What did the Task Force achieve?

The incidence rates for HIV and tuberculosis have flattened out or are declining at the end of this period (Fig 1 shows the incidence rates for TB). The direct impact of the Task Force can not be quantified; the changes to the better happened after strengthened efforts from the local authorities, and coincide with overall improvement of socioeconomic indicators. But the added effect of the Task Force is plausible.

National guidelines have been changed on tuberculosis control and antimicrobial resistance, surveillance has been strengthened, primary health care professionals have developed wide networks and collaborated on guidelines in the field of communicable diseases, and prison health improved, both as to improved routines in prisons, better hygiene and collaboration with the civilian sector. A permanent secretariat for the Council of the Baltic Sea Public Health Training Network is established in Estonia, work is underway to establish pilot areas for health sector reform in Lithuania, Poland, Russia and Norway. Extensive training in project planning and management has been given.

The Task Force has contributed to high political awareness of the problem in respective countries, of HIV/AIDS, tuberculosis or other communicable diseases, to changes in national neighbourhood cooperation policies and funding, and to increase in national budgets to combat communicable diseases.

One further aspect of the work was related to the enlargement of EU in May 2004, when the ‘political geography’ of the whole area changed. In this sense the activities of the Task Force have been guided to support accession priorities as well as encouraging the collaboration with the Russian Federation, as the frontier with EU became longer.

Evaluation

The Task Force collaboration has been evaluated under the oversight of a Steering Committee, with members from the London School of Hygiene and Tropical Medicine, The Moscow Medical Academy (Sechenov) and the Fridtjof Nansen Institute in Oslo. The evaluation has taken three approaches, looking at the political context, the programme areas and selected projects. The use of the database, and the monitoring of the database is a forth element (1, 2, 3, 4,).

What will be the follow up after the Task Force?

The available information on the burden of communicable diseases in the Eastern part of the Baltic Sea region strongly suggests that more needs to be done to contain these epidemics. Although the number of new cases may now be falling, the number of people living with HIV/AIDS continues to rise. The registered rates of new tuberculosis cases have stagnated, but are still unacceptably high.

A wide and well functioning network has been established, on the political level as well as the practical and professional level. These networks must be maintained, and preferably widened. The future collaboration will probably be less in the shape of project support and funding, as the economic indicators improve. Technical collaboration, common understanding and mutually supportive strategies, and acting through established networks. will probably be the core of the future collaboration of communicable disease control in the region.

The Task Force has also laid the basis for collaboration at the political level, and this is already reinforced through the initiative of EU Northern Dimension Partnership in Public Health and Social Well-being, in which the networks created within the Task Force framework are of importance. The partnership framework will cover future expert groups on HIV/AIDS, antimicrobial resistance, primary health care, prison health, and possibly tuberculosis. The Council of the Baltic Sea Public Health Training Network and the work on health sector reform will also fall under the Partnership. The Task Force database for project oversight will be adapted and used in the future collaboration.