Round Table Consultation on Strategic Health Planning Lisbon, Portugal, 28 and 29 July 2003 DIRECTORATE-GENERAL OF HEALTH MINISTRY OF HEALTH, PORTUGAL EUR/03/5045990 ORIGINAL: ENGLISH E82062 ABSTRACT The Ministry of Health of Portugal and the WHO Regional Office for Europe organized a Round Table Consultation on Strategic Health Planning involving European health policy-makers. The aim was to address policy challenges in developing a national health plan (NHP) in Portugal. The key findings were the following. 1. Different health systems outcomes, such as health gain, efficiency and equity, need to be identified, grouped, ranked and balanced. 2. The NHP has to target the expected health gain. 3. Productivity targets need to take account of the sociopolitical context and include change management. 4. Resources will need to be assured for a substantial period. 5. The Ministry should place emphasis on its stewardship function. 6. The NHP should establish a health information system with targeted objectives. 7. The Cabinet and Parliament should approve and support the NHP. 8. The NHP should address human resource strategies. 9. The NHP should pay attention to the use of policy-relevant research. 10. The NHP should take advantage of public health opportunities in the European Union. Keywords STRATEGIC PLANNING HEALTH POLICY POLICY MAKING NATIONAL HEALTH PROGRAMMES DELIVERY OF HEALTH CARE – TRENDS PORTUGAL EUROPE Address requests about publications of the WHO Regional Office to: x by e-mail publicationrequests@euro.who.int (for copies of publications) permissions@euro.who.int (for permission to reproduce them) pubrights@euro.who.int (for permission to translate them) x by post Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark © World Health Organization 2003 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization. CONTENTS Page 1. Background...............................................................................................1 2. Aim of the consultation ..............................................................................1 3. Content and methodology ..........................................................................1 4. Discussions ...............................................................................................2 Policy issue 1............................................................................................................... 2 Policy issue 2............................................................................................................... 3 Policy issue 3............................................................................................................... 4 Policy issue 4............................................................................................................... 5 Policy issue 5............................................................................................................... 6 Policy issue 6............................................................................................................... 7 Policy issue 7............................................................................................................... 8 Policy issue 8............................................................................................................... 9 Policy issue 9............................................................................................................. 10 Policy issue 10 ........................................................................................................... 11 5. Summary recommendations by the WHO expert panel................................ 12 6. Evaluation............................................................................................... 12 Annex 1. List of participants ......................................................................... 13 Annex 2. Programme ................................................................................... 15
EUR/03/5045990 page 1 1. Background In the context of the collaboration between the WHO Regional Office for Europe and its Member States, the Portuguese Ministry of Health requested support regarding a number of key policy issues pertaining to its ongoing reforms. After one year in office, the Portuguese Government is committed to introducing efficiency gains in service delivery, while exploring new public-private forms of ownership. The Government has explicitly committed itself to producing a National Health Plan (NHP), which will be broadly discussed throughout Portugal during the coming months. A draft of the NHP document was used as a basis for preparing the meeting. The Consultation took the form of a round table, together with the Division of Country Support at the Regional Office, at which the policy basis of the Portuguese health reforms was discussed with European experts. The meeting drew on current debates about the future of health systems in Europe, led by the Futures Fora programme of the Division of Country Support. The presentations made during the meeting and the minutes of the discussions are available on request from the Division of Country Support at the Regional Office (jan@euro.who.int). 