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30 May 2005

PORTUGAL PORTUGAL experienceexperience

Structural Funds and HealthStructural Funds and Health

21 March 2006 21 March 2006

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PORTUGAL

Year of EU entry : 1986

Total Area : 92.152 Km2

Population : 10,3 million inhabitants Aged over 65: 16,4% Aged below 14: 16%

Public expenditure on 9.6%Health % GDP (2003)

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ERDF ERDF RRegulation egulation (1986/89)(1986/89)

11stst Phase Phase 11stst Phase Phase

• Construction of 2 hospitalsConstruction of 2 hospitals• Construction of 2 hospitalsConstruction of 2 hospitals

Pioneering communitarian support to health projectsPioneering communitarian support to health projects Pioneering communitarian support to health projectsPioneering communitarian support to health projects

• Construction of several health centresConstruction of several health centres• Construction of several health centresConstruction of several health centres

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I Community I Community SSupport upport FFramework ramework (1989/93) (1989/93)

22ndnd Phase Phase 22ndnd Phase Phase

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

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

Non existence of a National Non existence of a National HHealth ealth PProgramme rogramme Financed through Regional ProgrammesFinanced through Regional Programmes

Non existence of a National Non existence of a National HHealth ealth PProgramme rogramme Financed through Regional ProgrammesFinanced through Regional Programmes

• Initial Initial trainingtraining for nurses and health technicians (ESF) for nurses and health technicians (ESF)• Initial Initial trainingtraining for nurses and health technicians (ESF) for nurses and health technicians (ESF)

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II Community II Community SSupport upport FFramework ramework (1994/99) (1994/99)

33rdrd Phase Phase 33rdrd Phase Phase

• Introduction of Health Operational ProgrammeIntroduction of Health Operational Programme• Introduction of Health Operational ProgrammeIntroduction of Health Operational Programme

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• Next to keeping focus on hospitals there was realised a need to invest also in primary care network (health centres)

• Great attention was given to continuous professional education/training of workers in healthcare

• In the 2nd phase of this Framework (1997/99) investment in information technologies has started

• Next to keeping focus on hospitals there was realised a need to invest also in primary care network (health centres)

• Great attention was given to continuous professional education/training of workers in healthcare

• In the 2nd phase of this Framework (1997/99) investment in information technologies has started

Main Guidelines Main Guidelines of Health Operational Programmeof Health Operational Programme

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II Community support framework (1994/99):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 ;

- 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 ;

Hospital investments

Health centres

investments

Communicationand informationtechnologies

Professional training

IV.

III.

II.

I.

- Construction and equipment of 39 health centres, including its extensions ;

- Reshuffling and equipment of 7 health centres, including its extensions ;

- Initial training for 10.229 nurses and therapeutic and diagnostic technicians;

- Continuous training for 216.605 health professionals

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IIII CSF II CSF (2000/06) (2000/06)

44thth Phase Phase 44thth Phase Phase

• Strategic change in the conception of the Health Operational Programme

• Evolution from focus on infrastructure to innovation and reorganisation of health services

• Strategic change in the conception of the Health Operational Programme

• Evolution from focus on infrastructure to innovation and reorganisation of health services

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• Improvement of health parameters = promoting health and prevention

• Improving citizens’ access to health care services of good quality

• Promoting new partnerships in health

The programme has 3 strategic goals :The programme has 3 strategic goals :

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The Programme StructureThe Health Operational ProgrammeThe Health Operational Programme

Promoting health and preventing disease

Promoting health and preventing disease

Improving the access to quality health care

Improving the access to quality health care

Promoting new partnershipsand new actors in health sector

Promoting new partnershipsand new actors in health sector

Measure 1.1Information, promotion and

public health defence

Measure 1.1Information, promotion and

public health defence

Measure 1.2Strategic areas for the intervention

(health problems)

Measure 1.2Strategic areas for the intervention

(health problems)

Measure 1.3Technical assistanceMeasure 1.3

Technical assistance

Measure 2.4Health modernisation projects

supporting training

Measure 2.4Health modernisation projects

supporting training

Measure 2.2Information and communication

technologies

Measure 2.2Information and communication

technologies

Measure 2.1Integrated hospital

referral network

Measure 2.1Integrated hospital

referral network

Measure 2.3Certification and quality

assurance

Measure 2.3Certification and quality

assurance

Measure 3.1Creation and adaptation

oh healthcare units

Measure 3.1Creation and adaptation

oh healthcare units

Measure 2.5Modernize and humanise

health services

Measure 2.5Modernize and humanise

health services

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The health budget and financing in the III CSF The health budget and financing in the III CSF

Intervention

Total CostPublic

ExpenditureStructural

Funds%

Value %

The Health Operational Programme

(Saúde XXI)698.318 68,4 634.083 475.574 66,3

The Health Regional Operational Intervention

322.403 31,6 322.538 241.902 33,7

TOTAL 1.020.721 100,0 956.621

*

717.476 100,0

( thousand euros)

** In the III CSF the health sector represents 3,7 % ( 73 % increase when compared to the previous CSF)In the III CSF the health sector represents 3,7 % ( 73 % increase when compared to the previous CSF)

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Examples of Projects

• Epidemiological studies

• Development of health information systems in order to better

understand helath status of population

• Publishing of health information and health education materials

• Creation of special health care mobile units, which allow tracing and

delivery of services

• Creation of emergency centres (e.g. stroke, heart attack, trauma)

• Stimulation of setting specialized units for palliative care, pain-

treatment etc...

Priority Priority AAxis I: Promoting Health and Preventing Illnessxis I: Promoting Health and Preventing Illness

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• To equipe hospitals with functional, interconnected and technical supporting systems

• To reinforce the use of integrated information and communication technologies in the health services

• Development of certification/accreditation projects for health

care centres

Priority Priority AAxis II: Improving the Access to a Better Quality xis II: Improving the Access to a Better Quality Health CareHealth Care

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• Incentives for creation of specific health care units • Reinforcement for partnerships with private sector in

needed areas, mainly chronic (medium and long-term) care, home and palliative care…

Priority Priority AAxis III: Promoting New Partnerships and xis III: Promoting New Partnerships and New Agents in HealthNew Agents in Health

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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