After waiting more than two years for the approval of the Five Regional Dementia Health Plans, in Portugal, which have been ready since July 2019, the country's Minister of Health finally issued the Act (nº 12761/2021 of 29.12.2021) approving these plans, at the end of 2021. This happened in the framework of The Mental Health Reform and the Portuguese Recovery and Resilience Plan. For the assessment of the implementation of each Regional Plan an Executive Committee was created and Alzheimer Portugal is a member of this Committee, represented by Catarina Alvarez, Institutional Relations Officer, and Rosário Zincke, Vice Chairperson.
The Committee is in charge of:
• assuring that the principles adopted in the Health Strategy for Dementia (Act of the Minister of Health nº 5988/2018) are followed (respect for the needs and preferences of people with dementia and for the ethical principles of care, informed consent and autonomy, community based care assuring their continuity, diversity, accessibility and equity
• monitoring the implementation of each plan and the fulfilment of the defined milestones
• collecting and coordinating the information provided by each region, according to the report model defined by the WHO Global Dementia Observatory
• giving opinions on issues related to the health of people with dementia, namely in what concerns health promotion, disease prevention and planning and organisation of care
• drafting a semesterly follow-up report to be submitted to the Minister of Health and to the Mental Health Politics National Coordination board.
The first follow-up report has been finalised and was delivered y to the Minister of Health at the end of July 2022. The above-mentioned Minister of Health Act (Act nº 12761/2021 of 29.12) also states that the Directorate General of Health is responsible for the updating of the Norm nº 53/2011 on the Therapeutic Approach in Cognitive Changes. This work is done and only waiting for formal approval. This is a very important achievement as it establishes the diagnosis criteria to be followed at the National Health Service. The same Act also defines that the ACSS, I.P. (Central Administration of the Health System) and the SPMS, E.P.E. (Shared Services of the Ministry of Health) are responsible for the creation of the framework necessary to make the mandatory informatic registration of the diagnosis (ICP2 and CID 10) at primary and hospital care. This will allow the identification of cognitive disorders and the improvement of the interoperability of information systems among the different levels of care. The final aim is to make possible the definition of an Individual Care Plan tailored to each person with dementia. This process is ongoing.
The implementation of the Regional Dementia Health Plans implies the creation, in each Health Region, of specific units, named “Unidades Coordenadoras Funcionais para as Demências” aiming to assure a better collaboration between the different levels of care and between these and people with dementia, family members and carers, in order to define the diagnosis and treatment pathways. These units exist already in the Five Regions but are still in the beginning of their implementation. According to guidelines defined by “The Conclusion of the Mental Health Reform and Implementation of the Dementia Strategy” each Region, bearing in mind its own specificities, defined a training plan on dementia to healthcare professionals and informal carers. There will be a common online training platform built by SPMS, E.P.E. (Shared Services of the Ministry of Health). Alzheimer Portugal, as a training entity recognised by the Governmental Department for Training Certification, will be involved in the delivery of training sessions having already being invited by the different Regions. This means that they will have the opportunity to share best practices and very specific knowledge and experience on dementia. The training is to be financed by funds from the Portuguese Recovery and Resilience Plan. Although training on dementia is obviously very important and needed, as it will enable healthcare professionals and informal carers to know more about dementia and to be more prepared to diagnose, treat and care for people with dementia, the reality is that, in Portugal, especially in inner and rural areas, people are not as aware as they could be about what dementia is and how to interact with a person with dementia. For this reason, and as a member of the Committee, Alzheimer Portugal stressed the importance of fighting against stigma and ignorance associated with dementia, and proposed the launch of a national awareness campaign led by the Government. This will, Alzheimer Portugal believes, significantly increase understanding and knowledge in the field of dementia. According to the organisation's proposal, part of the funds earmarked for the training programme will be allocated to this campaign. The awareness campaign will be launched by the end of this year. This is particularly good because it will not happen at the same time as Alzheimer Portugal's September awareness initiatives, for World Alzheimer's Day.
Alzheimer Portugal is very happy to be involved in the implementation of the Regional Dementia Health Plans. Its involvement is not only at national level, being a member of the Committee, but also at regional level, being also represented in the Algarve and in the Lisbon Health Regions. The organisation is aware that the process of really recognising dementia as a national priority in Portugal has been too slow and is far from being a complete reality. However, the ongoing implementation of the Regional Dementia Health Plans is nonetheless a very important step forward. Many achievements still are to happen. That is why Alzheimer Portugal has written a manifesto for a national, integrated approach to Alzheimer´s and other dementias, named “Pela Memória Futura” (For the Future Memory). It has four main axes: To prioritise (dementia has to be recognised as a national social and public health priority); to make it happen (“Concretizar” – turn ideas and politics into action); to create awareness (develop campaigns to make every stakeholders aware about dementia): and to connect (between the different stakeholders: health, social affairs and municipalities, among others, in order to reach a holistic approach to dementia care). This Manifesto has already been presented to the Members of the Parliament from the different parties of Portugal. The parties from the opposition showed interest in putting questions to the Government about the implementation of the Regional Dementia Plans, namely about the July 2022 report and when it will be published. Alzheimer Portugal's conversation with the Government's party was focused on what it thinks is the main gap – connection between the Ministry for Health and the Ministry for Labour and Social Affairs.
