The experts appointed by the Ministry of Health to audit the health system lament the administration’s lack of agility | The document will be published three years after the start of the health emergency
Two and a half years after the outbreak of covid-19, the report that is to evaluate the functioning of the National Health System during the pandemic is barely advancing and fails to meet the deadlines that both the Government and the committee of experts in charge had given themselves to write it. At the earliest, the final document will be ready by the end of this year or, more likely, already in 2023, three years after the start of the health emergency. “Bureaucratic obstacles” and “lack of agility of the administrations” are some of the causes of this enormous delay, point out sources close to the committee of experts that has been commissioned to carry out this work.
The pandemic management audit has been an obstacle course. In August 2020, 20 leading Spanish scientists published a letter in the scientific journal ‘The Lancet’ in which they demanded an examination of the functioning of Spanish health after the collapse suffered in the first wave of coronavirus, in the spring of that year. Given the lack of responses from the Ministry of Health, on September 21 they sent a second letter to ‘The Lancet’ and this time, yes, there was a reaction. The then Minister of Health, Salvador Illa, announced that a working group would be created with the autonomous communities to determine what the evaluation would be like.
“The objective of this working group will be to prepare a proposal for an evaluation framework for the National Health System (SNS). It will define the lines of evaluation, the scope, the objectives, the parameters and all those elements necessary to carry out an independent evaluation as complete as possible of the system as a whole. […] The evaluation of the actions carried out by the different health authorities during the pandemic, as well as the strengths and weaknesses of the SNS at the beginning of it, will allow the corresponding joint decisions to be taken to reinforce epidemiological surveillance, public health services and the entire healthcare system,” the Ministry of Health reported on October 7 in a statement. On December 2, the Interterritorial Council approved the text that would serve as a guide for this evaluation.
The broken calendar
of the evaluation of the
pandemic
20 renowned Spanish experts send a letter to the magazine
‘The Lancet’ to demand an independent evaluation of the
pandemic management.
Receiving no response, the scientists insist with a new letter in this journal.
The then Minister of Health, Salvador Illa, meets with the experts who demand the audit.
The Government and the communities agree to create a working group to define an independent evaluation of the management of
the pandemic by the National Health System.
The one-month period expires
the Interterritorial had been given to approve the evaluation guide.
Almost a month late, the report of the working group on the framework for conducting the evaluation is approved.
Ten months later, Minister Carolina Darias makes public
the names of the four experts
who will make up the committee.
The four month period expires.
that the Interterritorial had given to have the evaluation completed.
Deadline, also missed,
the experts had been given to
have the report.
The unfulfilled calendar
pandemic assessment
20 renowned Spanish experts send
a letter to the magazine ‘The Lancet’ to demand an independent evaluation of the management
of the pandemic.
Receiving no response, scientists insist
with a new letter in this magazine.
The then Minister of Health, Salvador Illa, meets with the experts who demand the audit.
The Government and the communities agree to create
a working group to define an independent evaluation of the management of the pandemic by the National Health System.
The period of one month that had been given
the Interterritorial to approve the evaluation guide.
Almost a month late, the report of the working group on the framework for conducting
the evaluation.
Ten months later, Minister Carolina Darias makes public the names of the four experts who will make up the committee.
The four-month period expires
the Interterritorial had been given to have
evaluation completed.
Deadline, also unfulfilled, that had been given
the experts to have the report.
The unfulfilled calendar
pandemic assessment
20 renowned Spanish experts send
a letter to the magazine ‘The Lancet’ to demand an independent evaluation of the management
of the pandemic.
Receiving no response, scientists insist
with a new letter in this magazine.
The then Minister of Health, Salvador Illa,
meets with the experts who claim the audit.
The Government and the communities agree to create
a working group to define an independent evaluation of the management of the pandemic by the National Health System.
The period of one month that had been given
the Interterritorial to approve the evaluation guide.
Almost a month late, the report of the working group on the framework for conducting
the evaluation.
