Oliveira Mónica D, Tavares Aida I, Miranda Rafael, Trindade Rosário, Vieira Ana C L
CEGIST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisbon, Portugal.
iBB-Institute for Bioengineering and Biosciences and i4HB-Associate Laboratory Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisbon, Portugal.
Health Res Policy Syst. 2025 May 19;23(1):58. doi: 10.1186/s12961-025-01329-5.
BACKGROUND: In the aftermath of the COVID-19 pandemic, health policymakers have been reflecting upon sustainability and resilience issues in health systems worldwide. Promoting sustainability and resilience requires policy changes built upon evidence and on the views of health stakeholders and experts. This study aimed to engage health stakeholders in designing and discussing policy recommendations with a high potential to improve sustainability and resilience in the Portuguese healthcare system. METHODS: As part of the Partnership for Health System Sustainability and Resilience initiative in Portugal (PHSSR-PT), this study proposes a novel policy dialogue that combines participatory methods-workshops and Web-Delphi processes-with content analysis tools-namely Dialogue Mapping-to promote agreement and help health stakeholders and experts to identify and discuss policy recommendations with high potential to improve health systems' sustainability and resilience. Departing from the COVID-19 pandemic as a critical event and drawing on evidence and data, a group of health stakeholders and experts ideated and agreed upon high-value policy recommendations across seven domains: Governance, Financing, Workforce, Medicines and Technology, Service Delivery, Population Health and Environmental Sustainability. RESULTS: 40 top-level Portuguese health stakeholders and experts successfully collaborated to generate and discuss the benefits, risks and implementation issues of 69 policy recommendations, out of which 43 were selected as having gathered a high level of agreement on their potential to improve system sustainability and resilience. The adopted policy dialogue promoted high convergence. Many of these 43 recommendations were shown to entail interconnectedness with other policy recommendations. CONCLUSIONS: This study provides actionable insights to advance discussions on sustainability and resilience in Portugal. It shows that Governance and Population Health policy recommendations are critical to improve sustainability and resilience in several domains, and there is a high level of agreement on the need to adopt many recommendations, but questions remain about their implementation. The study also shows that new ways of engaging health stakeholders and experts can be adopted to promote dialogue, consensus and transparent discussion in policy processes.
背景：在新冠疫情之后，卫生政策制定者一直在反思全球卫生系统的可持续性和恢复力问题。促进可持续性和恢复力需要基于证据以及卫生利益相关者和专家的观点进行政策变革。本研究旨在让卫生利益相关者参与设计和讨论具有高度潜力的政策建议，以提高葡萄牙医疗保健系统的可持续性和恢复力。 方法：作为葡萄牙卫生系统可持续性和恢复力伙伴关系倡议（PHSSR-PT）的一部分，本研究提出了一种新颖的政策对话，将参与式方法（研讨会和网络德尔菲法）与内容分析工具（即对话映射）相结合，以促进达成共识，并帮助卫生利益相关者和专家识别和讨论具有高度潜力的政策建议，从而提高卫生系统的可持续性和恢复力。以新冠疫情这一关键事件为出发点，并借鉴证据和数据，一群卫生利益相关者和专家构思并就七个领域的高价值政策建议达成一致：治理、融资、劳动力、药品和技术、服务提供、人口健康以及环境可持续性。 结果：40位葡萄牙顶级卫生利益相关者和专家成功合作，生成并讨论了69项政策建议的益处、风险和实施问题，其中43项因其在改善系统可持续性和恢复力方面的潜力获得了高度认可而被选中。所采用的政策对话促进了高度的趋同。这43项建议中有许多被证明与其他政策建议相互关联。 结论：本研究为推进葡萄牙关于可持续性和恢复力的讨论提供了可操作的见解。研究表明，治理和人口健康政策建议对于在多个领域提高可持续性和恢复力至关重要，对于采纳许多建议的必要性也有高度共识，但在实施方面仍存在问题。该研究还表明，可以采用新的方式让卫生利益相关者和专家参与，以促进政策过程中的对话、共识和透明讨论。
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