europe Estonia Our reference: Your reference: Notre référence: Votre référence: Unser Zeichen: Ihr Zeichen: См. наш номер: На Ваш номер: Dear Ms Sõber, Monitoring and Evaluation for the WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030 Currently, at least 135 million people in Europe and central Asia live with a disability. People with disabilities can often experience greater unmet healthcare needs, which can lead to detrimental effects on their well-being, as well as on health systems, in the form of worse health outcomes and unnecessarily high healthcare costs. A major advancement towards the introduction of inclusive health systems was the adoption, in September 2022, of the WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022-2030 (the Framework) by the 53 Member States of the WHO European Region (Resolution no. EUR/RC72/R3). To ensure that Member States are fully supported in their efforts to advance towards disability- inclusive health sectors, the adopted Framework (Background document EUR/RC72/BG7) requires the establishment of a Monitoring and Evaluation mechanism to assist Member States in reporting progress for the RC in 2026 (mid-point evaluation) and 2030 (final evaluation). I have pleasure in inviting you to nominate one or two representatives of your country to engage in the Monitoring and Evaluation of the WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030. Participants should be representatives from the Ministry of Health. Profiles that are particularly well suited for nomination include individuals working on disability inclusion, health equity and health for all policies, or monitoring and evaluation of health systems, or other areas where disability inclusion is actively considered. The tasks of these representatives may involve all or some of the following: 1. Fill out a short online survey (20-25 minutes) to ensure the indicators selected are relevant (Q3 2025); 2. Participate in the pilot implementation of the Monitoring and Evaluation of the WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030, which will include a survey and interviews (only a subset of participants will be required in Q4 2025); UN City, Marmorvej 51 Tel.: +45 45 33 70 00 Email: [email protected] DK-2100 Copenhagen Ø Fax: +45 45 33 70 01 Website: https://www.who.int/europe Denmark  3. Participate in one consultation event to discuss the Monitoring and Evaluation of the WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030. (Q4 2025); 4. Act as the focal point to assist in collating information as required by the Monitoring and Evaluation of the WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030 and reporting back to WHO/EURO (Q1-2 2026) for the mid-point and final evaluations, in 2026 and 2030 respectively. You or the nominated national representatives are also welcome to submit written comments on the M&E plan to [email protected] , regardless of participation in the tasks outlined above. The Monitoring and Evaluation of the WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030 will be sent in Q3 2025. Please send your nomination with the names, functional titles, and email addresses of the proposed nominee(s) at your earliest convenience, but no later than July 20th 2025, to Shirin Kiani, Technical Officer, Disability, Assistive Technology, Ear/Eye Care ([email protected]). We will then communicate with the nominees directly, sending their invitation to the virtual discussion and providing them with the draft working document. I would like to take this opportunity to thank you for the continued excellent collaboration Sincerely yours, Dr Natasha Azzopardi Muscat Director, Division of Country Health Policies and Systems Encls: Background document: The WHO European Framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030 Resolution EUR/RC72/7 Copy for information to: Ms Agne Nettan-Sepp, Head, European Union Affairs and International Co-operation Department, Ministry of Social Affairs, Suur-Ameerika 1, 10129 Tallinn, Estonia H.E. Ms Riia Salsa-Audiffren, Ambassador Representative of the Republic of Estonia, Permanent Mission of the Republic of Estonia to the United Nations Office and other international organizations in Geneva, Chemin du Petit-Saconnex 28A, CH-1209 Genève, Switzerland H.E. Mr Andre Pung, Ambassador Extraordinary and Plenipotentiary, Embassy of the Republic of Estonia, Frederiksgade 19, 4th floor, 1265 Copenhagen K, Denmark Ms Kristina Köhler, Liaison Officer, WHO Country Office, Estonia, Paldiski Road 81, 10617 Tallinn, Estonia –2– Regional Committee for Europe 72nd session Tel Aviv, Israel, 12–14 September 2022 August 2022 EUR/RC72/BG7 Original: English The WHO European Framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030 Background document • The proposed WHO European Framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030 has been developed in consultation with Member States of the WHO European Region and reaffirmed through multiple stakeholder consultations with Member States and organizations of persons with disabilities. • The framework’s objectives focus on (i) universal health coverage; (ii) the promotion of the health and well-being of persons with disabilities; (iii) the protection of persons with disabilities during public health emergencies; and (iv) the creation of an evidence base on disability and health. • This background document includes objectives, targets and specific actions for Member States, WHO/Europe and national and international stakeholders, as well as a detailed monitoring and evaluation framework, to ensure that the right to health for persons with disabilities is fully realized. • This background document is submitted for consideration by the 72nd session of the WHO Regional Committee for Europe, together with the related resolution (EUR/RC72/R3), working document (EUR/RC72/7) and information document (EUR/RC72/INF./4). Contents Overview and main elements of the framework .............................................................................. 3 Vision ................................................................................................................................................. 3 Objectives .......................................................................................................................................... 3 Approaches ....................................................................................................................................... 3 Objectives and strategic priorities ................................................................................................. 3 Objective 1. Ensure that all persons with disabilities receive quality health services on an equal basis with others ................................................................................................................................ 4 Objective 2. Promote the health and well-being of persons with disabilities ........................ 5 Objective 3. Ensure that all health policies and programming, as well as resilience- building and recovery plans during public health emergencies, are disability inclusive.... 6 Objective 4. Build an evidence base on disability and health ....................................................... 7 Implementation and governance ................................................................................................... 8 Monitoring and evaluation ........................................................................................................... 10 Implementation plan .......................................................................................................................... 11 Monitoring and evaluation framework ............................................................................................ 33 2 OVERVIEW AND MAIN ELEMENTS OF THE FRAMEWORK Vision 1. The WHO European Framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030 envisions that, by 2030, persons with disabilities will be fully included and considered in all health care planning, delivery and leadership across the WHO European Region, leading to a disability-inclusive health sector and the promotion of the health and well-being of all persons, in order to achieve the highest attainable standard of health for persons with disabilities of all ages and across all contexts in the Region. Objectives 2. The objectives of the framework are as follows: (a) Objective 1: Ensure that all persons with disabilities receive quality health services on an equal basis with others. (b) Objective 2: Promote the health and well-being of persons with disabilities. (c) Objective 3: Ensure that all health policies and programming, as well as resilience- building and recovery plans during public health emergencies, are disability inclusive. (d) Objective 4: Build an evidence base on disability and health. Approaches 3. The approaches suggested by the framework are as follows: (a) Human rights: Persons with disabilities should enjoy the same rights to health, employment, education and all other areas of life on an equal basis with others. (b) Universal design: The built environment, health care equipment and products, and all health services need to be accessible and usable by all people. (c) Life-course: The needs of persons with disabilities should be fully considered across the life course. (d) Health systems: Actions need to be developed to ensure that disability inclusivity is integrated in the six building blocks of health systems: (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to essential medicines, (v) financing, and (vi) leadership and governance. Objectives and strategic priorities 4. Given the complexity of health care and the diversity of disability, and acknowledging the huge diversity of the health landscape, including health systems, across the Region, the framework is flexible enough to be actionable across different settings, yet specific enough to monitor and measure progress and evaluate success. The following lists of targets and actions are to serve as guidelines and inspiration for action to Member States and stakeholders. 3 5. The framework consists of four objectives, aligned with the three core priorities of the European Programme of Work, 2020–2025 – “United Action for Better Health in Europe” (EPW). Each objective is accompanied by corresponding action areas, targets and indicators. The complete sets of actions for each objective are included in this background document, along with the complete monitoring and evaluation framework (with 20 indicators, accompanying measures of progress and data sources). Objective 1. Ensure that all persons with disabilities receive quality health services on an equal basis with others 6. WHO/Europe is committed to achieving universal health coverage and ensuring that people of all ages across the Region have access to health care, as outlined in the EPW. Universal health coverage includes the full spectrum of essential, quality health services from health promotion to disease prevention, treatment, rehabilitation and palliative care across the life course. The accomplishment of this objective will ensure that persons with disabilities have access to and can use affordable, timely, relevant and good-quality general and specialist health services in primary, secondary and tertiary care, including community and at-home service delivery. 