EUROPEAN COMMISSION

DIRECTORATE-GENERAL FOR HEALTH AND FOOD SAFETY

Public health, country knowledge, crisis management

Health programme and chronic diseases

CRITERIA TO SELECT BEST PRACTICES IN HEALTH

PROMOTION AND DISEASE PREVENTION
AND MANAGEMENT IN EUROPE
- Updated version -

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Background
An important part of the European Commission's approach to preventing and managing non-
communicable diseases is to identify and transfer best practices. This approach will support Member
States in reaching the WHO/UN targets on non-communicable diseases1. Particularly, in the areas of
EU policy priorities, as they can study these best practices and consider testing and implementing
them in their own countries. This is especially important for smaller countries, for which some do not
have the capacity to go through lengthy "trial and error" phases. The European Commission is
already successfully sharing best practices in migrant health and in the area of environmental
protection.

Much work has also been done by international and national organizations when it comes to collecting
and selecting "best" practices2-3. As a European example, the Spanish government has defined a full
validation strategy including criteria to evaluate best practices4. Further work has also been carried
out by actions co-funded under the Health Programme 5 and the European Innovation Partnership on
Active and Healthy Ageing6, as well as by research projects7, which have identified
best/good/promising/innovative practices on different health topics using varying methodologies and
criteria. In some cases, weighing is applied to the criteria.

The exchange of best practices is identified as one criterion on how actions can achieve EU added
value8. The 3rd Health Programme's 9 first objective is to "identify, disseminate and promote the uptake
of evidence-based and good practices for cost-effective health promotion and disease prevention
measures by addressing in particular the key lifestyle related risk factors with a focus on the Union
added value in order to promote health, prevent diseases, and foster supportive environments for
healthy lifestyles." The corresponding indicator to this objective is "the increase in the number of
Member States involved in health promotion and disease prevention, using evidence-based and good

1 DG SANTE has opted to support Member States in reaching the globally defined WHO/UN noncommunicable disease targets refraining
from developing different ones for EU Member States.
2 See, for example the work of WHO/AFRO on a guide for Documenting and Sharing “Best Practices” Health Programmes.

http://afrolib.afro.who.int/documents/2009/en/GuideBestPractice.pdf or from CDC Atlanta: Best Practices for Comprehensive Tobacco

Control Programs-2007 (http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm)
3 Eileen Ng and Pierpaolo de Colombani. Framework for Selecting Best Practices in Public Health: A Systematic Literature. J Public Health

Res. 2015 Nov 17; 4(3): 577

4 Procedure to collect best practices in the national health system in Spain

(https://www.mscbs.gob.es/organizacion/sns/planCalidadSNS/BBPP.htm)
5 Namely the CHORDIS Joint Action (https://drive.google.com/file/d/0B8Xu4R_n0-nzT3R4RVRDSnZ1UGc/view?pref=2&pli=1) the JAMPA

Joint Action (http://www.janpa.eu/work/wp6.asp), EU compass on Mental Health

(http://ec.europa.eu/health/mental_health/eu_compass/index_en.htm) and RARHA Joint Action
(http://www.rarha.eu/Resources/Deliverables/Lists/Work%20Package%206/Attachments/10/RARHA_Toolkit_W P6.pdf)
6 https://ec.europa.eu/eip/ageing/repository_en
7 http://www.rarebestpractices.eu/
8 https://ec.europa.eu/chafea/health/programme/documents/factsheets-hp-av_en.pdf
9 http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32014R0282&from=EN

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practices through measures and actions taken at the appropriate level in Member States." Actions co-
funded under this objective will therefore focus on best (good) practices. This is why it is important to
be able to identify which practices are "good" or even "best" when it comes to effective health
promotion and diseases prevention measures as well as other care options.

The Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable
Diseases (SGPP) agreed to the below criteria for the selection of best practices in April 2017. The Joint
Research Centre used these criteria to evaluate practices submitted to the Best Practice Portal (after
open calls for best practices) in September 2018 and March 2019. In June 2019, the SGPP agreed to
select best practices on how EU Member States could incite parents to vaccinate their children in
general and to receive the second dose of the measles vaccine in particular. In light of this agreement,
DG SANTE submitted the criteria to a group of experts for revision. Representatives from the national
and regional levels of immunisation programmes, public health institutes, WHO, ECDC, JRC and DG
SANTE participated in the revision. This document presents the updated version of the criteria.

