Brussels

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PORTUGAL
Mobilising EU Funding for Health
Brussels
23 November 2005
30 May 2005
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COMMUNITY SUPPORT AS INSTRUMENT FOR COOPERATION
Health Sector in Portugal Communitarian Support
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PORTUGAL
Year of entry 1986
Total Area 92.152 Km2
Population 10,3 million inhabitants
Aged over 65 16,4
Aged below 14 16
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GDP per capita (EU15 average)

• 1985 53,1
• 1995 69,8
• 2002 68,8

Lisboa 105,1 Açores 55,8
Unemployment rate

• 1985 8,7
• 1995 7,2
• 2002 5,1

Trade Balance as of GDP

• 1985 0,4
• 1995 -2,9
• 2002 -7,7

• 1985 19,4
• 2002 3,6

Inflation rate (consumer prices)
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Demography and Health Indicators
Life Expectancy

• 2001 76,9

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Mortality rate (for 1000 inhabitants)

• 1985 9,8
• 1995 10,4
• 2002 10,2

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Infant mortality rate (for 1000 live births)

• 1985 17,8
• 1995 7,4
• 2002 5,0

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Perinatal mortality rate (1000 births)

• 1996 8,4 (EU 6,5)
• 2000 6,1 (EU 6,3)

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Demography and Health Indicators
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Doctors (for 1000 inhabitants)

• 1990 2,8
• 2002 3,2

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Nurses/NHS (for 1000 inhabitants)

• 1990 2,4
• 2002 3,4

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Hospital beds (for 1000 inhabitants)

• 1990 3,4
• 2000 3,2

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Public expenditure on health of GDP

• 1990 4,1 (EU 5,7)
• 2000 6,4 (EU 6,0)

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1st Phase
ERDF Regulation (1986/89)
Pioneer communitarian support to health projects

• Construction of 2 hospitals

• Construction of several health centres

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2nd Phase
I Community Support Framework (1989/93)
Non existence of an autonomous Health Programme
Financing through Regional Programmes
Concerning for the construction of great
infrastructures having in mind the hospital
network enlargement and renewal

• Construction of hospital infrastructures (ERDF) -
  Construction of 4 district hospitals

• Initial training given to nurses and health
  technicians (ESF)

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3rd Phase
II Community Support Framework (1994/99)

• Creation of an autonomous programme for health
  (Axis 3 Promoting life quality and social
  cohesion)

• Communitarian financing 416 million euros
• (2,6 of global financing)

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Main Guidelines of Health Operational Programme

• Though keeping the objective of new hospital
  constructions, it arouses the concern to also
  enlargement the structure of a primary care
  network (health centres)
• It is given great attention to the professional
  formation of health technicians, including
  continuous formation
• On the 2nd phase of this Framework (1997/99),
  financing begins to include communication and
  information technologies

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Enlargement of Intervention Areas

• Construction and equipment of new hospitals
• Reshuffling, adaptation and equipment of
  hospitals
• Construction and equipment of health centres
• Reshuffling, adaptation and equipment of health
  centres
• Development of communication and information
  technologies
• Professional training (initial and continuous)

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II Community support framework (1994/99)

• Conclusion of the construction and equipment of 3
  hospitals, started in I CSF
• Construction and equipment of 6 new hospitals
• Reshuffling, enlargement and equipment for 2
  hospitals

I.
Hospital investments
Health centres investments

• Construction and equipment of 39 health centres,
  including its extensions
• - Reshuffling and equipment of 7 health centres,
  including its extensions

II.

• The SINUS project (implementation of an
  information and communication network in
• more than 2.000 health centres, including its
  extensions, in order to support the
• Beneficiary Identity Card)
• - Beginning of the implementation of the SONHO
  project (Integrated Hospital
• Information System) in all hospitals

Communication and information technologies
III.

• Initial training for 10.229 nurses and
  therapeutic and diagnostic technicians
• Continuous training for 216.605 health
  professionals (with a 37/year of effort
  retraining).

