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Health systems in transition
Portugal
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Programme, and uses the existing body of evidence that education, literacy
and self-care are critical not only to the population’s health promotion and
protection, but also to health care provision effectiveness and efficiency.
The DGH is responsible for leading the Programme implementation at the
national level, while the public health departments in RHAs and public
health units in ACES will coordinate the Programme at regional and local
levels, respectively.
Box 5.1
Assessing the effectiveness of public health interventions
Evidence on the effectiveness of interventions addressing risk factors (e.g. tobacco and alcohol
consumption) is limited. Tobacco control is a major priority for the DGH (included within the
priority health programmes), but actions taken are mostly legal (e.g. tobacco ban in public places,
prohibition of selling tobacco to people under age 18 years). There is no system for monitoring
tobacco uptake among the population. In primary healthcare settings, that information depends
on the registries recorded by GPs. This means that if a smoker does not go regularly to a GP, that
information is not recorded in the patient’s files. Also, GP’s registries are not reliable because of
different GP coverage. Latest figures on smoking prevalence in Portugal were recorded in the
National Health Survey in 2014 (see section 1.4). The same happens with alcohol consumption
(with some legal actions targeting adolescents: Decree-Law No. 106/2015, of 16 June 2015, forbids
public establishments to sell alcohol to people under age 18 years) and obesity. However, the lack of
reliable information systems makes it difficult to monitor the effectiveness of those interventions.
Currently, NHS users can voluntarily introduce information on tobacco use, weight, height and
other health issues at a specific area (
Patient Area
) on the NHS website. The use of these data is
still unclear.
Regarding immunization rates, information systems at primary healthcare settings record the
number of children and adults who receive vaccines from the National Immunization Programme.
Immunization rates among children are high in Portugal (see section 1.4). Data from 2014 show
that 96.5% and 98.2% of children aged 2 years were immunized against diphtheria, tetanus and
pertussis, and measles, respectively (DGS, 2015a). Additionally, in 2014 children aged 7 years
recorded a 95.7% immunization rate against diphtheria, tetanus and pertussis and a 95.7%
immunization rate against measles; while 97.9% of adolescents aged 14 years were immunized
against measles (DGS, 2015a). Influenza vaccination for older people became free for people aged
65 years or older and patients with specific conditions defined by the DGH. Latest data show that
influenza vaccination rates among people aged 65 years or older in the 2014/2015 influenza season
was 50.9% (Sousa Uva et al., 2015). Rates of vaccines included in the National Immunization
Programme are monitored twice per year (June and December) and reported at Regional and
National level.