Andalusia is a large region in southern Spain with over 8 million residents. It has a comprehensive public healthcare system with 1,500 primary care centers, 44 public hospitals, and over 88,000 healthcare professionals. The system aims to improve quality, access, and citizens' rights through measures like maximum wait times for procedures, second medical opinions, and adapting facilities for children and elderly. It also has numerous health plans and programs targeting issues like diabetes, cancer, cardiovascular disease, and tobacco use through prevention, care, education, and research.

1. Healthy
ANDALUSIA
2008

3. ANDALUSIA
Andalusia, one of the largest regions in Europe, is located in the south of Spain, with
its coastline bathed by the waters of the Mediterranean and the Atlantic.
With a size of 87,597 square kilometers, and a population of 8.059.461 inhabitants,
Andalusia is the most populated autonomous community in Spain. 16,22% of the
population is younger than 15 years of age and 14,63% is older than 65.
Main figures
1.500 Primary care centres (387 Main PHC, 1.113 Local PHC)
44 Public hospitals (5 level I, 9 level II, 6 level III, 14 level IV, 10
proximity H)1
8 Transfusion centers
88.310 Healthcare professionals
9.518,91 M € Health budget
1
Level I (≥1.000 beds), Level II (500-1.000 beds), Level III (250-500 beds), Level IV (≤250 beds); Proximity Hospitals in
remote areas.
Life expectancy at birth (2006):
Men 76,4 years, Women 82,5 years
≥1

4. HEALtH
PoLIcy GoALS
IMprove the publIc healthcare SySteM,
>
based on the values of universality, access to good quality care, equity and solidarity.
ModernIze health organIzatIonS,
>
making them more flexible and citizen – centred, ensuring good governance and
transparency.
IncreaSe the value of the publIc ServIce SySteM.
>
≥2

5. BASIc
INSPIrING PrINcIPLES
Quality as the driving force:
>
• A strongly coordinated and efficient public system in continuous growth.
• Quality-driven for response time, accessibility, continuity, familiarity, comfort,
human touch, high technology, safety and efficient performance.
Accesibility and Transparency:
>
• More and better-informed citizens with increased freedom to make decisions,
take greater responsibility over their own health, and gain equal opportunities
through transparent and accurate information.
Social Control:
>
• Active social participation on an individual and collective basis.
• An organization that listens to its citizens as allows them to participate in
decisions making.
Professional Participation:
>
• obtaining, recognizing and stimulating commitment by professionals is the key
to success and to secure their essential participation.
≥3

6. cItIzENS at the center of
the Health System
citizens are the center of the Andalusian Public Health System. they show great
sympathy for the health care received, the professionals and the organization, which is
measured with an annual user - satisfaction survey.
Different measures have been designed to empower citizens and patients with
>
new rights in health care:
• SeConD MeDICAL oPInIon: in case of severe diseases, citizens have the right to
demand a qualified second opinion, which is provided by experts within 30 days
since the application.
• LIVIng wILLS: Andalusian citizens have the right to record their wills, on a specific
registry, about the limits to health care when being in situations of not possible
communication. Physicians have the obligation to consult this registry before
applying special treatment to patients not able to communicate.
• DenTAL CAre for CHILDren AnD PregnAnT woMen: free from 6 to 15 years
old, and women during pregnancy.
• Surgery wAITIng LISTS: the Andalusian government has been the first in our
area to introduce the legal right to a guaranteed maximum waiting period for
surgery (180 days). recently it has been updated, reducing the waiting time for
the most common interventions to 120 days. the information is available at the
Department of Health web page.
• ouTPATIenT SPeCIALIzeD CAre AnD DIAgnoSTIC ProCeDureS wAITIng LISTS:
legal rights has been extended to guarantee a maximum delay for outpatient
specialized care (60 days for first referral from primary health physician) and the
most common diagnostic procedures (30 days).
• PreIMPLAnTATIonAL geneTIC DIAgnoSIS (PgD): the Public Health care System
has included PGD to avoid the transmission of genetic disorders. this service is
offered in a public hospital.
• geneTIC CounSeLIng: among a number of measured listed in the Andalusian
Genetic Plan, new integrated genetic units, providing genetic testing and
counseling, are being implemented.
≥4