7. Disability discrimination is a major impediment to achieving universal health coverage in the Region. According to Article 2 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD): 8. “Discrimination on the basis of disability” means any distinction, exclusion or restriction on the basis of disability which has the purpose or effect of impairing or nullifying the recognition, enjoyment or exercise, on an equal basis with others, of all human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field. It includes all forms of discrimination, including denial of reasonable accommodation. 9. In health care, disability discrimination can take many forms and can refer to policies, attitudes and/or systems that directly or indirectly disadvantage persons with disabilities. It is exemplified by compromised accessibility of health services, increased barriers to access and use of services, and a disregard for the fundamental right to health care and for the autonomy of persons with disabilities. Strategic priorities for Objective 1 10. The strategic priorities for Objective 1 are as follows: (a) Ensure that persons with disabilities and their families are treated with respect and dignity, and that they are fully informed and empowered (including legally) to consent before any decisions about their health are taken. (b) Eliminate disability discrimination by removing all barriers to access and use of health care services across the life course and provide reasonable accommodations when needed. (c) Strengthen health systems to deliver or coordinate rehabilitation, habilitation, assistive technology, assistance and support services (including peer support), and community-based rehabilitation. 4 (d) Develop and/or reform health and disability laws, policies, strategies and plans for consistency with the UNCRPD. Targets for Objective 1 11. The targets for Objective 1 are as follows: (a) Target 1.1. By 2030, ensure that health care services are accessible (b) Target 1.2. By 2030, ensure that the right of persons with disabilities to health care is fully protected (c) Target 1.3. By 2030, ensure that all persons with disabilities are fully covered by health insurance (d) Target 1.4. By 2030, ensure that all persons with disabilities have access to the full range of appropriate rehabilitation, habilitation, assistive technology, assistance and support services and community-based rehabilitation (e) Target 1.5. By 2030, eliminate direct and indirect costs that negatively affect access to health care Objective 2. Promote the health and well-being of persons with disabilities 12. Ensuring good health and well-being throughout the life course is essential for sustainable development and the building of prosperous societies. Studies have shown that wider health determinants – among others, poverty, inequality, life-course events, the built environment and public policies – shape not only people’s health but also their ability and resilience in facing health problems and seeking and accessing appropriate health care services. Well-being is generally associated with good health and the availability of and access to basic resources, and it is dependent on economic, social, gender, political, behavioural and environmental determinants. Good community support networks (including family members, next of kin and/or carers) are also essential, as they provide support for persons with disabilities across the life course. 13. Evidence has shown that persons with disabilities are disadvantaged in accessing and using health care services and public health interventions and are at higher risk of poor health outcomes, such as obesity, hypertension, fall-related injuries, and mood disorders, including depression. The COVID-19 pandemic has exacerbated such inequities, with persons with disabilities experiencing a higher risk of morbidity and mortality, as well as a higher risk of poor mental health status. 14. It is therefore essential to ensure that all interventions aimed at promoting health and well-being are disability inclusive to address inequities in health outcomes and improve quality of life for persons with disabilities. At the individual level, public health programmes need to address risk factors for health – such as tobacco use, substance misuse and abuse and unhealthy eating habits – and promote health literacy and healthy behaviour, including physical activity and preventive health examinations, as well as access to personal hygiene and devices to support it. At a community and societal level, interventions need to address economic, social, political and environmental factors that can have a direct impact on all aspects of life, including health and well-being. A Health-in-all-policies approach is needed. To realize this, intersectoral and multisectoral action – involving different disciplines and 5 sectors, such as public health, housing, childcare, education, infrastructure and transport, as well as partners operating at multiple levels, including state, local and community levels – is needed to achieve health equity, foster social justice and promote the health and well-being of persons with disabilities. Strategic priorities for Objective 2 15. The strategic priorities for Objective 2 are as follows: (a) Adopt an intersectoral and multisectoral approach to health that addresses social determinants of health, and promote healthy living and disability-inclusive living environments. (b) Introduce and promote programmes, initiatives and health care services – including preventive health examinations, sexual and reproductive care, and mental health services – that promote the health and well-being of persons with disabilities. (c) Address the health needs of persons with disabilities, across the life course and in all contexts, resulting from segregation and institutionalization, from neglect and abuse, and from violence, including physical, psychological and sexual violence. Targets for Objective 2 16. The targets for Objective 2 are as follows: (a) Target 2.1. By 2030, ensure that persons with disabilities have access to preventive health examinations (b) Target 2.2. By 2030, ensure that persons with disabilities have access to sexual and reproductive health care services, including family planning, information and education (c) Target 2.3. By 2030, substantially strengthen intersectoral action for health (d) Target 2.4. By 2030, reduce risks and threats to the health and well-being of persons with disabilities and offer protection from neglect, abuse and/or violence Objective 3. Ensure that all health policies and programming, as well as resilience-building and recovery plans during public health emergencies, are disability inclusive 17. The term “health emergencies” refers to a wide range of events, including pandemics, conflicts, and economic or other types of crises, such as climate change, that can pose a significant risk to people’s health. Health emergencies have a significant impact on persons with disabilities. Persons with disabilities often experience structural disadvantage and are thus more vulnerable than persons without disabilities to the effects of such emergencies. Vulnerability is not an inherent characteristic of people but rather, according to the Hyogo Framework for Action 2005–2015, can be defined as “the conditions determined by physical, social, economic and environmental factors or processes, which increase the susceptibility of a community to the impact of hazards”. Individuals experience health 6 emergencies in different ways, depending on their specific vantage point and the resources they have access to within a larger social and cultural context. 18. Health emergencies exacerbate existing health inequities experienced by persons with disabilities and create new ones. Persons with disabilities can be particularly exposed to the risks of health emergencies, and to measures taken to address them, as observed during the COVID-19 pandemic. Health emergencies, such as pandemics, can have an impact on health workforce issues, on the accessibility of health-related information and health promotion programmes, on access to health services and interventions, and on the coordination of health care across sectors. Interrupted access to health care and to social support, as well as lack of emergency deinstitutionalization or accessible evacuation shelters, and communication during health emergencies can have a negative impact on the health and well-being of persons with disabilities. The UNCRPD needs to be upheld during health emergencies and to be seen as an integral element of the health emergency response. Disability-inclusive emergency response is closely linked to the strengthening of health systems. Strategic priorities for Objective 3 19. The strategic priorities for Objective 3 are as follows: (a) Strengthen health systems so that they are resilient to health emergencies. (b) Ensure that risk, disaster and emergency management fully addresses the needs of persons with disabilities so that they are fully protected during health emergencies. (c) Address the conditions, including those related to information, communication, segregation, physical environment and economic factors, that make persons with disabilities more vulnerable to the effects of health emergencies. Targets for Objective 3 20. The targets for Objective 3 are as follows: (a) Target 3.1. By 2030, strengthen or develop leadership and governance for disability- inclusive health emergency response (b) Target 3.2. By 2030, ensure that all health emergency policies, initiatives, strategies and programmes are disability inclusive Objective 4. Build an evidence base on disability and health 21. Data collection contributes to national, regional and global development efforts and poverty alleviation, as it provides the basis for decision-making and policy implementation. The availability of reliable data is crucial for monitoring progress, evaluating measures and promoting disability inclusion. Evidence-based disability research is also essential for strengthening health systems to include and address the needs of persons with disabilities. 22. However, international and national data-collection systems often do not collect data on disability, a fact that has become even more evident during the COVID-19 pandemic. Also, where available, disability-disaggregated data are not usually internationally comparable, as indicators may use the term “disability” in a variety of ways, leading to 7 problems of data consistency and cross-country comparisons. Research in key priority areas, such as unmet needs for health care services, barriers to service delivery and level of health outcomes, including in rehabilitation, is further hindered by either a complete lack of data or a lack of good-quality and accessible data. As a result, disability research is relatively scarce, with great variability among Member States. 