These criteria shall be aligned with the relevant Sustainable Development Goals as well as other
internationally agreed health-related targets, which the Member States have committed to reach.

Objective
The overall goal is to provide Member States with a resource centre which, as well as providing other
information, will pool together a wealth of best practices in the fields of health promotion and chronic
disease prevention and management. The best practices to be selected may serve for a group of similar
Member States or for all of them. To achieve this, the first objective is to establish a definition of best
practice (to distinguish from "innovative" practice, for example). Secondly, to define quality criteria
that categorize the various practices. Thirdly, a methodology to evaluate practices collected against
those quality criteria will be developed (not developed in detail in this document).

Methodology
DG SANTE has reviewed existing guides, manuals and other documents concerning evaluation criteria
for best practices. Based on this review, a definition of "best practice" is proposed below, as well as
criteria. These criteria draw on WHO's best practice criteria, those from the Joint Action on Chronic
Diseases and Healthy Ageing and the work by the Spanish Ministry of Health as well as a systematic
literature review. Each criterion needs to be further broken down and operationalized, which has been
done below presenting the sub-criteria for each criterion. Indeed, depending on the public health issue

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and types of interventions, the framework of criteria is fine-tuned to emphasize specific criteria10. For
instance, when applying the framework to health systems, equity and sustainability of the health
financing mechanisms may be given greater weight due to their importance11 .

An expert meeting was organized bringing together all those experts who have worked on best practice
collection and selection in the area of health promotion and chronic disease prevention and
management, mainly through EU co-funded actions in order to agree on a set of criteria to select best
practices12 . The draft criteria were presented to Member State/EEA countries representatives for
comments at the first meeting of the Steering Group on Promotion and Prevention on 30 Nov 2016 in
Brussels. Following a consultation round, the Steering Group on Promotion and Prevention agreed the
criteria on March 2017. The Joint Research Centre used these criteria to evaluate practices submitted
to the Best Practice Portal (after open calls for best practices) in September 2018 and March 2019.

These criteria can then be used in any future action co-funded under the 3rd Health Programme to
select best practices on health promotion and chronic diseases prevention and management. Such
actions would be free to decide whether these criteria are a guidance for best practice selection or if
they would further adapt and develop e.g. into a specific evaluation matrix, depending on the topic of
the action. DG SANTE is developing an evaluation methodology and refine below criteria concerning
possible weighing, scoring, thresholds etc. as to provide a full method for criteria application. The
proposed criteria would be periodically updated to reflect new developments13.

Definition of best practices

The following working definition of "best practice" for the purpose of this exercise is proposed:

A BEST PRACTICE is a relevant policy or intervention implemented in a real life setting and
which has been favourable assessed in terms of adequacy (ethics and evidence) and equity as
well as effectiveness and efficiency related to process and outcomes. Other criteria are
important for a successful transferability of the practice such as a clear definition of the context,
sustainability, intersectorality and participation of stakeholders.

10 Bollars
C, Kok H, Van den Broucke S, Mölleman G. European quality instrument for health promotion. European project getting evidence
into practice. 2005. Available from: https://ec.europa.eu/health/ph_projects/2003/action1/docs/2003_1_15_a10_en.pdf
11 World Health Organization. World Health Report 2000. How well do health systems perform? 2000. Available from:
https://www.who.int/whr/2000/en/whr00_en.pdf?ua=1
12 The meeting took place on 7/8 Nov 2016 in Luxemburg.
13 Øyen E. A methodological approach to best practices. Øyen E, Cimadamore A, editors. eds. Best practices in poverty reduction: an
analytical framework. London: Zed Books; 2002. pp 1-28.

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Set of criteria to select best practices

In order to select "best" practices the criteria need to be assessed. For this assessment, the criteria
have been grouped into exclusion, core and qualifier criteria.

Criteria to assess the adequacy will be considered as Exclusion criteria, i.e. if they are not fulfilled other
criteria will not be checked. The Core criteria will entail the assessment of the effectiveness and
efficiency of the practice as well as how the practice has addressed equity issues. Both criteria will
consider whether the intervention was successful; and, finally the Qualifier criteria will be used to
assess whether the practice contains elements that are relevant for its transfer to other settings.

