From small projects to system change? Rethinking the policy impact of health funding in Europe

Health inequalities persist across Europe despite significant investment in national health systems. While large-scale EU funding mainly targets structural reforms, smaller instruments address specific service gaps, capacity-building needs and local-level challenges. The latter are often seen as fragmented and limited in impact, raising the question: can small-scale funding generate meaningful impact at policy or system level? This presentation examines the impact of health-related projects funded under the EEA and Norway Grants (2014–2021). Building on research covering 280 projects across 14 countries, it analyses how relatively small interventions interact with national systems and whether they can generate effects beyond their immediate scope. The analysis combines cross-country comparison, thematic review and stakeholder evidence to identify pathways of influence.

Findings indicate that small-scale funding can have impact beyond local settings. Projects often acted as entry points for policy change by piloting service models later scaled up, informing national strategies, or contributing to legislative and organisational reforms. However, policy impact was not systematic and depended on enabling conditions, including alignment with national priorities, institutional ownership, and integration into existing structures. Where these conditions were absent, effects remained localised and short-term. Overall, the impact of project-based funding appears to depend more on positioning than on scale. When strategically embedded and connected to decision-making processes, small projects can function as catalysts for system change. Strengthening links between projects and policy frameworks, and supporting mechanisms for scaling and longer-term institutionalisation, can enhance impact. This has implications for the design of funding instruments and calls for a shift from viewing projects as stand-alone interventions to treating them as part of broader policy processes.

Key messages

• Small-scale funding can act as a catalyst for policy change.

• Policy impact depends on strategic embedding, not project size.