23. To ensure that persons with disabilities in the Region are not left behind, it is important to ensure the availability of accurate, relevant and internationally comparable disability-disaggregated data on health, produced through a variety of research designs and with an emphasis on participatory methods. Evidence-based disability research in key health priority areas can serve as the basis for eliminating disability discrimination, promoting disability inclusiveness in health care and health care systems, and adopting equitable and effective health policies across the Region. Strategic priorities for Objective 4 24. The strategic priorities for Objective 4 are as follows: (a) Ensure the collection of reliable disability-disaggregated data within national health information systems. (b) Ensure that data in censuses, population surveys and national health surveys are disaggregated by disability in order to be able to obtain reliable information on the socioeconomic status and health of persons with disabilities. (c) Support research that seeks to address and eliminate disability discrimination and empower persons with disabilities. (d) Support disability research by increasing funding, adopting a multidisciplinary approach and actively involving persons with disabilities and their organizations. Targets for Objective 4 25. The targets for Objective 4 are as follows: (a) Target 4.1. By 2030, ensure the collection of relevant, standardized and internationally comparable data on disability (b) Target 4.2. By 2030, strengthen disability research Implementation and governance 26. Effective implementation at the national level will require strong political commitment to work towards a disability-inclusive health sector, including resource allocation, funding mechanisms, inclusion of persons with disabilities in all processes and the elaboration of detailed and measurable actions at all levels, from policy to service delivery, in order to reach national and regional targets. Implementation of the framework will also require solid partnerships between organizations of persons with disabilities, Member States, WHO/Europe, academia, and national and international organizations, including the European Disability Forum, at the subregional and national level. 8 27. Effective implementation of the framework will be through national disability- inclusion action plans, with clear strategies and mechanisms to accomplish national and regional targets. National action plans, which will include clearly defined priority actions, timelines and resources, will be elaborated with the support of national, regional and international stakeholders, assisted by WHO/Europe. WHO/Europe will support Member States in the development and implementation of national action plans that will promote disability-inclusive health policies (or in their further development, for Member States that have already established relevant action plans), with the aim of combating exclusion, promoting the rights of persons with disabilities, building resilient health systems and, ultimately, building healthier populations in the Region. 28. For the successful delivery of the framework, Member States will need to: (a) recognize the health inequities experienced by persons with disabilities; (b) include persons with disabilities and their organizations in all processes and decision- making; and (c) act, in partnership with persons with disabilities and their organizations, to implement the actions in this framework. 29. Actions are broadly divided into core strategic-level actions and operational-level actions, informed by a primary health approach. Core strategic-level actions refer to high- level actions and include governance, leadership, funding and community engagement. Operational-level actions refer to on-the-ground actions that support the strategic actions and include health care practices, training and accommodations. 30. As Member States demonstrate great variability in terms of their health care systems, policy frameworks and health sector infrastructure (including governance and leadership, and operational-level infrastructure), the exact prioritization of the actions in this framework needs to be decided by each Member State, in consultation with persons with disabilities and their representative organizations. Organizations of persons with disabilities will play a key role in the implementation of targets and indicators and in the achievement of the goals of the framework, as they will work closely with Member States to protect the rights of persons with disabilities and to promote their inclusion and empowerment. 31. It is recommended that core strategic-level actions are implemented first to establish a robust policy framework, appropriate governance and leadership infrastructure and the availability of funding mechanisms. The elaboration of these actions, in close partnership with persons with disabilities and their representative organizations, will also lead to capacity-building in preparation for the operational-level actions. 32. The implementation of the framework will be overseen by the WHO Regional Committee for Europe through consultations with an ad hoc a high-level advisory group of independent experts from various domains, which will: (a) advise Member States on implementation and offer technical assistance on the establishment of their own monitoring and evaluation framework at national and subnational levels; (b) advocate for political commitment and allocation of adequate financial resources to strengthen and sustain disability-inclusive health care across Member States; and (c) report to the WHO Regional Director for Europe at regular intervals regarding progress towards meeting the targets at the regional and subregional levels. 9 Monitoring and evaluation 33. Targets and indicators of success will act as measures of progress and drivers for policy action. The indicators are part of established international data collection, where possible, to reduce reporting burden. The targets and the indicators are aligned primarily with or developed through the following: (a) The EPW Measurement Framework, from which relevant indicators have been adapted to address disability specifically. This ensures alignment with programmatic work by WHO/Europe, not only helping to mainstream disability inclusion in health care, but also raising awareness of the needs of a substantial part of the population of the Region. (b) The WHO Global report on health equity for persons with disabilities (as decided by resolution WHA74.8 on the highest attainable standard of health for persons with disabilities, to be launched in December 2022), from which targets and indicators relevant to the European Region have been selected, and the WHO Global Disability Action Plan 2014–2021, which has been used to identify targets and indicators that are still relevant. This ensures that previous work is used and built on, where relevant. (c) The elaboration of indicators relevant to the Region and to disability from appropriate Sustainable Development Goals (SDGs) (specifically SDG 3, SDG 5, SDG 16 and SDG 17), the WHO Global Reference List of 100 Core Health Indicators (2018), the UNCRPD, and the Action Plan for the Prevention and Control of Noncommunicable Diseases in the WHO European Region 2016-2025, to ensure the framework can directly contribute to the 2030 Agenda for Sustainable Development. (d) The elaboration of new targets and indicators not included in the documents mentioned in (a), (b) and (c) above, or for which adequate data may not currently exist but which are nonetheless important. These targets and indicators need to be part of the agenda for WHO/Europe and Member States in the Region to be developed further in time for the midterm evaluation and to ensure that any existing data gaps are bridged. 34. Evaluation will require robust disability-disaggregated data. WHO/Europe will offer technical support at the national level and at the subregional level in liaison with the Central Asian Republics Information Network and the European Health Information Initiative. WHO/Europe will also support Member States’ national statistical offices in developing or strengthening their data-collection mechanisms to include disability. 35. Member States will prepare a midterm (2026) and a final (2030) monitoring report. WHO/Europe will prepare a midterm report (including a mapping exercise and relevant case studies) to be submitted to the 76th session of the Regional Committee (2026), with a final report planned for submission at the 80th session (2030). 10 IMPLEMENTATION PLAN Objective 1. Ensure that all persons with disabilities receive quality health services on an equal basis with others Proposed actions for Proposed actions for international Actions Level Proposed actions for Member States WHO/Europe and national partners Target 1.1. By 2030, ensure that health care services are accessible Develop leadership and Core strategic- • Identify focal points for disability • Provide support for • Provide support for Ministries of governance for disability- level within Ministries of Health and Member States to develop Health to build their leadership inclusive health formulate internal action plans and implement a training capacity for ensuring disability- that support inclusion and access package on disability inclusive health services. to mainstream health care inclusion in the health • Capacity-building for services. The focal points should sector organizations of persons with also oversee coordination with • Host regional workshops, disabilities to participate other sectors when it comes to integrated with effectively in health-service public health initiatives. ongoing/related initiatives governance. • Ensure participation of organizations for health ministry staff, of persons with disabilities in health policy-makers and policy-making and quality assurance representatives of processes. organizations of persons with disabilities on universal health coverage and equity, drawing on country experience. Operational- • Establish an independent level oversight agency to monitor disability inclusion in the health sector. Remove barriers to Core strategic- • Adopt national accessibility • Facilitate the exchange of service delivery level standards, including facilities, best practice on accessible (including impediments information and digital health services. to physical access, environment, and ensure • Provide technical guidance information and compliance with them. to support the inclusion of communication, and persons with disabilities in 11  Proposed actions for Proposed actions for international Actions Level Proposed actions for Member States WHO/Europe and national partners coordination) across all • Support mechanisms to improve public health policies, health care programmes, the continuum of care strategies and programmes. including those on sexual experienced by persons with and reproductive health, disabilities across the life course, mental health, health including discharge planning, promotion and other multidisciplinary teamwork, population-based public development of referral health initiatives pathways and service directories, and coordination between health and social care services. • Support and strengthen the availability and affordability of appropriate general and disability-related health services based on solid and reliable scientific data. • Provide and/or increase funding to accommodate increased expenditure aimed at removing barriers to service delivery. Operational- • Implement the principles of • Support the • Support user groups to audit level universal design so that all built identification of barriers disability inclusiveness in the environments, health care to particular services health sector to identify equipment and products, and through technical barriers and enablers for services (both existing and new) support for collecting persons with disabilities in are accessible. Universal design disability-disaggregated accessing health services. extends to water/hygiene points data on use of services. • Support health literacy for and toilets appropriately • Develop guidelines on persons with disabilities, designed and maintained. accessible telehealth. especially at the community • Provide a range of • Provide expertise and level. accommodation measures to technical