Structural Fund programmes run on a cycle that starts with strategic analysis of the region or territory, planning and evaluating programmes, implementing projects and then monitoring and evaluation. The diagram below shows a typical cycle for preparation and implementation of a Structural Funds programme (Operational Programme or OP).

There are three key phases in the Structural Funds programme cycle that represent key points for intervention on health gains. Below we explain how the guide can be applied in each of the three phases.

Strategic analysis and programming (The blue boxes)

Member States and regions carry out strategic socio-economic analysis as the basis for preparing investment programmes. The programmes include investment priorities and measures, and are evaluated before final approval.

The guide will be particularly useful for these stages of the programme cycle. The causal pathways identify linkages between health and each funding theme. Managing Authorities can check to see that health issues are considered, in strategic analysis and in the OPs. Consideration of these health issues early on in the programming process will set the stage for their inclusion – directly and indirectly – in investment priorities and measures.

The "understanding the policy context" parts of the  Approaches to Consider pages explain how EU legsilation and policies - including the ex-ante conditionalities for 2012-2020 Cohesion Policy are linked to health gains that the programmes can generate.

The "strategic analysis and programming" parts of the  Approaches to Consider pages provide examples of how this can be done in OPs. Health gains will often result from impacts on certain health determinants – the social, economic and environmental factors that are more directly impacted by Structural Fund programmes.

The causal pathways can also be useful in programme evaluation – both general ex-ante evaluation and the required Strategic Environmental Assessment (SEA) – as a source of information for review.

Developing projects (the green boxes)

Developing projects covers the development, selection and implementation of projects funded by Structural Fund programmes. 

The Operational Programmes identify broad priorities for investment and leave the development of specific projects up to the beneficiaries. Programmes and programme Managing Authorities can incorporate specific provisions into the programme implementation or delivery provisions that will encourage beneficiaries to include health concerns into the projects at the programme design stage. Some ways to encourage projects that deliver health gains are:

  • References to health and/or wellbeing issues in project application materials
  • Direct support through online documentation and/or programme staff assistance to project developers
  • Project appraisal criteria that give higher selection points for projects that integrate certain issues

The "developing projects" sections of the Approaches to Consider pages will give examples of or ideas for projects that have successfully integrated health and wellbeing.

Monitoring and evaluation

Monitoring and evaluation of Structural Fund programmes is vital to ensuring their success. It includes the design and use of achievement indicators and targets that define successful programme outcomes.

For health gains, particularly from investment priorities that are not directly aimed at health objectives, monitoring and evaluation is especially important for a number of reasons:

1.       Where applicable, the use of health-related targets for programme priorities and measures as well as projects will help to ensure that potential health gains are actually realised.

2.       Where health gains occur within programmes, but are not explicitly recognised during programme implementation, the use of targeted monitoring and evaluation programmes can help to ensure that the health gains are captured and made public.

3.       Tracking programme and project effects on key health determinants can help programme managers and health stakeholders to better understand the overall effect of programmes on health gains. See the health indicators page of this guide for ideas on how to do this.

Structural Funds will contribute to improving health and reducing health inequality, but these things will not be solely or even directly attributable to the Structural Fund projects or programmes. It can therefore be difficult to assign or commit to health-specific indicators for non-health investments. Nevertheless, there are some cases where it is warranted to use output and/or result indicators to track health-related outcomes of certain Structural Funds investment priorities or measures.