25 Investing in Health for a Competitive, Secure, and Resilient Europe: A Strategic Call to Action The Partnership for Health System Sustainability and Resilienceorganisations and local and regional authorities report insufficient involvement by Member States in both the preparation and implementation of Recovery and Resilience Plans (RRPs), resulting in a disconnect with local priorities and less efficient use of funds.118 Scaling up regional programmes or pilots delivered under EU investment requires a major financial commitment by the Member State and poses high operational demands; these challenges intensified in the post-COVID-19 period, when investments were postponed or redirected in the crisis response.119,120 The sustainable integration of project outputs is similarly important for collaborative initiatives such as Joint Actions. In the absence of long-term plans, the outcomes and recommendations of Joint Actions have been inconsistent in ensuring long-term improvements at the Member State level.121 Implementation of health system-level projects requires multilevel governance and consistent engagement of stakeholders across levels of the health system.122 Under the Recovery and Resilience Facility (RRF), stakeholder engagement in the development of national RRPs differed across levels.123 National stakeholders, such as ministries of health, reported direct involvement in the design of at least one activity funded under their respective RRPs. By contrast, subnational stakeholders described the process as centralised and lacking transparency, perceiving limited opportunity to provide constructive input and highlighting a lack of incentives for engagement. Encouraging collaboration and engagement among key stakeholders to create shared responsibility is crucial to ensuring that sustainable changes are implemented through shared decision-making and by identifying synergies with other initiatives. Recommendations � Elevate the role of targeted EU agencies and mechanisms, such as the Technical Support Instrument (TSI), to provide strategic guidance to health system actors on governance frameworks for planning investments in health system transformation, including: � Allocating funding towards long-term health goals and priorities based on the principle of subsidiarity, ensuring complementarity between national resources and EU-level financial support. � Promoting public consultation and sustained civil society engagement to ensure that investment decisions reflect population needs and priority areas. � Facilitating ongoing coordination across all levels of health governance—from local to national— to support coherent and integrated planning and implementation. � Emphasising scalability and sustainability, with forward-looking planning to enable the continuation and expansion of successful initiatives beyond the duration of EU funding. 2.B.2 Strengthen EU support for health system stakeholders to improve access to, and optimise use of, available EU mechanisms, and to foster cross-border collaboration and knowledge exchange A range of tools are available to promote good health in the EU, including funds, policies, regulations, and best practices. To obtain the right support to tackle health system challenges and ensure long-term impact, health system stakeholders have to identify and combine multiple, relevant EU financing instruments and blend these with national funding. Navigating the EU funding landscape is challenging, which hinders the efficient use of resources and can impede access to funds for those national, regional, and local health authorities that may need them most. A pilot programme under the TSI (see ‘Case study: Pilot EU Health Hub’) has validated the need for a resource hub for strategic investments in health that can provide tailored support to beneficiaries in navigating EU resources in order to address national health systems’ needs more efficiently. The

PHSSR European Union Investing in Health 2025