Implementation gaps of the Portuguese Nacional Health Plan 2012-2021: evidence mapping analysis

BACKGROUND: The National Institute of Health Doutor Ricardo Jorge (INSA) is responsible for carrying out the evaluation of the Portuguese National Health Plan (PNS) 2012-2016, extended to 2020 (and later to 2021). As part of PNS evaluation, this study aims to identify gaps in the implementation of the PNS 2012-2021, and to identify the degree of alignment and coherence between the strategic axis, goals, and monitoring framework issued by the PNS at different levels of implementation (national, regional, local and municipal). METHODS: A mix study, employing both qualitative and quantitative approaches was performed based upon a modified scoping review. Portuguese healthcare institutional websites and municipality websites were identified as the main data sources and secondary data were gathered. Evidence (plans, programs, or strategies) with publication date between 2015 and 2020 were included. A data collection matrix was validated by a group of experts from major stakeholders from academia and public health services. The matrix included 3 main categories following the PNS intervention logic (5 strategic axis, 4 goals and 37 monitoring indicators). RESULTS: A total of 204 documents met the inclusion criteria. Evidence from national level (55%) and local level (35%) represented about 90% of the sample. Overall, three implementation gaps were identified: 1) absence of two Regional Health Plans (in a total of 5 mainland health regions); 2) lack of about 1/3 of the expected Local Health Plans (16 out of 53) and, 3) low transposition (or approximation) of the PNS monitoring framework into the hospital and primary care contract-programs, one of the main management tools for planning. CONCLUSIONS: The identification and analysis of implementation gaps contribute to the final evaluation of the PNS. Moreover, the results can guide the next planning cycle pointing out sensitive areas of implementation which need more attention from various stakeholders. KEY MESSAGES: • Implementation gaps can compromise the impact of PNS as the strategic tool to set the necessary health interventions and their alignment at national, regional and local level of implementation. • The next planning cycle should tackle the identified implementation gaps with the purpose of strengthen PNS as a strategic planning platform and with the aim of maximize population health gains.