2. Aim of the consultation The aim of the Consultation was to address a number of key challenges regarding the development of a middle- to long-term national health strategy, in partnership with European policy-makers and under the auspices of the Regional Office, in order to provide effective leadership in the Portuguese health sector. 3. Content and methodology Ten policy issues were presented by Portuguese policy-makers (from the Ministry of Health and related institutions) to a panel of international experts and WHO staff. The following methodology was agreed. x In each case, a Portuguese policy-maker would make a short presentation, in which the issue was identified and implications outlined. x Members of the panel would react, highlighting both relevant conceptual and policy aspects, with emphasis on the European experience. x A discussion would follow and consensus agreements would be reached, if possible. x The panel of experts would present a set of recommendations in the final session. x The Minister of Health of Portugal, Dr Pereira, would summarize the lessons learned and the position of the Portuguese Ministry of Health in his closing speech. EUR/03/5045990 page 2 The list of policy issues was as follows. 1. Health improvement: patient and professional satisfaction, cost containment and health system reform – are they the same; are they compatible; what comes first? 2. Defining health gains: concepts and experience with health targets. 3. Productivity gains in health care delivery settings: clarifying the concept of productivity – how are targets defined, who defines them and who monitors them and with what consequences? 4. What are the budgetary implications of a reform process that wants to emphasize health gains as well as efficiency gains? 5. The role of the Ministry of Health: implications for health system design. 6. Health information systems (HIS) and gains in effectiveness: what is the evidence that it pays off to invest in relevant HIS? 7. Successful (?) experiences with the development and implementation of NHP: involvement of civil society, professionals, the private sector and the media; matching political action with technical advice and technical action with political feasibility. 8. Integrated planning and parallel implementation and monitoring: the case of human resources for health and intersectorality. 9. Research in the context of the NHP. 10. Health system reform and the European Union: opportunity or threat? 4. Discussions The following section summarizes the main discussions held regarding the above-mentioned policy issues. The views expressed by panel members do not necessarily represent the official position of any organization, be it WHO or their country of origin. Policy issue 1 Identified policy elements Are they the same? As is well known, there are several different health system outcomes (e.g. health, related economic and societal objectives) that need to be clearly identified. It is important that: x all outcomes be grouped together according to type; x the identified groups be ranked (e.g. The world health report 2000 ranks them differently from the European Forum of Quality Management) according to the interests and values of the implicated stakeholders in each country; x certain relationships are relevant in every system: – among outcomes – with the outputs and the processes EUR/03/5045990 page 3 – with the functions of the system – with the stakeholders’ interests; x in general, a balance is found between all the outcomes; and x the way in which objectives are explored is never “neutral” (for example, the results of patient surveys depend on the focus/approach). Are they compatible? Ideally, health gain, efficiency, equity, etc. outcomes are fully compatible, but experience shows that trade-offs need to be taken into account (e.g. equity concerns often limit efficiency gains; and efficiency gains are closely linked to cost control, especially if health gains are also expected). Not only the technical efficiency of existing services but also the ethical aspects (problem of value for money in resource allocation) are important. The Portuguese health system needs to be fully aware of existing trade-offs. A quality agenda, for example, would suggest an emphasis on patient care that many experts would see as partly conflicting with efficiency gains, cost control, equity, etc. What comes first? f In setting a strategic health system agenda, choices must be made within the competing health system objectives (equity, efficiency, freedom of choice, etc.). What comes first depends on the priorities of the relevant stakeholders, especially the political position of the government. The Portuguese Government has explicitly pointed out “health and efficiency gains” as first-level objectives. During the Consultation one participant, on behalf of the Ministry of Health, presented a list of priority activities. Other participants felt that health needs were not given sufficient priority in this list, “development of the NHP”, for example, being only item 12 on the list. Conclusions The Portuguese stakeholders have to be fully aware of the consequences of focusing on health and efficiency gains. Other health system results and the interplay between them also need to be considered. Policy issue 2 Identified policy elements How to de ine “health gains” Health