The Exclusion criteria will assess the following aspects:

 Relevance

 Intervention characteristics

 Evidence and theory based

 Ethical aspects

The Core criteria will assess the following aspects:

 Effectiveness and efficiency of the intervention

 Equity

The Qualifier criteria of the practice will assess the quality of the intervention in terms of its
implementation and transferability. These qualifiers will assess the following aspects:

 Transferability

 Sustainability

 Participation

 Intersectoral collaboration.

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Exclusion Criteria

RELEVANCE
This criterion refers to the political/strategic context of the practice or intervention, which needs to be
clearly explained and considered.

The description of the practice should include information whether it is:

 A priority public health area, a strategy or a response to an identified problem at

Local/Regional level, National level or European level, and/or

 put in place to support the implementation of legislation.

INTERVENTION CHARACTERISTICS
This criterion assesses the existence of a situation analysis (e.g. problem analysis, needs assessment –
before the practice has been started) of the target population, established objectives; a consistent
methodology is well documented, etc. A thorough description of the practice would include that:

 The choice of the target population is clearly described (scope, inclusion and exclusion group,
underlying risk factors, etc.),
 A detailed description of the methodology used is provided,
 SMART14 objectives are defined and actions to take to reach them are clearly specified and
easily measurable,
 The indicators to measure the planned objectives are clearly described (process, output and
outcome/impact indicators),
 The contribution of the target population, carers, health professionals and/or other
stakeholders as applicable was appropriately planned, supported and resourced,
 The practice includes an adequate estimation of the human resources, material and budget
requirements in clear relation with committed tasks,
 Information on the optimization of resources for achieving the objectives,
 An evaluation process was designed and developed including elements of effectiveness and/or
efficiency and/or equity including information affecting the different stakeholders involved,

14 SMART: Specific, Measurable, Assignable, Realistic, Time-related.

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  The documentation (guidelines, protocols, etc.) supporting the practice is presented properly,
referenced throughout the text and easily available for relevant stakeholders (e.g. health
professionals) and the target population.

EVIDENCE AND THEORY BASED

Scientific excellence or other evidence (including from grey literature, situation analyses or anecdotal
evidence) was used, analysed and disseminated in a conscious, explicit and thoughtful manner. The
assessment of this should check if:

 The intervention is built on a well-founded theory, is well-documented and is evidence-based,

 The effective elements (or techniques or principles) in the approach are stated and/or justified.

ETHICAL ASPECTS
To be respectful with ethic values and guarantees the safeguarding of dignity, a practice should
accomplish all the following (other aspects may be added, if needed):

 The expected benefits are superseding the potential harms, including animal welfare.
 The intervention was implemented proportionally to target group needs,
 Individuals rights (for example, data protection) have been protected according to national
and European legislation,
 Conflicts of interest (including potential ones) are clearly stated, including measures taken,
 The practice should not advertise a specific product, device or relate to any commercial
initiative,
 The practice is respectful with the basic bioethical principles of Autonomy (should respect the
right of individuals to make their own, informed decisions, based on adequate, timely
information); Nonmaleficence (should not cause harm)/Beneficence (should take positive
steps to help others) and Justice (benefits and risks should be fairly distributed).

Core Criteria

EFFECTIVENESS AND EFFICIENCY

This criterion defines the degree to which the intervention was successful in producing a desired result
in an optimal way. It measures the extent to which the objectives of quantity, quality and time have
been met under real conditions at the lowest possible cost. Any tools used in the practice such as
Information and Communications Technology (ICT) tools (including website or platforms) should be
presented in order to be included in the assessment.

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Two approaches are process and outcome evaluation.

For process evaluation, the sub-criteria that could be considered when assessing how effectively and
efficiently a practice has been implemented are:

 The practice has been evaluated (internally or externally) taking into account social and
economic aspects from both the target population and the perspectives of relevant other
stakeholders concerned (e.g. formal or informal caregivers, health professionals, teachers,
health authorities),
 The evaluation outcomes (e.g. clinical, health, economics) and objectives were linked to the
stated goals,
 A study has been performed (based on needs and challenges) between the initial and final
situation. The purpose of this study would be to determine if the practice was implemented
proportionally (i.e. proportional to the identified needs),
 The practice has been implemented in an effective and efficient way.