Professional training
IV.
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4th Phase
III CSF (2000/06)

• Strategic change in the conception of the
  Operational Programme
• Evolution from an infrastructural logic to the
  logic of innovation and reorganisation of health
  services
• New solutions to needs and problems, which affect
  the citizens health state and the functioning of
  portuguese health system
• Allocation of resources by national and regional
  programmes

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ANALISYS SWOT
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ANALISYS SWOT
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PROGRAMME INDICATORS
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PROGRAMME INDICATORS
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The programme has two great strategic goals
Strategic goals

• To obtain health benefits
• To guarantee the access of citizens to quality
  health care services

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Considering these three strategic goals, the
Programme was conceived with three Priority Axis

• Promoting health and preventing illness
• Improving the access to a better quality health
  care
• Promoting new partnerships and new agents in
  health

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The Health Operational Programme

• The Programme Structure

Priority Axis I Promoting health and preventing
disease
Priority Axis II Improving the access to quality
health care
Priority Axis III Promoting new partnershipsand
new actors in health sector
Measure 1.1 Information, promotion and public
health defence
Measure 2.1 Integrated hospitalreferral network
Measure 3.1 Creation and adaptation oh
healthcare units
Measure 2.2 Information and communication
technologies
Measure 1.2 Strategic areas for the intervention
(health problems)
Measure 2.3 Certification and quality assurance
Measure 1.3 Technical assistance
Measure 2.4 Health modernisation
projectssupporting training
Measure 2.5 Modernize and humanise health services
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The health budget and financing in the III CSF
( thousand euros)
In the III CSF the health sector represents
3,7 (more 73 when compared to the previous
CSF)
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Priority Axis I Promoting Health and Preventing
Illness

• To improve the health information system in order
  to understand the health state of the population
• To reinforce the infrastructures of health
  promotion and surveillance
• To improve better environmental conditions

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Priority Axis I Promoting Health and Preventing
Illness

• Examples of Projects
• Epidemiological assessment
• Development of health information systems
• Production of health information and health
  education materials
• Use of special health care mobile units, which
  allow tracing and care services
• Creation of emergency devices (brain stroke,
  heart attack, trauma)
• Use of specialized units for palliative care,
  pain-treatment, etc

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INDICATORS MEASURE 1.2
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Priority Axis II Improving the Access to a
Better Quality Health Care

• To reorganize and equip hospitals using the
  Hospital Reference Networks
• To reinforce the use of new information and
  communication technologies in the health services
  
• To introduce the use of better quality practices
  and the certification of services

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Priority Axis II Improving the Access to a
Better Quality Health Care
Hospital Reference Networks Creation of
functional, interconnected and technical
supporting systems among hospitals, guaranteeing,
therefore, all patients access to health care
services Project Development Areas The
adaptation, reshuffling and equipment of
hospitals towards their organization by
technological platforms within the reference
networks
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INDICATORS MEASURE 2.1
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Priority axis II Improving the Access to a
Better Quality Health Care

• Information and Communication Technologies
• Implementation of integrated information systems
  supported by reliable communication networks,
  inside and among hospitals and other health
  units.
• Management of clinical practice
• Transmission of clinical data
• Management of the users of the health system
• Prescriptions management and control

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Priority Axis II Improving the Access to a
Better Quality Health Care

• Certification and Quality Assurance
• Development of certification/accreditation
  projects of health care units
• Development of continuous quality improvement
  projects
• Development of the health care units efficiency
  management

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Priority Axis III Promoting New Partnerships and
New Agents in Health

• To increase and reinforce partnerships for health
  care in needed domains and areas, namely
  continuous care

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Priority axis III Promoting New Partnerships and
New Agents in Health

• Creation and Adaptation of Health Care Units
• Development of incentive for the creation of
  specific health care units in the private and
  social sectors, namely
• Medium and long-term care
• Continuous care
• Home care
• Specialized support on dependency cases

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Health Professional Continuous Training

• Support for the development of professional
  demanding evolution abilities
• Support for the development of management
  abilities considering the health system
  efficiency
• Support for the implementation of reorganization
  and modernization service projects

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INSTITUTO PORTUGUÊS DO SANGUE
Promotion for Blood Donation
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Hospital do Espírito Santo - Évora
Updating Diagnostic Capacity in Tomography
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Hospital do Espírito Santo - Évora
Updating Diagnostic Capacity in Tomography
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Instituto Português de Oncologia - Porto
Nuclear Medicine Service and Day Hospital
Portuguese Oncology Institute (OPorto)
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Hospital de Barcelos
Post- Anaesthesia Care Unit
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Hospital de Barcelos
Post- Anaesthesia Care Unit