gains need to be defined both in terms of level (mortality, morbidity or health-adjusted life expectancy (HALE)) and the distribution of the target groups affected. Health gains are one outcome of the health system and are closely interrelated with health policies/strategies and health system development. The periods chosen for achieving health gains (short- or long-term) are vital. Some determinants of health (e.g. socioeconomic development, environmental or educational changes) produce results only after a considerable period, whereas others, such as infant mortality related to vaccine-preventable diseases, may improve rather quickly under certain conditions. EUR/03/5045990 page 4 Experience with health targets The European experience with clearly targeted objectives is complex. The long “wish lists” typical of the 1980s are now discredited, but well targeted efforts have shown good results in many countries. Health gains should be properly articulated within the context of a health policy and strategy, including health system development in the country concerned. In addition, good management of the relevant resources is needed. Conclusions To achieve health gains, the Portuguese NHP has to adequately target those that require technically sound planning and careful implementation. Thus, the process should be managed by the Ministry of Health and be consistent with societal values. Policy issue 3 Identified policy elements The concept of productivity Strictly speaking, the economic definition of productivity (also known as technical efficiency) is the ability to maximize outputs with some given inputs. The issue of productivity gains in health care settings, however, has wider implications. The concept of “allocative efficiency” has also to be taken into account. This kind of efficiency is related to the optimum allocation of resources, that is, it includes alternative allocation of resources and not just the maximum productivity of already allocated resources in a given situation. Productivity and efficiency are thus not necessarily synonymous. Roughly speaking, productivity is an attribute that mostly belongs to the service provision function. This is one of the four key health system functions identified in The world health report 2000, the others being financing, resource generation and stewardship. Productivity gains in health care have to be part of the country’s health strategy. How are productivity targets defined? In principle, each health facility and the overall health system may decide which productivity targets (again, measured as output/inputs) it should strive for. Nevertheless, as explained under policy issue 1 above, productivity is a genuine health system objective but it also needs to be compatible with other system objectives, cultural values, etc. Who defines productivity targets? Normally, productivity is defined by the stakeholders (policy-makers, managers, medical associations, trade unions, etc.). Productivity targets are influenced by societal and organizational values and thus have to be seen in the sociopolitical context (never as isolated statements!). In particular, productivity of human resources depends on performance, which, in turn, eventually depends on the knowledge, skills and motivation of the staff. EUR/03/5045990 page 5 Productivity gains in health care are thus part of a political negotiation. Again, that is why the NHP should be led by the Ministry of Health, which can provide the proper stewardship and good management required. Who monitors productivity targets, and what are the consequences? In strict managerial terms, target monitoring depends on the structure and function of the health services. In broader terms, it is related to the health system’s overall philosophy (e.g. in terms of democratic, technocratic and social factors). One requirement for ensuring that practitioners monitor the defined targets is a good health information system, with transparent and up-to-date data, not only health but also on health system issues. Conclusions It is a mistake to deal with productivity only as a pure economic issue; it involves a political discussion not only of precisely defined objectives, but also of the values and interests of stakeholders, health system orientation, etc. The Portuguese NHP needs to define productivity targets, taking account of the sociopolitical context in which the reform process takes place. It needs to include a change management dimension adjusted to the sociopolitical context and the specific characteristics of the health system. Policy issue 4 Identified policy elements Evidence on efficiency and health gains According to OECD data, expenditure on health has increased everywhere in Europe in recent decades, both in per capita terms and as a percentage of gross domestic product. Nowhere have efficiency and health gains been achieved without cost increases. In any case, it will nor be possible to produce the necessary efficiency and health gains in just one year, especially considering the community interventions needed and the cultural changes that will have to occur in the health system. This will involve allocation of resources for a substantial period and proper mid- to long-term planning. It is well known that growth rates in the