7. • DenTAL CAre for HAnDICAPPeD: the coverage by the public dental care services
has been extended to handicapped people.
• CHILDren neeDS In HeALTH CAre fACILITIeS AnD SerVICeS: health care
facilities and services are being adapted to the special needs and requirements
of children and newborns, such as being accompanied by a close relative (mother
or father) during their stay in hospitals.
• eLDerLy AnnuAL CHeCk-uP: people over 65 years old are being contacted, in
order to assess their health status, and are being offered with the health services
they may need.
• PoDIATrIC/CHIroPoDIC CAre for PeoPLe wITH DIAbeTeS, under the Diabetes
care Plan.
family support measures
>
• chronic homecare plans and community nursing activities
• Extension of rehabilitation units throughout the territory, including mobile units
for home rehabilitation care.
• Improvement of mental health care services.
The citizens’ voice
>
• Area Health committees by province.
• Annual survey on user satisfaction.
• Virtual office –InterS@S-, where the user can choose a primary health care
physician or center, update his/her personal data, make requests,…
• call center: single telephone number, where demands and suggestions can be
made, as well as asking for medical appointments or basic medical advice.
• citizens’ expectations Bank: web site to foster citizens’ participation as well as
associations and other health system stakeholders.
≥5

8. ProtEctING Health
and Promoting Wellness
III andaluSIan health plan (2003-2008)
>
• Strategic initiative to reach the goals set out as a result of the analysis of the
health problems in our region. It follows the recommendations of the XXI Health
Policy by WHo-Europe.
Specific Health Promotion Programmes:
>
• Food Safety and Quality
• Environmental Health Activities
Health Programmes:
>
• Young People (Young Form): promotes healthy life style providing consultation
services in high schools.
• Immigrants: specific health care services, minimizing language and cultural
barriers, with the active participation of NGo.
• Deafness screening: early detection of hearing impairment at birth.
≥6

9. Integrated and coMprehenSIve planS have been designed to compile the
>
different measures and actions adopted in a wide range of fields, in respond to
major health problems. Some highlights of the different Plans are detailed below.
• Diabetes Care Plan: information for the public and patients, improve health
care services, including early detection for major complications (retinopathy),
prevention and health education, citizens participation, training and research.
• OnCOlOgy Plan: health promotion activities, oncology day care in all hospitals,
palliative care, new radiotherapy units, improve social and emotional support.
research and training.
• CarDiOvasCular Disease Care Plan: secondary prevention and rehabilitation
programme, pediatric surgery, adult congenital cardiovascular disease unit,
training and research.
• Mental HealtH Plan: mental welfare promotion, information for the public, increase
accessibility, community mental health units, day care units, training and research.
• tObaCCO Plan: media campaigns, web portal and telephone service supporting
tobacco cessation, training programmes for health professionals, education and
work, special smoking cessation units at primary and specialized care, special
situations (mental health patients, prisons), training and research. Legal actions
(suit) against tobacco companies.
• DePenDent PeOPle strategy: designed to support people with special needs.
coordinated with the Social Welfare Department.
• alZHeiMer’s Disease Plan: in collaboration with associations of relatives and
caregivers, includes different programmes designed for the needs of these
patients and their families, such as healthcare, family support, stimulation and
reeducation, training, volunteering and research.
• infant Obesity Plan: includes more than a hundred preventive, healthcare,
training and research measures. School dining rooms support services.
• aCCiDents HealtHCare Plan: different measures in order to reduce accidents,
and to minimize their consequences.
≥7

10. • Patient safety strategy: designed to improve the management, training and
information systems. Includes an observatory on Patient Safety and a registry on
adverse events.
• genetiCs Plan: establishes a network for providing genetic services for the
population, identifying and optimizing the available resources, and opening new
lines for the development for research and health care.
• rare Diseases Plan: early identification of rare diseases, structured health care
network within the health system, coordination with different units involved.
• Palliative Care Plan: designed to attend patients at end stages of their
diseases, under a common protocol, and to support their families and close
carers.
• Pain Care Plan: standardizes care and pain relief throughout the Andalusian
health system.
• assisteD rePrODuCtiOn PrOgraMMe: extension of public health care services
of assisted reproduction techniques in the public hospitals and centers for those
who need them, including women without male partners.
≥8

11. QUALIty-DrIVEN
cArE
In 2005, the Department of Health launched its Second Quality Plan for the Andalusian
Public Health System, continuation of the first comprehensive Quality and Efficiency
Plan of 2002. this Second Healthcare Quality Plan echoes the vocational search for a
different, more modern organization, placed at the service of the Andalusian public,
that strives to provide a public service committed to guaranteeing the best possible
care, imbuing the Andalusian Public Health System of an entrepreneurial attitude with a
view to taking on new challenges to ensure survival of a public healthcare system that
is caring, fair and sustainable.
This second Healthcare Quality Plan has a process-based structure. five major
>
strategic processes have been pinpointed:
• To ASSuMe CITIzenS’ neeDS AnD exPeCTATIonS: defines the relationship
between citizens and the APHS, and points to the public’s central role in the
system, as well as the duty to establish a set of guidelines to safeguard that
principle. the plan suggests developing new rights and fresh mechanisms to step
up citizen’s participation and decision-making powers, as well as their clinical
safety, fostering projects that will enhance interaction between citizens and the
system in a more individualized, transparent and interactive manner.
• To guArAnTee HeALTH CAre SerVICeS QuALITy MAnAgeMenT: attempts to
build up the innovations in service management that have unfolded in Andalusia
over the last few years. Indeed, clinical management, process-based management
and skills management, continue to be vital tools that need to be enhanced by
implementing actions that will lead to their definitive consolidation in the system.
It incorporates an Andalusian Accreditation Model, reinforcing the Andalusian
Healthcare Quality Agency.
• To guArAnTee QuALITy In PubLIC HeALTH PoLICIeS: intends to bring about
a system of public guarantees on the basis of three processes; foster policies
targeting health promotion and disease prevention, boosting quality in public
health surveillance policies and promote quality policies in health protection.
≥9