guidance for • Provide training and guidance access health services, including Member States on the for relevant authorities and structural modifications to strengthening of sexual health professionals on the facilities, adjustments to and reproductive health, development of mental health appointment systems, alternative mental health and health 12  Proposed actions for Proposed actions for international Actions Level Proposed actions for Member States WHO/Europe and national partners models of service delivery and promotion services services for persons with communication of information in targeted towards disabilities. appropriate formats, such as sign persons with disabilities. • Take measures to mainstream language, Braille, large print, Easy disability inclusion in health Read and pictorial information. care and in the coordination of • Provide health services via health care across sectors, and telehealth which address barriers the accessibility of health- related to the digital divide to related information, health promote equitable participation. promotion programmes, and • Ensure that websites from health services and Ministries of Health, public health interventions. bodies and health care providers conform to the Web Accessibility Initiative (WAI), by the World Wide Web Consortium. • Support and strengthen the availability and affordability of appropriate, safe, effective and high-quality mental health services for persons with disabilities by increasing funding and investment in mental health care and retaining appropriately trained health personnel. • Support high and equitable immunization coverage for persons with disabilities throughout the life course and in all contexts. Include training on Core strategic- • Include disability awareness as a • Build understanding and • Provide funding or in-kind disability-inclusive health level required competency for all services promote the importance contribution for curriculum care in health care in the health sector. and inclusion of disability development. educational curriculums issues (including rights) in health care curriculums. 13  Proposed actions for Proposed actions for international Actions Level Proposed actions for Member States WHO/Europe and national partners Operational- • Collaboration with the higher • Design model • Ensure persons with disabilities level education sector to ensure curriculums on disability are involved as designers and disability training is included in for health care providers of education and curriculums and continuing professionals. training, where relevant. professional development for all • Provide technical support • Provide opportunities for persons personnel in the health sector. for Member States with disabilities to develop self- • Ensure training programmes for seeking to implement advocacy skills to effectively health and social care professionals model curriculums on address specific challenges in at all levels are accessible to disability and health. accessing health services. persons with disabilities. • Share examples of good • Implement measures to improve practices and case recruitment and retention of studies. appropriately trained health personnel, particularly in rural and remote areas Target 1.2. By 2030, ensure that the right of persons with disabilities to health care is fully protected Develop and/or reform Core • Review, amend or develop • Develop guidelines on • Support opportunities for health and disability strategic- national and subnational health- disability-inclusive health exchange on effective policies laws, policies, strategies level related legislation to ensure systems strengthening to to promote the health of and plans for consistency compliance with the UNCRPD. help achieve universal persons with disabilities. with the principles of the • Eliminate discriminatory provisions coverage. • Facilitate the participation of UNCRPD in existing policies and legislation. • Provide technical support relevant national bodies, • Develop laws or directives requiring and build capacity within including organizations of full information and consent by Ministries of Health and persons with disabilities and persons with disabilities or their other relevant sectors for other civil society entities, in carers before any health care the development, reforming health and disability interventions. implementation and laws, policies, strategies and • Develop laws or directives requiring monitoring of laws, plans. participation of children with policies, strategies and disabilities in decisions on medical plans ensuring health in procedures and other healthcare all policies. issues that affect them in accordance with their age and maturity and with provision of age- 14  Proposed actions for Proposed actions for international Actions Level Proposed actions for Member States WHO/Europe and national partners appropriate and disability-related supports. • Mobilize the health sector to contribute to the development of a multisectoral national disability strategy and action plan that ensures clear lines of responsibility and mechanisms for coordination, monitoring and reporting. • Promote people-centred health services and the active involvement of persons with disabilities and organizations of persons with disabilities throughout the process. Operational- • Provide health-sector support for level monitoring and evaluating the implementation of health policies’ compliance with the UNCRPD. Target 1.3. By 2030, ensure that all persons with disabilities are fully covered by health insurance Introduce or review Core strategic- • Review and amend existing • Offer technical expertise on • Disseminate information on legislation ensuring level legislation or introduce new providing health insurance available health insurance and that persons with legislation to prohibit insurers from or social protection for social protection options and the disabilities, in all discrimination against persons with persons with disabilities, rights of persons with disabilities. contexts, are fully disabilities. including those covered by health • Introduce legislation where all experiencing multiple insurance or people, independent of age, sex, disadvantages. appropriate social disability, etc., are fully covered protection by health insurance and/or mechanisms appropriate social protection mechanisms. Target 1.4. By 2030, ensure that all persons with disabilities have access to the full range of appropriate rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabilitation Provide leadership and Core • Introduce, develop or revise • Provide technical • Participate directly in the governance for strategic- legislation, policies and standards guidance, training and development and/or developing and level for rehabilitation, habilitation, capacity-building in strengthening of legislation, 15  Proposed actions for Proposed actions for international Actions Level Proposed actions for Member States WHO/Europe and national partners strengthening policies, assistive technology, support and Ministries of Health and policies, strategies, plans and strategies and plans on assistance services and other relevant sectors for programmes related to habilitation, community-based rehabilitation the development, health services, and to rehabilitation, assistive across the continuum of care, implementation, include persons with technology, support and covering primary (including monitoring and disabilities, through their assistance services, community), secondary and evaluation of legislation, representative organizations community-based tertiary levels of the health care policies, strategies, plans in this work. rehabilitation, and system. and programmes. • Provide technical related strategies • Integrate rehabilitation and guidance, training and habilitation services within support to Member States existing health, social and that are introducing educational infrastructures. and/or expanding rehabilitation and habilitation services. Operational- • Undertake situation analyses to • Organize regional events • Support persons with level inform policies and planning. on developing and/or disabilities in accessing • Raise awareness about strengthening action information on rehabilitation rehabilitation and habilitation, plans on rehabilitation as and habilitation services, and and devise mechanisms for part of health systems. community-based national sector planning, rehabilitation. coordination and financing. Provide adequate Core • Provide adequate financial • Provide, in collaboration • Advocate for increased financial resources to strategic- resources to ensure the provision with other relevant resource allocation for ensure the provision of level of appropriate habilitation and agencies, evidence-based rehabilitation. appropriate habilitation rehabilitation services, and guidance for Ministries of • Provide financial support and rehabilitation assistive technologies, including Health, other relevant through international services, as well as any adaptations necessary to sectors and stakeholders cooperation, including in public assistive technologies address access barriers. on appropriate funding health emergencies. mechanisms for rehabilitation. Develop and maintain a Core • Formulate and implement • Provide technical support • Build training capacity in sustainable workforce for strategic- national health, rehabilitation for supporting Ministries accordance with national rehabilitation and level and habilitation plans to increase of Health, other relevant health, rehabilitation and the numbers and capacity of sectors and stakeholders habilitation plans. to build the capacity of 16  Proposed actions for Proposed actions for international Actions Level Proposed actions for Member States WHO/Europe and national partners habilitation, as part of a human resources for training providers and broader health strategy rehabilitation. develop standards for • Produce national standards in training. training for different types and levels of rehabilitation and habilitation personnel that can enable career development and continuing education. Operational- • Improve working conditions, • Provide evidence-based level remuneration and career guidelines for Ministries opportunities to attract and of Health and other retain rehabilitation and relevant sectors on the habilitation personnel. recruitment, training and • Ensure training programmes for retention of health care professionals at all rehabilitation personnel. levels are accessible to persons with disabilities. Expand and strengthen Core • Review existing rehabilitation and • Support Member States • Work with Ministries of Health rehabilitation and strategic- habilitation programmes and in integrating to expand and strengthen the habilitation services, level services and make necessary rehabilitation and provision of rehabilitation and ensuring (a) integration changes to improve coverage, habilitation services into habilitation services in line across the continuum of effectiveness and efficiency. the health system with a with national plans. care, covering primary • Ensure equitable access to focus on decentralization • Work with relevant (including community), rehabilitation through health and of services at the stakeholders to establish and secondary and tertiary social insurance coverage. primary/community streamline referral systems to levels of the health care level. ensure that persons with system, and (b) equitable disabilities have access to the access, including timely modes of service delivery they early