public and private components of health care expenses do not necessarily follow similar patterns. Whereas public expenses are mostly driven by budget- related decisions, such as investments and centrally determined salary increases, cost increases in the private sector are usually less sensitive to direct government intervention. Budgetary implications For a health sector involved in a reform process that wants to emphasize health gains as well as efficiency gains, there are three main budgetary implications: (a) budget proposals covering several years for the approval of the Ministry of Finance; (b) budgetary discipline and political know-howl; and (c) solid political back-up and consensus-building. EUR/03/5045990 page 6 Conclusions Ensuring institutional and political support for a reform process lasting several years should be one of the main aims of the Portuguese NHP. This should be supplemented by budgetary discipline and transparent management of existing resources. Policy issue 5 Identified policy elements Changing role of government Separation of health system functions is one of the key findings from evaluation of European experience in health system reforms in the last decade. This pays tribute to the fact that every organization has weak and strong points and thus should not concentrate on the weak points. Such separation of functions aims at ensuring: x a public health-orientated health policy with fair rules for all x the delivery of high-quality services x support through sustainable and solidarity-based financing and x use of modern and efficient resources of all kinds. The key function of government in this respect is stewardship, i.e. assuming responsibility for managing the health system and its stakeholders. The three main aspects involved are: (a) formulating the health policy: providing vision and direction; (b) regulation: establishing the (fair) rules of the game; and (c) providing intelligence: assessing performance and sharing information. Stewardship is a vital function. Experience with health system reforms in central and eastern Europe, for example, shows that focusing only on financing without strengthening the Ministry of Health can be disastrous. The rather imbalanced approach promoted by some international organizations in the period 1990–2000 has had severe negative consequences. Decentralization and delegation are also important aspects to be carefully addressed before establishing any “fixed” arrangement for the role of government. Steering and privatization Dealing with the private sector is a particularly important dimension of the stewardship function. By its very nature, the private sector’s profit motive has serious implications for equity, quality and accessibility that need to be carefully regulated by the public sector. In addition, the consequences of private sector involvement vary widely, depending on whether it involves the financing of services (private insurance), resource generation (pharmaceuticals, technology, manpower development) or service production and delivery. Each of these has to be addressed separately, with different norms and tools. Any change of policy/management aimed at increasing the role of the private sector has important implications. Paradoxical as it may sound, a successful pro-private health system reform calls for a stronger (though not necessarily larger) role for the Ministry of Health. EUR/03/5045990 page 7 Conclusions For its reform to be successful, the Portuguese Ministry of Health should place emphasis on the stewardship function while making sure that financing, resource generation and service production are efficiently developed. This is particularly important in the light of the explicit intention to achieve a growing partnership with the private sector in Portugal in the coming years. Policy issue 6 Identified policy elements Relationship between HIS and gains in effectiveness As shown by the business world, availability of information is a precondition for proper decision-making at all levels in the so-called “information era”. A HIS is essential in order for the government to generate its health policy, to analyse the level of risk and to ensure proper use of resources. Every modern health system thus needs a powerful HIS, with health surveillance and health service management components. Nevertheless, some organizations are, to quote several authors, “drowning in data while lacking quality and applicable information”. A HIS thus needs clearly targeted objectives, especially for avoiding being burdened by useless information. Aspects such as who wants the information and what they want to do with it need to be addressed before, or at least during, the development of a HIS. Consequently, a balance needs to be struck between the policy (purposes) and the resources available, thus maximizing the returns from a minimum core of information standards compulsorily applied throughout the system. Evidence that investing in HIS pays off All developed countries spend vast amounts of money on improving the information available to doctors, managers and policy-makers, and there is no evidence that such money is being wasted. Beside costs considerations, governments are finding it especially important to set up an appropriate way