12. • knowLeDge MAnAgeMenT: the health system is a knowledge factory, an
intelligence system, implementing a health information strategy, promoting and
consolidating research excellence in Andalusia.
• InnoVATIon AnD MoDernIzATIon of THe SySTeM: innovation is a cross-cutting
process influencing the entire array of actions to be unfurled by the Second
Healthcare Quality Plan.
two major strategic strands are established: horizontal innovation policies and
information and technology management.
It is a proposal to address the Healthcare System challenges in an efficient
>
manner. The challenges can be summarized as follows:
• Improve all aspects concerning relations with the public.
• create an organization in line with the healthcare targets.
• continue process-based work, so that all healthcare activities revolve around
the patient.
• Make further progress in skills management for professionals.
• Strive towards the integration of healthcare in a knowledge-based society.
• Enhance the system’s overall transparency – financial, operational, quality, etc
–in the eyes o the public, bearing in mind at all times that we are managing vast
and increasing, albeit limited resources.
• Boost organizational research and Innovation.
• Provide added value to the Second Modernization Plan for Andalusia by
contributing to well-being and creativity while fostering a more modern public
administration, which is closer to community grassroots.
≥ 10

13. rESEArcH and
Innovation
one of the strategic objectives of the Ministry of Health of the Andalusian regional
Government is to foster the generation of knowledge within the Andalusian Public
Health System, in particular biomedical research. therefore, the Strategic Plan for
research, Development and Innovation for the period 2006-2010 has been launched
by the regional Ministry of Health, which is aligned with and coordinated by existing
programmes at a European, national and regional level, including all parties actively
involved in the innovation system. the Plan’s structure reflects the articulation of
biomedical r+D+i in its triple perspective: of resources, production and the transfer of
research results.
Legal framework for stem cell research: Law for cellular reprogramming for therapeutic
purposes. Support to clinical trials, pre-implantation genetic diagnosis in Andalusian
public hospitals.
research centers and institutions: combining basic research (at universities
>
and the Spanish research Council) and applied research (health professionals
at the Andalusian Public Health System) with the biotechnology sector.
• new THeMATIC reSeArCH CenTerS: linked to the main research areas in the
region, molecular biology and regenerative medicine, genetics and nanomedicine.
1. regenerative Medicine (cABIMEr - Andalusian Molecular Biology and regenerative
Medicine center) is a groundbreaking multidisciplinary biomedical research
center in Andalusia, drawing together basic and applied research with the aim
of transforming the results of the scientific work carried out there into direct
improvements to citizens’ health and quality of life, Seville.
2. Genomics and oncology (GENyo), Granada. *
3. Nanomedicine (BioNAnd), Malaga.*
4. Advanced technologies in Medical traning (cMAt), Granada.
* construction in process
≥ 11

14. • MultiDisCiPlinary researCH institutes:
1. IBIS (Biomedical research Institute of Seville) is a model in which basic and
applied research live together, within a big hospital complex, Seville. *
2. Maimonides Institute, cordoba. *
3. IMABIS, Malaga (in project).
4. cádiz (in project).
• bIobAnkS:
1. Andalusian Stem cell Bank, central node of the Spanish Sc Bank.
2. Andalusian tumor Bank (network).
3. Andalusian Human DNA Bank (network).*
• sPeCifiC suPPOrt PlatfOrMs:
1. olive oil and Health Excellence center, Jaen.
2. tobacco Smoking, Seville.
3. Sports and health (in project).
* construction in process
research foundations (fIbAo, fAbIS).
>
Virtual Library of the Andalusian Public Health System.
>
Three-fold increase in the scientific production of our region from 1992 to
>
2004.
Within the framework of Innovation and Modernization Policies in Andalusia, the
regional Ministry of Health has assumed a firm commitment to continue its promotion
of scientific knowledge and place itself at the forefront of high-quality research in the
fields of biomedicine and biotechnology.
≥ 12

