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1. National Health Service in Portugal : Highlight in cooperation experiences 4/5 Dez. 2007 www.acss.min-saude.pt

2. SAÚDE 24 Aims to answer the needs of the citizens concerning their health. It improves accessibility and contributes to a better use of resources. CONTACTS: Filomena Parra / Sérgio Gomes – DGS (General Directorate for Health) e-mail:dgsaude@dgs.pt

3. SAÚDE 24 It started last 25th April, pooling together lines “Dói, Dói? Trim Trim!” (for children) and “Linha Saúde Pública” (for public health) but now for all types of situations and in a multi-channel format (phone, Web, e-mail and fax) The basis of the system is CAS (Centros de Atendimento de Saúde). It is also used in other countries, namely in UK (NHS Direct), enhancing substantially its functionality and the “triage”mechanisms

4. ELVAS (PORTUGAL) / BADAJOZ (SPAIN) Cooperation between Hospital de Stª Luzia de Elvas and Complexo Hospitalar Universitário de Badajoz in: • Radiotherapy • Maternity and new-born • Emergency • PET

5. ELVAS (PORTUGAL)/ BADAJOZ (SPAIN) Radiotherapy • Distance from Elvas to Radiotherapy centers • Written agreement between the hospitals in October 2004, for 24 patients/year • Radiotherapy treatments in ambulatory (28 treatments/patient) • Patients treated: 2004 (13), 2005 (19),2006 (25),2007 (27)

6. ELVAS (PORTUGAL)/ BADAJOZ (SPAIN) Maternity and new-born • Closure of local Maternity: quality and efficiency • Written agreement between the two hospitals in May 2006 • Health care: outpatients, exams, emergency, inpatient • From June06 till July07 = 113 + 133 deliveries

7. ELVAS (PORTUGAL)/ BADAJOZ (SPAIN) Emergency • Written agreement between the two hospitals in 02/2003 • Assistance to patients in critical health conditions • Assistance to patients with diseases that do not advise the transfer to the Portuguese network of hospitals • Inpatient treatment in ICU • Patients assisted every year = 12 + 10 + 11 + 16 + 8

8. ELVAS (PORTUGAL)/ BADAJOZ (SPAIN) PET • Written agreement between the two hospitals in 02/2003 • Assistance to patients in critical health conditions • Assistance to patients with diseases that do not advise the transference to the national network of hospitals • Inpatient treatment in ICU • Patients assisted = 12 + 10 + 11 + 16 + 8

9. TOBACCO WHO Framework Convention on Tobacco Control (WHO FCTC) – on the 21st May 2003 it has been approved unanimously. This is a huge step in international cooperation. This convention was signed by Portugal on the 9th January 2004, approved by the Government and published in the official journal (Decreto n.º 25-A/2005 de 8 de Novembro). Portugal made a commitment to reinforce the protection of the present and future generations against the devastating effects caused by consumption and exposure to the smoke of tobacco.

10. TOBACCO In EU legislative measures are the backbone of the Community's present and future tobacco control activities. Legislative measures in Portugal (from Health Ministry): • In 20 years, between 1983 and 2003, we had 2 measures • In 2 years, between 2003 and 2005, we had 1 measures • In the last 2 years, between 2005 and 2007, we had 3 measures, one every year HELP - For a life without Tobacco

11. TOBACO: phoneline QUIT SMOKING 808 20 88 88 LINE SOS – QUIT SMOKING started in 2002. Its purpose is to inform people about how harmful smoking can be and to help smokers who wish to quit. It is supported by a team of health professionals with specific training. It is the only line with this service and it is integrated in the European network of “Quit lines”. LINE SOS – QUIT SMOKING is supported by InstitutoNacional de Cardiologia Preventiva from Professor Fernando de Pádua. Phone:217 910 169 E-mail: sosdeixardefumar@incp.pt Web Site: http://www.incp.pt/

12. Programa INTERREG III - A União Europeia Fundo Europeu de Desenvolvimento Regional • INTERREG III is a Community Initiative programme financed by the ERDF (European Regional Development Fund) for 2000 to 2006. It supports cross border (A), trans-national (B) and inter-regional cooperation (C). • Strand A – Galicia / North of Portugal • Projects already finished: CALENO for Telemedicine, prevention and treatment of Alcohol addiction and cross border map of health equipments and accessibility

13. Programa INTERREG III - A União Europeia Fundo Europeu de Desenvolvimento Regional GAMITE: telemedicine project between Northern Health Region and Galicia Health Service, for Radiology, Dermatology, Ophthalmology, Psychiatrics, Alcohol problems, Gastroenterology and Cardiology. This project, as well as the ones already finished, promotes better usage of health equipments and human resources and improves accessibility of patients to health services. This project will finish by 31 December 2007.

