Estrategia de Vigilancia en Salud Pública del Sistema Nacional de Salud: Respondiendo a los Retos de la Vigilancia en España: Modelando el Futuro

Objectives

The Strategy seeks to establish a modern, integrated, harmonised and equity-oriented public health surveillance system across Spain’s National Health System. It envisages the State Public Health Surveillance Network as a network of networks that coordinates surveillance of health status, wellbeing, morbidity, mortality, risks, determinants, inequalities and other factors affecting population health, producing timely evidence for public health action and decision-making.[1][2][3]

• Develop homogeneous and effective surveillance by setting common minimum requirements, quality standards, core indicators, information sources, functional structures and an updated public health service portfolio, while reducing territorial differences in capacity, information quality and risk assessment.[4][5][6]
• Strengthen workforce capacity by defining professional profiles and competencies, assessing staffing requirements, supporting recruitment, training, accreditation, career development and generational renewal, and enabling multidisciplinary teams with analytical, technological and multisectoral expertise.[7][8][9]
• Support evidence-based decisions by providing timely, accessible, contextualised and interpretable surveillance information for authorities, managers, professionals and the public, including for health-impact assessment of laws, plans, programmes and projects.[10][11][12]
• Modernise information systems through interoperability, common exchange standards, reusable and scalable technologies, unique identifiers, detailed coding standards, secure data linkage and improved access to relevant health and non-health data.[13][14][15]
• Promote innovation and applied research on new data sources, data protection, emergencies, climate change, health inequalities, mental health, emerging technologies and effective communication of surveillance findings.[16][17][18]
• Apply ethical, rights-based and equity-focused surveillance by balancing individual rights and collective interests, collecting only necessary and sufficient data, protecting confidentiality, preventing harm, supporting participation and addressing social determinants and inequalities.[19][20][21]
• Embed a One Health approach that connects human, animal and environmental health, including work on food safety, zoonoses, antimicrobial resistance and other shared threats.[22][23]

Implementation

Implementation is based on coordinated action by the Ministry of Health, autonomous communities and cities with Statutes of Autonomy, the Carlos III Health Institute and other health and non-health actors. A Royal Decree is intended to establish the State Public Health Surveillance Network, including the Early Warning and Rapid Response System, while the Strategy uses phased actions, baseline assessments, technical working groups and periodic evaluation to guide delivery.[2][24][25][26]

• Govern through an Institutional Committee, identified as the Public Health Commission, which approves and prioritises objectives, actions, indicators and evaluation, and through a Technical Committee that develops objectives, actions and indicators, provides scientific input and participates in implementation and evaluation.[24][4]
• Engage an Advisory Group of scientific societies and subject experts, alongside relevant Ministry units, autonomous-community representatives, the Carlos III Health Institute, research bodies, public health managers, professionals, citizens and other sectors affecting population health.[27][28][4]
• Establish central coordination within the Ministry of Health and corresponding regional public-health-led structures to centralise and coordinate territorial surveillance, define organisational procedures and maintain stable data-collection and transmission arrangements.[29][25][30]
• Integrate existing surveillance systems and data sources across health care, laboratories, public health, environmental and social sectors, while addressing differences in regional organisational models, technology, data access and system maturity.[31][32][33]
• Develop digital infrastructure through a central surveillance node, improved communicable-disease notification, interoperable information systems, automated data ingestion, interactive presentation tools and capabilities for large-scale data analysis.[33][34][17]
• Support workforce implementation through a Human Resources Commission working group, staffing-need indicators by population and surveillance subject, defined access-training requirements, continuing education and recognition of professional careers.[9][10]
• Coordinate intersectoral action through collaboration agreements, identified stakeholder groups and an intersectoral body involving relevant ministerial departments, particularly where surveillance requires health, social, environmental, animal-health or other data.[22][30][35]

Monitoring combines updated situation analyses, system catalogues, capacity assessments, implementation indicators and evaluation of network performance. Indicator definitions are to cover their rationale, dimensions, formulas, populations, data sources and standards; the Strategy provides for evaluation at two to three years and again at five years after approval by the Interterritorial Council of the National Health System.[36][6][26][37]

• Measure implementation through structure, process and outcome indicators, including standards for surveillance units, workforce profiles and competencies, interoperable systems, data-sharing procedures, dissemination arrangements and legal development of the Network.[24][38][39]
• Assess data quality and governance through procedures covering completeness, reliability, validity, timeliness, protocol compliance, secure identifiable-data handling, regulated research access and records of unsuitable or refused transfers.[13][20]
• Evaluate whether surveillance outputs are used in public health measures, health-impact assessments, decision-making and communication with professionals, policymakers, civil-society organisations and the public.[11][12][40]
• Finance information-system development partly through credits transferred to autonomous communities in 2021 under Component 18 of Spain’s Recovery, Transformation and Resilience Plan, alongside European funding for central developments; the supplied material does not provide monetary amounts or a total Strategy budget.[36][33]

Monitoring & Evaluation

The Strategy establishes a national monitoring, evaluation and accountability framework for the State Public Health Surveillance Network, combining periodic assessment, structure, process and outcome indicators, baseline analysis, technical reporting and governance oversight.[24][26]Surveillance is defined as the collection, analysis, interpretation and dissemination of information on population health and its determinants to inform timely public health action, intervention planning and evaluation.[41][42]