For outcome evaluation, the sub-criteria that could be considered when assessing how effective and
efficient the practice has been, are:

 The outcomes found are the most relevant given the objective, programme theory and the
target group for the intervention,
 All improvements in comparison to the starting point, for example the baseline concerning,
e.g. structure, process and outcomes in different areas, are documented and presented,
 The practice has been evaluated from an economic point of view,
 The evaluation outcomes demonstrated beneficial impact,
 Possible negative effects have been identified and stated.

Equity
This criterion considers that the practice should take into account the needs of the population when
allocating the resources and identify and reduce health inequalities.

As the reduction of inequities is a major issue in Europe, a practice that includes elements that promote
equity, should be ranked higher (for example, if considering a gender perspective)15. Sub-criteria that
could be eventually used to assess ‘equity’ are:

15 http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52010DC0491&from=EN

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  The relevant dimensions of equity are adequately and actively considered throughout the
process of implementing the practice (e.g. age, gender, socioeconomic status, rural and/or
urban area, vulnerable groups),
 The practice makes recommendations or guidelines to reduce identified health inequality.

Qualifier Criteria

TRANSFERABILITY
This criterion measures to which extent the implementation results are systematized and documented,
making it possible to transfer it to other contexts/settings/countries or to scale it up to a broader target
population/geographic context. It would be a plus if transfer of the practice would address EU added
value elements16.

Sub-criteria that could be considered to assess this criterion are:

 The practice uses instruments (e.g. a manual with a detailed activity description) that allow for
repetition/transfer,
 The description of the practice includes all organizational elements, identifies the limits and
the necessary actions that were taken to overcome legal, managerial, financial, sociocultural
or skill-related barriers,
 The description includes all contextual elements of the beneficiaries (e.g. patients,
subpopulation, general population) and the actions that were taken to overcome personal and
environmental barriers,
 A communication strategy and a plan to disseminate the results have been developed and
implemented,
 The practice has already been successfully transferred / repeated,
 The practice shows adaptability to different contexts and to challenges encountered during its
implementation.

16 https://ec.europa.eu/chafea/health/programme/documents/factsheets-hp-av_en.pdf

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SUSTAINABILITY
This criterion assesses the practice's ability to be maintained in the long-term with the available
resources, adapting to social, economic and environmental requirements of the context in which it is
developed. Sub-criteria that could be considered to assess this criterion are:

 The practice has institutional support, an organizational and technological structure and stable
human resources,
 The practice presents a justifying economic report, which also discloses the sources of
financing,
 The continuation of the practice has been ensured through institutional anchoring and/or
ownership by the relevant stakeholders or communities in the medium and long term in the
planning of the practice,
 The practice provides training of staff in terms of knowledge, techniques and approaches in
order to sustain it,
 A sustainability strategy has been developed that considers a range of contextual factors (e.g.
health and social policies, innovation, cultural trends and general economy, epidemiological
trends, environmental impact, migration and cross-border movement).

INTERSECTORAL COLLABORATION
This criterion assesses the ability of the practice to foster collaboration among the different sectors
(e.g. health, social, education) involved in the domain of interest (e.g., health promotion, disease
prevention and management, etc.). Sub-criteria that could be considered to assess this criterion are:

 Several sectors collaborated to carry-out the practice,

 A multidisciplinary approach is supported by the relevant stakeholders (e.g. health and social
care professionals at all levels, civil society, public institutions from education, employment
and digital services),
 It promotes the continuity of care through the coordination between social and health services
(if applicable),
 The practice creates ownership among the target population and several stakeholders
considering multidisciplinary, multi-/inter-sectoral, partnerships and alliances (if applicable).

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PARTICIPATION
This criterion assesses the inclusion of stakeholders throughout the whole life cycle of the process and
the ability of the practice to foster collaboration among the different sectors involved. Sub-criteria that
could be considered to assess this criterion are:

 The structure, organization and content (also evaluation outcomes and monitoring) of the
practice was defined and established together with one or more of the following: the target
population and families or caregivers and more relevant stakeholders and civil society,
 Mechanisms facilitating participation of several agents involved in different stages of the
intervention as well as their specific role, have been established and well described,
 Elements are included to promote empowerment of the target population (e.g. strengthen
their health literacy, ensuring the right skills, knowledge and behaviour).

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