to collect data without overburdening health professionals. Conclusions Since Portugal is considered to lack a good HIS, the Portuguese NHP should establish one with clearly targeted objectives, collecting data of real interest for policy-makers, managers and doctors alike. EUR/03/5045990 page 8 Policy issue 7 Identified policy elements Experiences with development and implementation of NHP: who, what and when Experience of the “planning euphoria” that was typical of the 1980s is, at best, mixed. Many NHPs have not been implemented. In addition to particular technical problems (especially in keeping pace with technological change and balancing long- and short-term measures), many failed to survive because they were too closely aligned with the policies of the government of the day, which were often abandoned when the government changed. Other important reasons are that (a) a health plan belongs not just to the Ministry of Health but to several other ministries also; and (b) insufficient attention was systematically paid to flexible implementation (including a “change management” programme, a public communication dimension and detailed follow-up and evaluation timetables). After the wave of health system reforms in the mid-1990s, health plans are now seen as subsidiary to good health policy development. This means paying attention, first and foremost, not only to the proposed content but also to (a) the political–macroeconomic context, including societal values; (b) the interests of stakeholders and (c) the process (e.g. fast or slow, long or short, with or without major disruptions). Evidence from the last decade of European reforms singles out the process as the most important factor. Otherwise perfectly sensible proposals in terms of content have failed owing to their inability to gain support as they were being implemented. Involvement of civil society, professionals, the priva e sector and the media t Consistent with the above, communication with civil society (e.g. making clear that societal values are not being abused, who the involved actors are and their contribution to the process, what has to be done by whom, and what the likely impacts on different items will be) is an extremely important issue. The NHP in the Netherlands is a paradigmatic example of a slow yet steady process of planned changes involving, inter alia, trade unions, professionals and consumer associations. The main lessons learned are that a NHP should not be launched without matching technical action with political feasibility, and that health system reforms take time. Involving the private sector in the health system is proving to be particularly challenging (see also policy issue 5). Conclusions A 10-year NHP, as proposed by the Portuguese Ministry of Health, should be sustainable. In other words, it needs to be able to survive political change. In short, for the NHP to be successful, the Portuguese Cabinet and, if possible, Parliament should approve and support it. EUR/03/5045990 page 9 In the short run, the NHP has to include a good implementation component, with detailed and flexible schedules. Policy issue 8 Identified policy elements Integrated planning and parallel implementation and monitoring While acknowledging its desirability, the expert panel agreed that integrated planning, with its correlated implementation and monitoring, is easier said than done in the health sector. One important reason is that health planners have little direct leverage, let alone explicit command, over those in charge of implementing the required actions (see also policy issue 7). This has also to be seen in terms of the broader picture of planning complexity, something that affects both commercial and public organizations. Human resources and intersectorality Creating human resources is part of the resource generation function (see policy issue 3). It includes staff training, maintaining staff quality and productivity through in-service training, planning the size and composition of the workforce at both national and local level, and investing in creating knowledge and skills. Conceptually speaking, therefore, human capital should be treated in the same way as physical capital, with education and training as key investment tools to adjust the (human) capital stock and determine the available knowledge and skills. This approach is particularly important since the health sector is manpower-intensive, staff costs usually comprising around two thirds to three quarters of total costs. However, some specific characteristics make human resource planning in health systems very difficult: x it takes 10 years to train a specialist, which conflicts with the current fast rate of technological development; x machines do not replace the workforce, but create the need for more skilful human resources; and x since doctors are “professionals”, they follow their own criteria rather than their managers’ in many aspects of their practice. This explains why, despite serious efforts in both western and eastern Europe, human resources have been one of the most difficult areas to cope with in recent decades, as shown by the very different staff ratios throughout Europe. Increasing mobility and other factors (including privatization in some countries) have also