• Assess implementation continuously through updated baseline analyses of surveillance systems, procedures and organisational structures at state, autonomous-community and autonomous-city levels.[5][6]An updated national and autonomous-community baseline assessment is planned in the first year.[37]
• Develop a basic indicator set for the Network and standards covering functional structures, human resources and technology, enabling assessment of differences between autonomous communities.[6]Indicator definitions are to cover their rationale, dimensions, formulae, populations, information sources and standards.[26]
• Use structure, process and outcome indicators to assess implementation after approval by the Interterritorial Council of the National Health System.[24]Annex II contains achievement indicators, while a working group is expected to submit a final proposal on definitions to the Institutional Committee within six months of approval.[26]
• Evaluate the Strategy two to three years after approval and again after five years.[26][37]Use evaluation findings, emerging evidence and new knowledge to update the Strategy during its period of validity.[24]
• Assign oversight roles to the Institutional Committee, which approves and prioritises objectives, actions and indicators and approves the evaluation; the Technical Committee develops objectives, actions and indicators and participates in implementation and evaluation; and the Advisory Group supports monitoring.[24][4]
• Monitor implementation of the Network through the Strategy’s Technical Secretariat, and periodically assess whether national and regional surveillance structures meet their objectives and possess the necessary resources.[30][26]
• Assess surveillance-system capacity through structured surveys of organisational arrangements, workforce and professional profiles, 24-hour alert systems, their legal basis, shift arrangements and on-call remuneration.[36]Maintain a catalogue and baseline assessment of systems, documenting their basic characteristics, strengths, weaknesses and potential use.[36]
• Monitor information-system development, including autonomous-community projects funded for the Network, interoperability with central developments, and the requirements for further central-level development.[36]Track interoperability between disease surveillance, laboratories, hospital records and primary-care records, as well as system characteristics such as coding standards, data-quality controls, evaluation procedures and access arrangements.[33]
• Apply common procedures for disseminating surveillance-data analyses and evaluate the Network to improve effectiveness and efficiency at all levels.[8]Use surveillance outputs to support policy-making, public communication and intervention assessment.[7][33]
• Ensure that public health measures include surveillance mechanisms for evaluation and follow-up, including use of Network information in health-impact assessments of regulations, plans, programmes and projects.[11][13]
• Measure workforce implementation through indicators on professional profiles, competencies, workforce needs by population and surveillance subject, advertised posts, suitability of access profiles and recognition of professional careers.[43][44]
• Monitor data quality through standardised procedures for reliability, validity, completeness and epidemiological analysis, alongside quality controls verifying the sufficiency, timeliness, reliability, validity and protocol compliance of Network data.[13][20]
• Monitor ethical and equity dimensions by tracking protocol changes, assessing potential harms for people in vulnerable situations, measuring inclusion of inequality axes in surveillance information and analysis, and evaluating whether communications reach and are used by intended audiences.[19][20][21]
• Track digital modernisation through inventories of relevant data, agreements for data-source use, compatibility standards, identification of interoperable systems, annual counts of connected systems, use of unique identifiers and adoption of coding standards.[39][45]
• Monitor innovation through coordination mechanisms, methods to identify and pilot good practice, repositories and websites, participation in research and innovation calls, and the number of Spanish surveillance publications in journals with an impact factor.[46][18]

The Strategy includes some explicit binary indicators, including whether the legal basis is updated through the Royal Decree and related ministerial orders, and whether designated coordinating structures and an intersectoral coordination body exist.[47][40][35]Several extracts do not specify numerical targets, a consolidated reporting timetable, enforcement measures, sanctions or an independent evaluation mechanism.[23][5][20]

Costing & Financing

Costing information is limited: the Strategy repeatedly identifies workforce, technological, material and budgetary capacity as necessary for effective surveillance, but does not provide a total budget, monetary allocations, unit costs, quantified funding gaps or economic assumptions.[48][7][5]

• Provide adequately sized multidisciplinary workforces, technological capacity and budgetary resources for public health structures, including continuous 24/7/365 surveillance and health-protection capacity.[7]
• Plan staffing by population covered, surveillance subject and professional profile, while supporting recruitment, training, competency development, professional recognition and generational renewal.[8][9][10]
• Use Ministry of Health credit transferred to autonomous communities in 2021 to develop the State Public Health Surveillance Network information system under Component 18, “Increasing response capacities to health crises”, of Spain’s Recovery, Transformation and Resilience Plan.[36]
• Use European credits for central-level information-system developments and for autonomous-community and central surveillance-node projects under the Recovery, Transformation and Resilience Plan; no monetary value is supplied.[36][32][33]
• Mobilise health-research resources primarily through the Carlos III Health Institute under the State Plan for Scientific, Technical and Innovation Research 2021-2023, which prioritises health research and public health.[28]
• Minimise software-development costs by reusing modular and scalable systems, assessing open-source software, and exchanging technological developments between administrations.[15][45]
• Identify financing sources for innovative surveillance projects and align surveillance needs with regional, national and European research and innovation programmes and calls.[16][17]

No source extract specifies the amount of the 2021 transfer, the value of European credits, expenditure by activity, financing mechanisms beyond the cited programmes, or a resource-mobilisation plan to close identified gaps.[36][32][16]