Abstract
This study examines the barriers to integrating Malta’s secondary healthcare sector into the European Reference Networks (ERNs), an EU initiative that aims to improve care for patients with rare and complex diseases through cross-border collaboration. Despite the benefits ERNs offer, Malta’s participation remains constrained by regulatory fragmentation, limited resources, data governance concerns, and infrastructural shortcomings.
Adopting a qualitative interpretivist approach, the research involved five semi-structured interviews with healthcare professionals and policymakers selected through snowball sampling due to the specialised nature of the topic. Thematic analysis identified seven interconnected challenges, including weak governance structures, policy misalignment with EU expectations, limited digital interoperability, workforce capacity gaps, unclear institutional roles, and outdated infrastructure. A key issue highlighted was the absence of a dedicated national ERN coordination mechanism, which hampers strategic alignment and effective implementation.
The findings indicate that successful ERN integration requires more than regulatory compliance. It demands coordinated national leadership, sustainable investment in digital systems and specialised training, and strengthened cross-sector governance. Although stakeholders expressed optimism regarding ERNs’ potential benefits for small Member States like Malta, the study concludes that targeted health policy reform and long-term strategic planning are essential to enhance rare disease care delivery and ensure meaningful integration.
Publication Date: 2026-06-20