made it more difficult to ensure inter-territorial uniformity in resource distribution. Many people abandon public service to work full time in the private sector. More (often the better) staff tend to concentrate around urban, more wealthy and better equipped areas. For example, while it is EUR/03/5045990 page 10 generally accepted in Europe that intersectoral approaches to health are necessary, almost no country trains its health personnel in multidisciplinary groups. Intercountry learning is hampered by the fact that none of the possible human resources strategies (sustainable medical school intake, more efficient use through better geographical distribution, greater use of multi-skilled personnel where appropriate, and ensuring a closer match between skills and functions) has proved fully effective. Conclusions As The world health report 2000 correctly puts it, “today’s health systems have a clear responsibility to provide the knowledge for the health systems of tomorrow. Doing so is a critical investment”. The Portuguese NHP will have to devote a great deal of effort to addressing this important issue. Policy issue 9 Identified policy elements As with human resources, health technologies and other inputs, research is yet another element of the resource generation function The rationale is that if evidence is a decisive factor in health- related decision-making, then it has to be properly generated. Both the public and the private sectors are involved in this function throughout Europe. The well known distinction between pure and applied research needs to be taken into account. Pure research has to be seen at the global level (most countries, and particularly those that are not too large or too rich, cannot even dream about self-sufficiency). But what is most relevant for all countries is applied research. International experience shows that there are many possibilities of linking research and government (within the health system) so that research results might inspire and be included within policy and planning activities. Research can be commissioned, for example, or an institute of public research (with the possibility of collaboration with international agencies) can be created. Experience shows that research programmes should include a multidisciplinary advisory board, consisting not only of medical and research staff but also of people who are able to ensure the policy relevance of the proposed research. The same applies at a health service management level. Good managers and good researchers are not necessarily interchangeable. It should not be a key requirement, for example, that every manager of a medical centre has a reputation as a scientific publisher. Research activities should be included in the official system for professional career development. However, there is uncertainty as to what weight research work should be given. A possible compromise solution could be to make it job-specific (giving, say, 5 points out of 20 to a research background for jobs that are highly important for research and zero for jobs without any research relevance). EUR/03/5045990 page 11 Conclusions The Portuguese NHP should pay specific attention to the applied use of nationally developed research. There is a need to design research to be used in decision-making processes, including a research component addressing public health aspects. Policy issue 10 Identified policy elements Public health legislation The European Union (EU) has long developed public health legislation relevant to all its member countries. This legislation is promulgated through a complex system of directives that each member then is requested to adopt. This system has been strengthened in recent years, and is increasingly enforceable even in accession countries. The usual content of such legislation has to do with: (a) defending with public health measures the borders of the EU against external threats (epidemics, hazards, etc); and (b) ensuring the safe and free circulation of goods and persons within the EU. A powerful and increasingly harmonized health information system (see also policy issue 6) ensures proper monitoring and follow-up. Health system legislation Nevertheless, the EU has always refrained from trying to influence national health systems and health system reforms, areas in which each country is given full freedom to develop its own laws and arrangements. Health system reforms may affect any of the health system functions. Typical elements of a reform package are changes in the financing arrangements, improved resource allocation or strategic purchasing mechanisms to maximize health gain, new strategies to increase efficiency in service delivery, and refined government stewardship. Again, EU legislation does not deal with such aspects. Not threats, but opportunities All members of the panel agreed that the EU should not be seen as a threat for health system reforms in Member States. Quite the contrary, experience from Finland, Ireland, Spain and many other countries highlights the many opportunities derived from generous EU support in the field of public health development, including health information systems. Conclusions The Portuguese NHP should take full advantage of every opportunity offered by the EU in terms of public health. This could best take the form of a flexible and mutually acceptable mechanism whereby the member countries learn from each other within the EU framework, with the support of the WHO Regional Office for Europe. EUR/03/5045990 page 12 5. Summary recommendations by the WHO expert panel The following list of recommendations was presented by the expert panel. 