WHO Evaluation of the National Health Plan of Portugal (2004-2010)

31 de Janeiro de 2011 / Bookmark and Share

omsA Organização Mundial de Saúde (OMS) em parceria com o Alto Comissariado da Saúde publicaram em livro o documento apresentado em Maio 2010 sobre a avaliação do Plano Nacional de Saúde (PNS) 2004-2010, “WHO Evaluation of the National Health Plan of Portugal (2004-2010)”. Foi efectuado no âmbito do protocolo de colaboração assinado, em 2008, entre o Ministério da Saúde de Portugal e esta instituição.

O estudo visa avaliar a relevância, execução e o impacto do PNS 2004-2010, com o objectivo de obter uma análise dos pontos fortes e dos que necessitam de melhorias, permitindo uma recolha de contributos, recomendações e sugestões para a elaboração do PNS 2011-2016.

Os resultados da avaliação baseiam-se: na evolução estatística dos indicadores do PNS e das respectivas metas; numa análise funcional do sistema de saúde português e em entrevistas realizadas pela OMS-Euro a mais de 100 dirigentes, responsáveis e intervenientes da área da saúde, a nível nacional, regional e local; nas discussões decorridas em duas mesas-redondas, envolvendo uma dezena de especialistas internacionais nas diversas áreas.

Informação Chave

“The World Health Organization (WHO) Regional Office for Europe carried out an evaluation of the National Health Plan of Portugal (2004–2010) in the framework of its Biennial Collaborative Agreement (2008–2009) with the Ministry of Health of Portugal. The objectives of the evaluation were to assess the design, implementation and achievements of the National Health Plan and to provide policy recommendations to support the efforts of the Portuguese Government in strengthening the country’s health system.

The findings of this evaluation are based on: a statistical analysis of monitoring indicators and related targets attached to the Plan; a review of national studies undertaken in relation to the Plan; a functional review of the Portuguese health system; interviews with over 100 health system policy-makers and stakeholders at national, regional and local levels; two round table discussions with policy-makers and health system experts; and a selective review of the scientific literature.

The most significant achievements include: the creation of a function and structure responsible for coordinating the development, implementation, monitoring and evaluation of the Plan; strong support of the Plan by health system stakeholders and a sustained commitment to the achievement of health gains; a focus on accountability and on the achievement of measurable health system improvements through the monitoring of key performance indicators and targets; and an emphasis on the role of Regional Health Authorities and of interministerial action to implement the Plan.

The most important challenges related to the design and implementation of the National Health Plan include: numerous policy gaps, notably how to address health inequalities, health system sustainability and human resources for health, and health care quality and safety; fragmentation of the health system stewardship function of the Ministry of Health and a lack of alignment at central level between strategy, decision-making and implementation; an insufficient culture of performance management and accountability, despite recent efforts; limits and variations in interministerial collaboration; challenges and inconsistencies in the way Regional Health Authorities carry out their planning and implementation role; selective and insufficient stakeholder engagement; and a limited use of information to monitor and drive performance improvement.

Of the 64 performance indicators that could be analysed statistically, 28 had either already achieved their targets or were likely to achieve them by the end of 2010. Another 34 performance indicators were unlikely to meet their targets, while for the remaining 2 the trend was unclear. Most performance indicators for which international comparisons are available are improving and converging towards the average of the EU15 group (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom). Nevertheless, the methods used to select the targets for the performance indicators attached to the Plan were not documented and it was therefore difficult to assess the adequacy of the targets set, even if they met with a rather broad agreement among health system stakeholders.

The main policy recommendations are:

  • to build on the broad consensus created by the current National Health Plan on achieving health gains and use it as an asset for the next Plan;
  • to refocus the role of the Ministry of Health on health system stewardship, which should concentrate on defining health system goals, the roles of actors and boundaries for action;
  • to report regularly to the Parliament on the implementation of the National Health Plan and improvements on key targets related to public health and health system strengthening in Portugal;
  • to address the fragmentation of the health system stewardship function of the Ministry of Health and related lack of coordination, so that health system performance can be managed appropriately and public health goals can be achieved;
  • to strengthen interministerial involvement and collaboration (starting with the Ministry of Finance and the Ministry of Foreign Affairs) and develop capacities for health impact assessment across government;
  • to empower the Regional Health Authorities to lead stakeholders and community engagement and planning at local level;
  • for the next Plan, to propose a good balance between broad public health goals providing directions for action and a limited number of priority objectives for strengthening the health system, to be achieved within the timeframe of the Plan; and
  • for the next Plan, to build on a strong evidence base addressing important policy gaps in the current Plan, specifically health inequalities, health system sustainability, human resources for health, health care quality and safety, and equity in financing.”

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