intervention require at each level of the services for children with health system and throughout disabilities their life course. Operational- • Integrate rehabilitation and • Develop relevant tools • Support the development of level habilitation services within and training packages to community-based existing health, social and develop and strengthen rehabilitation programmes. educational infrastructure. habilitation and 17  Proposed actions for Proposed actions for international Actions Level Proposed actions for Member States WHO/Europe and national partners • Establish mechanisms for rehabilitation services effective coordination between throughout the life different rehabilitation and course, including children habilitation service providers and and older adults. levels of the health care system. • Use community-based rehabilitation as a strategy to complement and strengthen existing rehabilitation and habilitation service provision, particularly in Member States where few services are available. • Introduce and/or strengthen early assessment, timely intervention and other services for all (including children and older adults with disabilities), and ensure coordination between responsible agencies. Make available Core • Include the provision of assistive • Prepare and disseminate • Provide technical and financial appropriate assistive strategic- technologies in health, evidence-based guidance support for Member States to technologies that are level rehabilitation, habilitation and on the provision and use build capacity to develop and safe, good quality and other relevant sectoral policies, of assistive technologies. strengthen provision of affordable strategies and plans, with • Provide technical support assistive technologies. accompanying necessary for Member States to • Advocate the development of budgetary support. build capacity to develop policy frameworks to ensure • Define standards for assistive and strengthen provision the effective provision of technology provision. and use of assistive assistance and support • Design a range of financing technologies. services. mechanisms and programmes, such as rental systems. Operational- • Strengthen referral mechanisms level between rehabilitation and habilitation services, and assistance and support services. 18  Proposed actions for Proposed actions for international Actions Level Proposed actions for Member States WHO/Europe and national partners Engage, support and Core • Include persons with disabilities, • Promote awareness and • Advocate the inclusion of build the capacity of strategic- their family members and/or understanding of the persons with disabilities, their persons with disabilities level informal carers in all aspects of rights of persons with families and/or carers in all and their family developing and strengthening disabilities and the role aspects of developing and members and/or rehabilitation, habilitation, of families and/or strengthening rehabilitation informal carers to support and assistance services. informal carers. and habilitation services. support independent • Ensure informal carers are • Advocate the importance of living and full inclusion in appropriately protected and informal carers in the lives of the community supported through capacity persons with disabilities, and building, training and financial the importance of promoting support. their health and well-being. • Provide training and support for community workers and informal carers who assist persons with disabilities in accessing health services. Operational- • Collaborate with other sectors • Maintain and strengthen • Invest in a range of targeted level besides the health sector to partnerships with support for persons with ensure appropriate support organizations and disabilities, including accessible (including training, financial associations representing information, training, support and respite care) is persons with disabilities, empowerment and peer provided for informal carers, the their family members support. majority of whom are women. and/or carers. Target 1.5. By 2030, eliminate direct and indirect costs that negatively affect access to health care Remove barriers to Core • Allocate adequate resources to • Provide technical support • Provide guidance for Member financing and strategic- ensure disability-inclusive health. to Member States for the States in establishing and affordability through level • Ensure that financing schemes for development of health maintaining nationally defined options and measures to national health care include financing measures that social protection floors. ensure that persons with minimum packages and poverty increase access and disabilities can afford and social protection measures affordability of all and receive the health that target and meet the health general and condition- care they need without care needs of persons with specific health services. impoverishing and disabilities, and that information about the schemes reach persons 19  Proposed actions for Proposed actions for international Actions Level Proposed actions for Member States WHO/Europe and national partners catastrophic with disabilities via accessible expenditures formats. Operational- • Reduce or remove out-of-pocket • Support persons with level payments for persons with disabilities in accessing disabilities who have limited information on health care means of paying (directly or financing options. indirectly) for health care. • Promote multisectoral approaches to meeting the indirect costs related to accessing health care (e.g., transport). • Where private health insurance exists, ensure that it is affordable and accessible for persons with disabilities and that any discriminatory practices are prohibited. 20 Objective 2. Promote the health and well-being of persons with disabilities Proposed actions for Proposed actions for Member Proposed actions for Actions Level international and national States WHO/Europe partners Target 2.1. By 2030, ensure that persons with disabilities have access to preventive health examinations Introduce evidence- Core • Provide adequate financial • Provide technical • Provide, in collaboration with based screening strategic- resources to ensure the provision guidance to support the other relevant agencies, programmes and level of screening programmes. inclusion of persons with evidence-based guidance for services that are • Promote equitable access to disabilities in preventive Ministries of Health, other disability-inclusive preventive health examinations health programmes, relevant sectors and through health and social services and initiatives. stakeholders on preventive insurance coverage. • Organize regional events health services for persons with on developing and/or disabilities. strengthening action plans on disability- inclusive preventive health examinations. Operational- • Introduce, develop or strengthen • Identify barriers to • Provide information and level evidence-based, population- preventive health guidance for persons with based and quality-assured services through disabilities regarding disability-inclusive screening technical support for preventive health services and programmes. collecting disability- initiatives. • Provide adequate modifications disaggregated data on to equipment, built environment use of services. and products for persons with disabilities to be able to participate in examinations. • Ensure effective, appropriate and rapid referral, diagnostic and treatment pathways for management of those detected. Provide disability- Core • Establish educational • Provide technical • Produce training standards for inclusive health care strategic- competencies required for guidance on disability- health personnel involved in training and level disability-inclusive health care inclusive health care preventive health services for specialized training for and incorporate them in training. persons with disabilities, in health professionals collaboration with 21  Proposed actions for Proposed actions for Member Proposed actions for Actions Level international and national States WHO/Europe partners educational requirements for organizations of persons with health care professionals. disabilities. Operational- • Provide training on disability- • Promote best practice • Provide financial or in-kind level inclusive health care for health regarding disability- support for the development professionals and all workers in inclusive health care and provision of training on the health sector. training. disability-inclusive health care. • Ensure clinical competencies in early diagnosis and management by providing specialized training. • Raise awareness of the risk factors, early signs and symptoms of breast, cervical and colorectal cancers among health professionals and the general public to avoid diagnostic overshadowing (i.e., attributing cancer symptoms to disability- related conditions or symptoms). Target 2.2. By 2030, ensure that persons with disabilities have access to sexual and reproductive health care services, including family planning, information and education Introduce, strengthen Core • Introduce, develop or revise • Provide evidence-based • Advocate national leadership and promote sexual strategic- legislation, policies and guidance for Ministries for increased resource and reproductive level programmes on sexual and of Health, other relevant allocation for sexual and health care services, reproductive health, including sectors and stakeholders reproductive health initiatives including health health education. on the elaboration and and services. education, for persons • Provide adequate financial strengthening of sexual • Provide evidence-based with disabilities resources to ensure the provision and reproductive health guidance for Ministries of of sexual and reproductive health initiatives and services, Health, other relevant sectors initiatives and services, including including health and stakeholders regarding health education. education. accessibility and possible • Provide technical barriers to accessing sexual and guidance to support the reproductive health services. inclusion of persons with 22  Proposed actions for Proposed actions for Member Proposed actions for Actions Level international and national States WHO/Europe partners disabilities in sexual and reproductive health programmes, services and initiatives. Operational- • Remove barriers to service • Produce training standards for level access and delivery (including health personnel involved in impediments to physical access, sexual and reproductive health transportation, information and initiatives for persons with communication, and disabilities. coordination) across all sexual • Provide information and peer and reproductive health services, support for persons with health promotion and other disabilities regarding sexual population-based public health and reproductive health initiatives. initiatives and services, • Promote equitable access to including health education. sexual and reproductive health initiatives and services through health and social insurance coverage. Target 2.3. By 2030, substantially strengthen intersectoral action for health Introduce, strengthen Core • Adopt intersectoral policies on • Provide technical • Provide guidance for Member and promote strategic- health through interventions guidance to support States and other stakeholders intersectoral level involving organizations of health and other on the development of approaches to health persons with disabilities and ministries and disability-inclusive