15. e-HEALtH Strategy
the Andalusian Public Healthcare System has adopted corporate information systems as a
strategy, given the increasing mobility of the citizens and the participation of many professionals
in attending to the processes, forming complex multidisciplinary teams. All this, linked to the
integrated concept of health and the leading role of the citizen in democratic societies, leads
to the concept of the Single Health record and the use of unified procedures.
DIrAyA
>
computer system for information and care management support. Diraya integrates all
the information of each user, into a Single Health record, so that it is available where
and when it is needed for his/her care. It also facilitates accessibility to all the services
and provisions of the health system, and ensures that all the relevant information is
structured. Diraya, meaning “knowledge” in Arabic, is the outcome of the organization’s
shared knowledge.
Diraya consists of a set of related modules that share information
• basiC COMPOnents:
- User Data Base (UDB): supply every citizen with a Single Andalusian Health
record Number (NUHSA), to which all his/her information is linked. 7.96
millions registered users (98.8% of the population).
- centralized operator Access Module (coAM).
- Structure Module, including departments and functional units as well as
physical locations.
• single HealtH reCOrD, in 682 primary health care centers, covering 7,373,409
inhabitants (93.7% total population); 6.6 millions with relevant clinical data (90%).
In specialized care: 71.1% emergency episodes, 14.4% outpatient visits.
• PresCriPtiOn XXi: electronic prescription: in 653 primary health care centers,
covering 7,272,090 inhabitants (92.4% total population), 3,496 pharmacies
(97.8%), and 70 millions prescriptions (38%).
≥ 13

16. • aPPOintMent: manages primary care, outpatient specialized consultations
and diagnostic procedures agendas. 73.439.928 appointments in Diraya during
2007.
• InterS@S: Public Health System Virtual office, allows users to change doctor, to
see and update their personal data, or request a second medical opinion.
HeALTH reSPonDS (SALuD reSPonDe)
>
Information and Service center, available 24 hours a day all days of the year. Multi-channel
access to the Public Health System of Andalusia, designed to satisfy the information and
service needs of citizens and health professionals, improving the capacity of response
of the health system and making it faster. It services include medical appointments
for primary care, information of the Public Health System of Andalusia, information
≥ 14

17. about the health smart card, dental health programme, free choice of hospial, second
medical opinion, community link nursing, living will statement, health campaigns, follow-
up on fragile patients after hospital discharge or heat waves, and medical advice. It also
offers SMS information services (health campaigns, appointments reminder, health
prevention measures,...), information on tobacco (quit-line), citizens’ service line for
health technology and devices.
InforMArSe.eS SALuD
>
Health information service using multichannel platforms such as internet, mobile phones,
tV and other media. A new model of communication in health, based on innovation,
assuring information accuracy and quality, and accessible trough different channels
and platforms.
oPInAr.eS SALuDAbLe
>
New tool for the reception and knowledge of citizens’ expectations. People can leave
opinions, suggestions and needs. It helps the Health System to seek what the citizenship
expect from the services provided, and the initiatives launched.
InnoVATIVe PrACTICe bAnk
>
Strategy for the identification, sharing and acknowledgement of innovative professional
practices. It includes a network of agents among the health professionals in the
organization. It promotes the development of innovation forums ,ideas contests and
best practices identification and diffusion.
obSerVATory of InnoVATIVe PrACTICeS In CHronIC DISeASe MAnAgeMenT
>
created as a network focused on the identification, process, synthesis and dissemination
of innovative practices in Spain and the world. Accessible at a web page, it supports
knowledge management, as well as collaboration between excellence focuses. Developed
in open source technology.
≥ 15

18. ANDALUSIAN Public
Healthcare System
activity figures 2007
gP and pediatricians consultations 57.933.420
nurses home visits 2.812.821
Admissions 557.970
Hospital stays 4.142.563
outpatient specialist consultations 10.094.015
emergencies PHC 5.658.895
emergencies hospitals 3.599.682
Surgical interventions 503.806
Ambulatory major surgery 149.556
organ transplantations 595
kidney 344
Liver 175
Heart 37
Lung 26
Pancreas 13
“The modern Andalusian public health system is a sector
of public policy closely affecting the daily concerns of
its citizens. It is also an element of primary importance
in welfare policy which is founded on the principles of
equality and solidarity.”
Mª Jesús Montero
regional Minister of Health
Andalucia, Spain
w w w. j u n t a d e a n d a l u c i a . e s / s a l u d
≥ 16

20. Junta de Andalucía. Consejería de Salud
Avda. de la Innovación s/n Edif. Arena 1
41020 Sevilla (SPAIN)
Phone: +34 955 00 63 00
Fax: +34 955 00 63 28
portalsalud.csalud@juntadeandalucia.es