1. The NHP should be approved and supported at the highest political level (Cabinet, Parliament). 2. The NHP should be managed by the Ministry of Health, owing to the Ministry’s stewardship function. 3. The NHP should include time-linked implementation and financial action plans, with clear lines of responsibility and accountability. 4. The NHP should include a major “change management” programme to prepare health care workers for changes in culture and practices, including public information aspects. 5. The NHP should include an accepted evaluation timetable and protocol. 6. The NHP should also include an effective health information system and research component to effectively address public health aspects. 6. Evaluation At the end of the Consultation, although no formal evaluation had been carried out, the participants expressed a high degree of satisfaction with both the quality of the debates and the relevance of the issues discussed. The Minister of Health also emphasized this aspect in his closing speech. The Portuguese Ministry of Health and WHO agreed to maintain close contact, and to explore in the coming months a continuation of their collaboration as the Strategic Document is further developed. EUR/03/5045990 page 13 Annex 1 LIST OF PARTICIPANTS Country Experts Professor Henrique Barros Oporto Medical School, Porto, Portugal Professor José Calheiros Institute of Biomedical Sciences Abel Salazar, Porto, Portugal Dr Margarida Carrolo Directorate-General of Health, Lisbon, Portugal Dr Cláudia Conceição Portuguese Health Systems Observatory, National School of Public Health, Lisbon, Portugal Professor Maria de Sousa Laboratory of Molecular Immunology, Institute for Molecular and Cell Biology, Porto, Portugal Dr Rui Diniz Partner, McKinsey & Company, Lisbon, Portugal Dr António Faria Vaz Administration Council, INFARMED, Lisbon, Portugal Professor Paulo Ferrinho Directorate-General of Health, Lisbon, Portugal Dr Francisco George Sub-Director of Health, Directorate-General of Health, Lisbon, Portugal Professor Guilherme Jordão Institute of Preventive Medicine, Lisbon, Portugal Professor José Pereira Miguel Director-General of Health, Lisbon, Portugal Dr Luís Pisco Director of the Institute of Quality in Health, Lisbon, Portugal Dr Aldino Salgado Institute for the Management of Informatics and Health Financing, Lisbon, Portugal Dr Isabel Santiago Taskforce on Hospitals S.A., Lisbon, Portugal Dr Teresa Sustelo Hospital of Stª. Marta, Lisbon, Portugal EUR/03/5045990 page 14 Dr Margarida Theias Ministry of Health, Lisbon, Portugal Professor Jorge Torgal Director of the Institute of Hygiene and Tropical Medicine, Lisbon, Portugal Representatives of other organizations European Commission Dr Isabel de La Mata Principal Administrator G1, Directorate of Public Health, Brussels, Belgium WHO Temporary Advisers Ms Anna Dixon Strategy Unit, Department of Health, London SW1A 2NS, United Kingdom Dr Jarkko Eskola Helsinki, Finland Dr Alain Fontaine Deputy Chief, Office of Health Needs Assessment and Objectives, Direction Générale de la Santé, Paris, France Dr James Kiely Chief Medical Officer, Department of Health and Children, Dublin, Ireland Professor José M. Martin Moreno Director-General of Public Health, Ministry of Health and Consumer Affairs, Madrid, Spain Dr Ronald Mooij Head of Public Health Services, Ministry of Health, Welfare and Sport, The Hague, Netherlands WHO REGIONAL OFFICE FOR EUROPE Dr Sabine Abig (Rapporteur) Consultant, Division of Country Support Dr Mary Collins Health Care Policy Adviser, Health Care Policy and Stewardship Russia, WHO/Russia Dr Antonio Duran-Moreno Consultant, Division of Country Support Dr Nata Menabde Director, Division of Country Support EUR/03/5045990 page 15 Annex 2 PROGRAMME Monday, 28 July 2003 9.00–9.30 Opening remarks Dr Nata Menabde and Professor José Pereira Miguel 9.30–10.00 Coffee break 10.00–11.30 The Portuguese National Health Plan (NHP) Presentation: Professor Paulo Ferrinho Towards a strategy to increase access in gains in efficiency Presentation: Dr Rui Diniz Chair: Dr Antonio Durán 11.30–13.00 Panel Discussions: the NHP in the light of European experience Chair: Dr Antonio Durán 14.00–15.30 Panel Discussions: the NHP in the light of European experience Chair: Dr Antonio Durán 15.30–16.00 Coffee break 16.00–17.30 Panel Discussions: the NHP in the light of European experience Chair: Dr Antonio Durán Tuesday, 29 July 2003 9.00–10.00 The role of the WHO Regional Office for Europe in supporting health strategy development in Europe Presentation: Dr Nata Menabde Chair: Professor José Pereira Miguel 10.00–10.30 Coffee break 10.30-12.30 Summing up the key messages Presentation: Dr Antonio Durán Chair: Dr Nata Menabde Implications of the key messages to further development of the NHP in Portugal Presentation: Professor José Pereira Miguel Chair: Dr Nata Menabde 12.30 The way ahead – Minister of Health