living different Ministries and departments into environments. departments, such as adopting an intersectoral Infrastructure, Housing, Social and multisectoral Affairs, Sports, Health, approach to health. Environment, Transport, Urban • Publish and disseminate Planning and city or municipal research results on councils. intersectoral approaches • Ensure the Ministry of Health to health. assumes its stewardship role in any cross-sectoral coordination 23  Proposed actions for Proposed actions for Member Proposed actions for Actions Level international and national States WHO/Europe partners regarding public health interventions. • Promote the deinstitutionalization of persons with disabilities, independent living in the community and disability-inclusive living environments. Operational- • Integrate broad or specific health • Engage with relevant level priorities into other sectors’ ministries, departments and policy processes. other stakeholders and assist in • Involve persons with disabilities the elaboration, monitoring and their organizations in the and evaluation of disability- development, monitoring and inclusive intersectoral policies evaluation of intersectoral on health. policies on health. • Integrate any health data collected or disaggregated by disability from other sectors into the health information system. Target 2.4. By 2030, reduce risks and threats to the health and well-being of persons with disabilities and offer protection from neglect, abuse and/or violence Introduce, develop Core • Introduce fiscal policies, • Elaborate and • Provide, in collaboration with and promote strategic- programmes and initiatives disseminate evidence- other relevant agencies, disability-inclusive level making healthy food and food based guidelines on evidence-based guidance for well-being activities supplements more affordable for disability-inclusive Ministries of Health, other related to physical persons with disabilities, preventive health relevant sectors and and mental health including people living with measures. stakeholders on preventive chronic illnesses. • Ensure that all health health initiatives that promote • Use fiscal policies and marketing promotion and the health and well-being of controls to influence demand, prevention guidance is persons with disabilities. access and affordability for disability inclusive. • Provide funding or in-kind tobacco, alcohol and foods and support for the development of drinks high in saturated fats, disability-inclusive sports and trans fats, salt and sugar. leisure facilities. 24  Proposed actions for Proposed actions for Member Proposed actions for Actions Level international and national States WHO/Europe partners Operational- • Introduce, develop and promote • Provide technical • Provide information, training level disability-inclusive well-being guidance on disability- and peer support for persons initiatives, including programmes inclusive environmental with disabilities to promote regarding good nutrition, modifications that their health and well-being, exercise and good mental well- facilitate healthy including mental health. being for all age groups. behaviour and active • Provide training, guidance and • Introduce and/or extend living, such as walking peer-support to family programmes and initiatives and cycling for transport. members and/or carers to aimed at preventing substance improve the physical and abuse, tobacco use and excessive mental well-being of persons alcohol consumption. with disabilities. • Promote physical activity at all ages by focusing on the planning and design of disability-inclusive community environments, sports and leisure centres and transport infrastructure. • Develop and strengthen mental health programmes, including prevention, treatment and rehabilitation, by providing funding and appropriate training to health care personnel. • Increase the number of health and social care workers (especially in the community) that can assist persons with disabilities in living independently and improve their physical and mental well-being, and invest in the development of this workforce. 25  Proposed actions for Proposed actions for Member Proposed actions for Actions Level international and national States WHO/Europe partners Introduce and/or Core • Introduce and/or strengthen • Support Member States • Engage in promoting the rights strengthen relevant strategic- legislation and policies that in aligning legislation of persons with disabilities, legislation and level protect persons with disabilities with the WHO Quality especially those with programmes aimed at from neglect, abuse, violence Rights approach. psychosocial, intellectual or protecting persons with and/or institutionalization and cognitive disabilities, and disabilities against segregation, paying particular improve the quality of services neglect, abuse and/or attention to the intersections and support provided, in line violence with vulnerability (due to with international human rights gender, age or other standards, particularly the characteristics) and ensuring all UNCRPD. persons with disabilities are adequately protected. • Initiate, promote and/or sustain de-institutionalization and transform communities for inclusion. Operational- • Provide emotional, psychological • Provide evidence-based • Provide support for persons level and legal support and guidelines for health and with disabilities who have been appropriate physical health social care professionals abused or exposed to physical, services for persons with on how to detect psychological or sexual disabilities who have been neglect, maltreatment, violence. institutionalised, segregated, abuse or violence against • Train health personnel to neglected and/or abused. persons with disabilities recognize early signs of abuse • Provide training for front-line across the life course and violence of persons with health workers in identifying and in all contexts. disabilities, and to take neglect, abuse and violence • Provide evidence-based appropriate measures. against persons with disabilities. guidelines on preventive measures to protect persons with disabilities across the life course and in all contexts from neglect, abuse and physical, psychological or sexual violence. 26 Objective 3. Ensure that all health policies and programming, as well as resilience-building and recovery plans during public health emergencies, are disability inclusive Proposed actions for Proposed actions for international Actions Level Proposed actions for Member States WHO/Europe and national partners Target 3.1. By 2030, strengthen or develop leadership and governance for disability-inclusive health emergency response Ensure appropriate Core • Ensure that the UNCRPD is upheld • Provide technical guidance • Provide guidance for relevant leadership for disability- strategic-level during health emergencies. to support the authorities and health inclusive health • Strengthen the health sector to development of disability- professionals on the development emergency response, ensure resilience during health inclusive health emergency of disability-inclusive health with active involvement emergencies. response, with a focus on emergency policies, initiatives, of persons with • Develop appropriate leadership and appropriate leadership and strategies and programmes. disabilities and their governance mechanisms (including governance mechanisms. organizations decision-making infrastructure and • Provide technical guidance policy framework) with one agency to support the inclusion of having an overall coordinating role. persons with disabilities • Develop a disability-inclusive “build and their organizations in back better” approach to recovery health emergency policies, and reconstruction. initiatives, strategies and • Actively involve persons with programmes. disabilities, carers and their organizations in the elaboration and evaluation of health emergency policies and programmes. Operational- • Provide appropriate training for • Provide technical guidance • Provide financial or in-kind level health officials, practitioners and to support training on support for the development of policy-makers on disability-inclusive disability-inclusive health training on disability-inclusive health emergency policies, emergency policies, health emergency policies, programmes, plans and actions. programmes, plans and programmes, plans and actions. actions, including in the • Provide capacity-building for recovery phase. persons with disabilities to ensure meaningful involvement as designers and providers of disability-inclusive health emergency response. 27 Target 3.2. By 2030, ensure that all health emergency policies, initiatives, strategies and programmes are disability inclusive Ensure the development Core • Integrate disability in health • Provide technical guidance • Include disability in risk of appropriate disability- strategic-level emergency risk management for the development of assessments, ensure disability is inclusive health policies, assessments, plans and disability-inclusive health considered in emergency response emergency response programmes. emergency risk and recovery, and produce • Include emergency risk management management policies, training materials for health in disability policies, services and assessments, plans and professionals. programmes. programmes. • Source funding for disability- • Strengthen health workforce capacity • Provide guidance on inclusive health emergency risk on disability inclusion in health funding mechanisms for management policies, emergencies. disability-inclusive health assessments, plans and • Ensure there is a dedicated budget emergency risk programmes. available to plan, implement and management policies, maintain disability-inclusive health assessments, plans and emergency risk management programmes. policies, assessments, plans and programmes. • Strengthen or develop social care services, including psychosocial support, personal assistance and support for independent living, and ensure contingency plans are in place to enable the continued operation of these services before, during and after (recovery phase) health emergencies. Operational- • Improve transparency and • Provide technical guidance • Disseminate information on level accountability of decision-making on workforce training in policies, guidelines and resources processes in health emergencies by disability-inclusive on health emergency response to introducing interdisciplinary response to health persons with disabilities and their committees which include persons emergencies. carers. with disabilities and their respective organizations. • Ensure uninterrupted access to health care for persons with disabilities during health emergencies. 