1 30 May 2005 PORTUGAL experience Structural Funds and Health 21 March 2006

2 PORTUGAL Year of EU entry : 1986 Total Area : Km2 Population : 10,3 million inhabitants Aged over 65: 16,4% Aged below 14: 16% Public expenditure on 9.6% Health % GDP (2003)

3 ERDF Regulation (1986/89) 1 st Phase Construction of 2 hospitalsConstruction of 2 hospitals Pioneering communitarian support to health projects Construction of several health centresConstruction of several health centres

4 I Community Support Framework (1989/93) 2 nd Phase Construction of hospital infrastructures (ERDF) - Construction of 4 district hospitalsConstruction of hospital infrastructures (ERDF) - Construction of 4 district hospitals Non existence of a National Health Programme Financed through Regional Programmes Initial training for nurses and health technicians (ESF)Initial training for nurses and health technicians (ESF)

5 II Community Support Framework (1994/99) 3 rd Phase Introduction of Health Operational ProgrammeIntroduction of Health Operational Programme

6 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 2 nd phase of this Framework (1997/99) investment in information technologies has started Main Guidelines of Health Operational Programme

7 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 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 Communication and information technologies 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 nurses and therapeutic and diagnostic technicians; - Continuous training for health professionals

8 III CSF (2000/06) 4 th Phase Strategic change in the conception of the Health Operational Programme Evolution from focus on infrastructure to innovation and reorganisation of health services

9 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 :

10 The Programme Structure The Health Operational Programme Promoting health and preventing disease Improving the access to quality health care Promoting new partnerships and new actors in health sector Measure 1.1 Information, promotion and public health defence Measure 1.2 Strategic areas for the intervention (health problems) Measure 1.3 Technical assistance Measure 2.4 Health modernisation projects supporting training Measure 2.2 Information and communication technologies Measure 2.1 Integrated hospital referral network Measure 2.3 Certification and quality assurance Measure 3.1 Creation and adaptation oh healthcare units Measure 2.5 Modernize and humanise health services

11 The health budget and financing in the III CSF Intervention Total Cost Public Expenditure Structural Funds % Value% The Health Operational Programme (Saúde XXI) , ,3 The Health Regional Operational Intervention , ,7 TOTAL , * ,0 ( thousand euros) * In the III CSF the health sector represents 3,7 % ( 73 % increase when compared to the previous CSF)

12 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 Axis I: Promoting Health and Preventing Illness

13 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 Axis II: Improving the Access to a Better Quality Health Care

14 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 Axis III: Promoting New Partnerships and New Agents in Health

15 INSTITUTO PORTUGUÊS DO SANGUE Promotion for Blood Donation

16 Hospital do Espírito Santo - Évora Updating Diagnostic Capacity in Tomography

17 Hospital do Espírito Santo - Évora Updating Diagnostic Capacity in Tomography

18 Instituto Português de Oncologia - Porto Nuclear Medicine Service and Day Hospital – Portuguese Oncology Institute (OPorto)

19 Hospital de Barcelos Post- Anaesthesia Care Unit

20 Hospital de Barcelos Post- Anaesthesia Care Unit