Ten months later, Minister Carolina Darias makes public the names of the four experts who will make up the committee.
The four-month period expires
the Interterritorial had been given to have
evaluation completed.
Deadline, also unfulfilled, that had been given
the experts to have the report.
But Illa left the ministry to lead the PSC’s candidacy for the Catalan elections on February 14, 2021, he was replaced by Carolina Darias and everything stopped again. It took ten months for the Health and community technicians to select those in charge of writing the report. Darias made their names public on September 22, 2021, just one year ago. Those chosen were: Rosa Urbanos, expert in health economics and president of the Spanish Society of Public Health (Sespas); Fernando Rodríguez Artalejo, professor of preventive medicine; Carmen Pérez Romero, president of the Health Economics Association, and Xurxo Hervada Vidal, an epidemiologist who was deputy director of Information on Health and Epidemiology of the Xunta de Galicia.
unrealistic date
With a one-year delay since Illa brought the project forward, the specialists received a schedule that soon became impossible to meet. According to the agreement of December 2, 2020, the report had to be prepared four months after the election of the experts, that is, by the end of January 2022. But the experts were aware that this date was not realistic and they agreed. a new deadline: the summer of 2022. And yet, this new forecast has not been viable either.
In fact, the experts have not yet begun to write the final report. The Ministry of Health has contracted several companies that are carrying out “field work” collecting basic information “through surveys, workshops and focus groups, following ‘post-action’ methodologies established by the World Health Organization (WHO) and the European Center for Disease Prevention and Control (ECDC)’.
Carolina Darias and Salvador Illa at a press conference..
The four ‘wise men’, who hold regular meetings via videoconference, are now receiving the first reports, but they believe they will not have all of them until the end of this year, or even later, as some of the companies doing the fieldwork have set longer deadlines to finish their work. “And since the primary information is received, it will take at least another two months, being optimistic, to digest everything, synthesize and be able to finish the work,” explain the sources consulted, who do not hide a certain “disappointment.”
“The report is much more delayed than it was planned. It is advancing with the times of the administration”, lament those same sources who, however, maintain “the hope” that the document “is of some use because many changes are needed in many areas and above all, within public health” . “It is not about handing out sticks to everyone, but about contributing ideas that can help improve the system,” they maintain.
“Don’t Blame”
The committee of experts agrees with this idea with Rafael Bengoa, one of the great Spanish scientists and signer of the letters of ‘The Lancet’, who also believes that the result of the evaluation should offer solutions “for the future” and not be “guilty”. to prevent the administrations from feeling singled out and being able to get into a shell that prevents the necessary improvements». But at the same time, this former director of WHO Health Systems and former adviser to Obama believes that Spain “is a country that has decided that it is not necessary to quickly manage the pandemic. That does not interest either the PSOE government or the regional executives of the PP. And if we do not evaluate, are we going to be prepared for future variants, which are very likely to be? No. Are we still vulnerable? Yes”.
In addition, Bengoa considers that the evaluation in Spain has been too linked to the Ministry of Health to be considered “independent”. “We need more transparency,” says Bengoa, who is in favor of the creation of an independent health responsibility authority, in the style of AIReF, which is in charge of financial matters. “A healthcare AIReF would allow citizens to be credibly and periodically informed about the situation of our healthcare system,” asserts this expert.
The Spanish committee that is evaluating the health system has seen how other reports have come before them, such as the one published last week in ‘The Lancet’, which charged against the management of the pandemic by the WHO. And although there were no specific chapters for each country, the epidemiologist Jeffrey Lazarus, co-director of the Viral and Bacterial Infections Program at the Barcelona Institute for Global Health (ISGlobal) and one of the 28 experts chosen by the scientific journal to write his text, underlines that in Spain “many mistakes have been and continue to be made”. “The Government still does not have a plan in the face of the possibility that the pandemic scenario worsens,” Lazarus stresses.
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