28  • Ensure that the specific needs of persons with disabilities for health care services are met during health emergencies, including psychosocial support and mental health services, especially for people experiencing multiple disadvantages. • Protect persons with disabilities from violence, abuse, neglect and exploitation during health emergencies. • Ensure all information on health emergency policies, initiatives, strategies and programmes is provided in accessible formats and through ways that reach everybody. • Prohibit blanket decisions on medical rationing on the grounds of disability. • Establish a mechanism to collect disability-disaggregated data on mortality and morbidity caused by health emergencies, and on the factors that contribute to the risks that persons with disabilities face. Ensure active Core • Prepare or strengthen health • Share examples of good • Direct capacity-building efforts involvement of persons strategic-level emergencies policies, plans and practice and case studies and empower persons with with disabilities and programmes with the involvement of of successful involvement disabilities to lead and promote their organizations in all organizations of persons with of persons with disabilities universally accessible health phases of health disabilities. and their organizations in emergency response, emergency risk the health emergency incorporating recovery, management cycle. rehabilitation and reconstruction approaches. Operational- • Ensure co-design of all health • Develop training materials on level emergency policies, assessments, disability-inclusive response to plans and programmes with health emergencies. organizations of persons with disabilities. 29 Objective 4. Build an evidence base on disability and health Proposed actions for Member Proposed actions for Proposed actions for international Actions Level States WHO/Europe and national partners Target 4.1. By 2030, ensure the collection of relevant, standardized and internationally comparable data on disability Ensure the availability Core strategic- • Reform or strengthen national data- • Provide technical guidance • Provide technical and financial and use of robust data- level collection systems, including health and training for Member support for Ministries of Health collection tools on information systems, to include States to strengthen their and other relevant stakeholders on disability gender- and age-disaggregated data-collection systems to the strengthening of the disability disability data, by providing ensure good-quality, component of national data- adequate financial resources and accessible, timely, reliable collection systems and the appropriate training. and disaggregated health development of tools for data • Consult with WHO/Europe, national data. collection on disability. and international partners, • Promote the adoption and universities and research institutes, use of standardized, and persons with disabilities and internationally comparable their organizations on the methods of data collection. development, adoption, use and • Provide technical assistance evaluation of tools for data on the budget and collection on disability. expenditure needed for strengthening data- collection systems and the identification of key data gaps. • Promote international cooperation to support expertise exchange, building capacity and harmonization of data collection and reporting processes through the promotion of initiatives such as the European Health Information Initiative. Operational- • Improve disability data collection • Support Member States in • Support Ministries of Health and level through the development and translating evidence into other relevant stakeholders in the 30  Proposed actions for Member Proposed actions for Proposed actions for international Actions Level States WHO/Europe and national partners application of standardized policy action and decision- development of guidelines on disability surveys, such as the Model making by facilitating the involving persons with disabilities Disability Survey, that will provide establishment of national in the collection, analysis and use relevant, reliable and internationally data platforms based on of disability data. comparable data on disability. global research, local data • Collect robust qualitative data on and specific contextual health care access and use by knowledge. persons with disabilities. • Develop guidelines on • Include valid and reliable disability involving persons with instruments in surveys. disabilities and their • Integrate disaggregated data – organizations in the including disability – from the collection, analysis and use private sector in health of disability data. information systems. Target 4.2. By 2030, strengthen disability research Support, strengthen Core • Support disability research to • Collaborate with • Provide technical support, and promote disability strategic- identify key research areas, Member States, national guidance and training to research level barriers and challenges to and international strengthen human resource achieving equitable coverage and partners, and other capacity in the area of disability access to health care for persons stakeholders on the research, with specific emphasis with disabilities, and use that elaboration of strategies on capacity-building for persons research to inform decision- that strengthen human with disabilities to become making. resource capacity in the research leaders. • Ensure research agendas are set area of disability by, or in collaboration with, research. persons with disabilities and meet their needs. • Provide and/or increase funding on disability research by (a) increasing state funding for disability research, and (b) working with funding agencies to promote disability as a research priority area. 31  Proposed actions for Member Proposed actions for Proposed actions for international Actions Level States WHO/Europe and national partners • Include disability in existing research agendas (e.g., in cancer research). Operational- • Conduct systematic reviews and • Support dissemination • Support Member States and level evidence syntheses to identify on disability research WHO/Europe in the evidence gaps where data are findings and application identification of key research needed. in policy-making and areas on disability, in close • Strengthen human resource planning, through collaboration with organizations capacity in the area of disability evidence-based of persons with disabilities. research in a range of disciplines publications on priority • Support Member States and to achieve an interdisciplinary disability issues. WHO/Europe to conduct and multisectoral approach. research on priority disability • Support the inclusion of persons areas (e.g., needs and unmet with disabilities in the research needs for health care services, workforce. barriers to service delivery and • Ensure that persons with health and rehabilitation disabilities and their outcomes). organizations are actively involved in and lead disability research as consultants, participants or researchers. 32 MONITORING AND EVALUATION FRAMEWORK Objective 1. Ensure that all persons with disabilities receive quality health services on an equal basis with others EPW core Indicator priority / Source Definition Measurement of success Means of verification name flagship initiative Target 1.1. By 2030, ensure that health care services are accessible Indicator • New • EPW core Proportion of Member States that All Member States routinely • Data to be collected through 1.1.1. indicator priority 1 routinely provide information in provide information in surveys of key informants in (universal accessible formats (including sign accessible formats in health Ministries of Health and civil Informational health language interpretation, Braille, services, public health society/organizations of barriers: coverage Easy Read and live captioning) in broadcasts and elsewhere, as persons with disabilities. accessible – UHC) health services, public health appropriate. information broadcasts and elsewhere, as appropriate. Indicator • New • EPW core Proportion of Member States that All Member States • Data to be collected through 1.1.2. indicator priority 1 embrace and implement universal incorporate universal design surveys of key informants in (UHC) design, develop accessible built principles in all health care Ministries of Health, other Universal environments, health care planning and design, and ministries (e.g., transport, design equipment, products and services, across other relevant sectors infrastructure, etc.) and civil and make accommodations as (e.g., transportation). society/organizations of appropriate. persons with disabilities. Target 1.2. By 2030, ensure that the right of persons with disabilities to health care is fully protected Indicator • Modified • EPW core Proportion of Member States All Member States • Biannual reports from the 1.2.1. from priority 1 with legislation protecting incorporate UNCRPD into Committee on the Rights of UNCRPD (UHC) persons with disabilities from national legislation or Persons with Disabilities. Anti- human discrimination. develop other • Data to be collected through discrimination rights comprehensive, disability- civil society/organizations of legislation indicators specific, anti-discrimination persons with disabilities. (Article 5) legislation. Indicator • Modified • EPW core Proportion of Member States All Member States have laws • Biannual reports from the 1.2.2. from priority 1 with laws or directives calling for or directives requiring full Committee on the Rights of UNCRPD (UHC) full information and consent by information and meaningful Persons with Disabilities. human persons with disabilities or their consent by persons with 33 Information rights carers before health care disabilities or their carers • Data to be collected through and consent indicators procedures. before all health care civil society/organizations of (Article procedures. persons with disabilities. 25) Target 1.3. By 2030, ensure that all persons with disabilities are fully covered by health insurance Indicator • Modified • EPW core Proportion of persons with All, or almost all, persons • Data to be collected through 1.3.1. from priority 1 disabilities who are covered either with disabilities are insured surveys of key informants in WHO (UHC) by health insurance or by or covered by appropriate Ministries of Health. Health Global appropriate social protection social protection insurance Disability mechanisms. mechanisms. Action Plan 2014– 2021 Target 1.4. By 2030, ensure that all persons with disabilities have access to the full range of appropriate rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabilitation Indicator • WHO • EPW core Proportion of Member States with Existence of rehabilitation, • Data to be collected through 1.4.1. Global priority 1 national policies regarding habilitation and community surveys of key informants in Disability (UHC) rehabilitation, habilitation, services, legislation, policy and Ministries of Health, Social Policies on Action assistive technology, assistance regulation across all Member Affairs, Social Security and rehabilitation Plan and support services, and States in the Region, other relevant branches of 2014– community-based rehabilitation. compatible with the principles the government. 2021 of the UNCRPD. • Data to be collected through civil society/ organizations of persons with disabilities. Indicator • WHO • EPW core Coverage of rehabilitation services Availability of rehabilitation • Data obtained from 1.4.2. Global priority 1 (including assistive technology), services across all Member Ministries of Health and Disability (UHC) both inpatient and community- States in the Region, Social Development. Availability of Action based, disaggregated by compatible with the rehabilitation Plan urbanization level, sex and principles of the UNCRPD. services 2014– geographical region. 