14. MEETAG (Middle East and European) Technical Advisory Group • Labeling standardization of blood components according ISBT128 specifications. It allows the exchange of information both in routine and catastrophic situations, in a safer environment and easier procedures. • Portugal has established this standard in 2004 • Portugal leads this European group ever since 2005 Instituto Português do Sangue

15. EBA – European Blood Alliance • European Blood Alliance: joins European blood services in a forum over transfusion practices with similar organizations in USA, Canada and Australia. • The results of these activities have strong impact in the Portuguese transfusion practices • Emergency Planning Action Group: prepares for situations of catastrophes, bioterrorism and pandemics Instituto Português do Sangue

16. FLU: contingency health plan for a pandemic situation The national plan aims to integrate the effort, National and European, to reduce the damage of a pandemic situation and to improve the surveillance of flu and avian flu. It is expected that these plans can contribute to the reduction of morbidity, mortality and social disruption, at a National and European level, namely through the stockpile of medicine and vaccines and through the development of cross border cooperation. The integration in European groups has been of great value to our internal plans and we have a strong commitment to cooperate.

17. PANDEMIC INFLUENZA PREPAREDNESS • Spain (Autonomous Region of Galicia) / Portugal (Northern Region) • The threat of a pandemic influenza is an opportunity to strength the cooperation between different national and international institutions, specially between neighbour countries. • The aim of this work was to share and discuss the health system organization and develop a System of Alert and Communication between Health Authorities of Northern Region of Portugal and Galicia to adequately control public health emergency situations that could affect them, as avian and pandemic influenza.

18. PANDEMIC INFLUENZA PREPAREDNESS (2) Results: A simulation exercise of an avian influenza outbreak affecting wild birds and humans was developed by Galicia, during a period of 8 days in April-May 2007 and the e-mail was used as the communication tool. During the exercise, the national guidelines for WHO phase3 pandemic influenza alert were tested. During the meetings for the preparation of the pandemic influenza simulation exercise was possible to work in others public health programmes like tuberculosis; HIV infection; food borne diseases, improving the development of a strong partnership between the two regions.

19. PANDEMIC INFLUENZA PREPAREDNESS (3) Conclusions: Although the global aim of this cooperative work was not yet fully achieved, the shared experience and knowledge were considered very positive for both Health Authorities, and should be improved. Were identified some aspects that need to be reviewed, namely: • to establish standard guidelines for the different interveners • to clarify and improve the distribution procedures and the prescription criteria of chemoprophylaxis. The need to reinforce the cooperation through borders was considered important, also for other Regions and other Public Health problems

20. Global Evaluation (Northern Health Authority) • The cross border cooperation is now wider and deeper; • It is desired by both regions; • It has been seen as an opportunity to improve equipments and the health care provided to the populations; • It still depends on the leadership of Health Authority in each Region; • “Health without borders” has still a way to go before achieving cross border strategic planning for health care deployment and complementary and articulated provision of health care.

21. EudraPharm EudraPharm is intended to be the database of medicinal products authorised in the European Union. Its intended purpose comprises both the support of regulatory activities, and the making available of information on medicinal products to the public. Once fully developed, EudraPharm will include the information contained in the summaries of product characteristics, the patient or user package leaflet and the information shown on the labelling. As the database will be designed to be accessible to the general public, the information thus made available will be worded in an appropriate and comprehensible manner and with a fully multilingual interface (all EU official languages).

22. Early Warnings Response System (EWRS) This network made possible quick access (in real time) to relevant confidential information among Health Authorities in situations of pressure generated by the media or by people anxiety. The Health Authorities can coordinate the efforts and the measures to control different situations. It is very important to risk management in Portugal. Portugal has been sharing information on diseases that affect us and can also influence other countries and cause pressure and political problems.

23. THANK YOU FOR YOUR ATTENTION lprates@acss.min-saude.pt www.acss.min-saude.pt