2021 Target 1.5. By 2030, eliminate direct and indirect costs that negatively affect access to health care Indicator • Modified • EPW core Proportion of households of a All Member States have • Data to be collected through 1.5.1. from EPW priority 1 person with disability that eliminated impoverishing and surveys of key informants in (UHC) experience: a) impoverishing catastrophic out-of-pocket 34 Health • Modified health expenditure (i.e., is pushed health expenditures for Ministries of Health and expenditure from below or further below a relative households of persons with Social Development. WHO poverty line by out-of-pocket disabilities (compared with Global payments); and/or b) catastrophic national pre-framework Reference spending (i.e., out-of-pocket baseline). List of 100 payments greater than 40% of core capacity to pay for health care). Health Indicators (2018) 35  Objective 2. Promote the health and well-being of persons with disabilities EPW core Indicator priority / Source Definition Measurement of success Means of verification name flagship initiative Target 2.1. By 2030, ensure that persons with disabilities have access to preventive health examinations Indicator • Modified • EPW core Proportion of persons with Increase in the proportion of • National disability and health 2.1.1. from WHO priorities 1 disabilities who are screened for persons with disabilities who surveys. Global (UHC) and cancer according to national or are screened for cancer • European Health Interview Cancer Reference 3 (Health WHO guidelines. (compared with the national Survey (EHIS). screening List of 100 and well- pre-Framework baseline). • EuroStat database on health. Core Health being) Indicators • Flagship (2018) initiative: Healthier behaviours Target 2.2. By 2030, ensure that persons with disabilities have access to sexual and reproductive health care services, including family planning, information and education Indicator • Modified • EPW core Existence of laws and regulations All Member States have laws • Data from Ministries of 2.2.1. from EPW priorities 1 that guarantee that all persons and regulations that Health. • Modified (UHC) and with disabilities, in all contexts, guarantee that persons with • Interviews with key officials Laws on from SDG 3 (Health have access to affordable, disabilities, in all contexts, in Ministries of Health. sexual and target 5.6.2 and well- accessible, acceptable and have access to affordable, reproductive being) quality sexual and reproductive accessible, acceptable and health • Flagship health care, information and quality sexual and initiative: education. reproductive health care, Healthier information and education. behaviours Indicator • Modified • EPW core Persons with disabilities, Increase in the proportion of • Use of national disability and 2.2.2. from SDG priorities 1 disaggregated by sex, who make persons with disabilities, health surveys. target 5.6.1 (UHC) and their own informed decisions disaggregated by sex, who Access to 3 (Health regarding sexual relationships, have access to sexually sexual and and well- contraceptive use and transmitted diseases reproductive being) reproductive health care. screening and who can make health • Flagship their own informed decisions initiative: regarding sexual 36  EPW core Indicator priority / Source Definition Measurement of success Means of verification name flagship initiative Healthier relationships, contraceptive behaviours use and reproductive health care (compared with the national pre-Framework baseline). Target 2.3. By 2030, substantially strengthen intersectoral action for health Indicator • New • EPW core All Member States have Number of Member States that 2.3.1. indicator priorities 1 policies on health that • Interviews with key officials have policies that address the (UHC) and address the intersections in various Ministries, intersections between disability, Intersectoral 3 (Health between disability, health including Infrastructure, health and wider health policies and well- and wider health Health, Transport, Education determinants (e.g., transport, being) determinants (e.g., transport, and Housing. education, etc.). education, etc.). Target 2.4. By 2030, reduce risks and threats to the health and well-being of persons with disabilities and offer protection from neglect, abuse and/or violence Indicator • Modified • EPW core Prevalence of insufficiently A 10% relative reduction in • Data to be collected through 2.4.1. from the priority 3 physically active persons with prevalence of insufficient national disability and health Action Plan (Health and disabilities. physically active persons with surveys. Physical for the well-being) disabilities (compared with • EuroStat database on health. inactivity Prevention • Flagship the national pre-Framework and initiative: baseline). Control of Healthier Noncomm behaviours unicable Diseases in the WHO European Region (2016) Indicator • Modified • EPW core Proportion of persons with Minimum 10% reduction in • Data to be collected through 2.4.2. from SDG priority 3 disabilities (disaggregated by age the number of official reports surveys of key informants in target 16.1.3 (Health and and sex, subjected to neglect, regarding persons with Ministries of Health and civil well-being) violence, maltreatment or abuse disabilities who are subjected 37  EPW core Indicator priority / Source Definition Measurement of success Means of verification name flagship initiative Violence • Flagship in all forms, including physical, to neglect, or violence, society/ organizations of against initiatives: psychological and/or sexual, in maltreatment or abuse in all persons with disabilities. persons with Mental all contexts, with special forms, including physical, disabilities health attention to women and girls and psychological and/or sexual Healthier to people living in institutional (compared with the national behaviours settings. pre-Framework baseline). 38  Objective 3. Ensure persons with disabilities are fully protected during health emergencies EPW core priority Indicator Source / flagship Definition Measurement of success Means of verification name initiative Target 3.1. By 2030, strengthen or develop leadership and governance for disability-inclusive health emergency response Indicator 3.1.1. • New • EPW core Number of Member States All Member States have disability- • Data to be collected through indicator priority 1 where all health emergency inclusive health emergency surveys of key informants in Disability- (UHC) policies, initiatives, strategies and policies, initiatives, strategies and Ministries of Health and civil inclusive health • EPW core programmes are disability programmes. society/organizations of emergency priority 2 inclusive. persons with disabilities. policies (Health emergencies) Target 3.2. By 2030, ensure that all health emergency policies, initiatives, strategies and programmes are disability inclusive Indicator • Modified • EPW core Number of Member States with All Member States comply with • Data to be collected through 3.2.1. from SDG priority 2 IHR (2005) disability-inclusive IHR (2005) disability-inclusive surveys of key informants in target (Health capacity and health emergency capacity and health emergency Ministries of Health. International 3.d.1 emergencies) preparedness. preparedness. Health Regulations (IHR) (2005) Indicator • New • EPW core Persons with disabilities have Similar mortality rates [(number • Data to be collected from 3.2.2. indicator priority 2 similar mortality rates to the of deaths due to health Ministries of Health. (Health general population during health emergency / total population) x Mortality rate emergencies) emergencies. 100 000 inhabitants] between persons with disabilities and the general population resulting from health emergencies. 39  Objective 4. Build an evidence base on disability and health Indicator EPW core priority / Source Definition Measurement of success Means of verification name flagship initiative Target 4.1. By 2030, ensure the collection of relevant, standardized and internationally comparable data on disability Indicator • Adapted from • EPW core priorities Number of Member States that All Member States use a valid, • Inclusion of disability 4.1.1. SDG target 1 (UHC), 2 (Health use a valid, reliable monitoring reliable monitoring tool in censuses, 17.18 emergencies), and tool providing internationally providing internationally population surveys Country • Adapted from 3 (Health and well- comparable data on the health comparable data on the health and national health data on WHO Global being) and social situation of persons and social situation of persons surveys. disability Disability with disabilities. with disabilities. • Use of internationally Action Plan comparable surveys 2014–2021 on health and disability. Indicator • Adapted from • EPW core priorities Number of Member States Increase in the number of • Routine facility 4.1.2. WHO Global 1 (UHC), 2 (Health where more than 50% of health Member States where more than information systems Reference List emergencies), and care facilities provide disability- 50% of health care facilities (including Reporting of 100 Core 3 (Health and well- disaggregated reports. (public and private) provide surveillance). by health Health being) disability-disaggregated reports. care Indicators facilities (2018) Target 4.2. By 2030, strengthen disability research Indicator • WHO Global • EPW core priorities Number of Member States Increase in the number of • National reporting 4.2.1. Disability 1 (UHC), 2 (Health that provide research grants Member States that provide from Ministries of Action Plan emergencies), and for disability research. research grants for disability Health and Education, Disability 2014–2021 3 (Health and well- research. national centres of research being) excellence or academic bodies. === 40 Saatja: "eurofpwds" <[email protected]> Saaja: "Helen Sõber - SOM" <[email protected]> Teema: Invite to nominate/ Monitoring and Evaluation European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030 Kuupäev: 2025-07-01 13:23 Tähelepanu! Tegemist on välisvõrgust saabunud kirjaga. Tundmatu saatja korral palume linke ja faile mitte avada. Dear National Counterpart, Please find attached nomination letter for your kind attention, noting that the deadline for nomination is 20th July 2025. Thank you and best regards, Health Workforce and Service Delivery Programme WHO Regional Office for Europe Copenhagen, Denmark Web: <https://www.who.int/> www.who.int Follow WHO on <https://www.facebook.com/WHO/> Facebook | <https://twitter.com/WHO> Twitter | <https://www.youtube.com/user/who> YouTube | <https://www.instagram.com/who/> Instagram Regional Committee for Europe 72nd session Tel Aviv, Israel, 12–14 September 2022 EUR/RC72/R3 14 September 2022 | 220776 ORIGINAL: ENGLISH The WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030 Resolution The Regional Committee, Having considered document EUR/RC72/7 on the WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030,1 which was developed through consultation with Member States in the WHO European Region; 1. ENDORSES the WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030; 2. URGES Member States,2 at national and, as appropriate, subnational level to develop actions and evaluation mechanisms, guided by the implementation plan and the monitoring and evaluation framework, as per background document EUR/RC72/BG/7;3 3. REQUESTS the Regional Director: (a) to provide technical support to Member States in implementing the recommendations of the WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities 2022–2030; (b) to report to the Regional Committee through a midterm report at its 76th session (2026) and a final report at its 80th session (2030). = = = 1 See https://apps.who.int/iris/handle/10665/360966. 2 And, where applicable, regional economic integration organizations. 3 See https://apps.who.int/iris/handle/10665/362016.