Evaluability assessment (EA), conducted independently or as part of a broader evaluation process, is performed to determine whether a program, policy, or intervention is ready and suitable for evaluation. This study explores the innovative application of EA as a design-stage tool for guiding complex health interventions. It focuses on the VAX-TRUST - Addressing Vaccine Hesitancy in Europe project, where EA was employed to design and refine interventions addressing vaccine hesitancy across seven European regions. EA was applied in a qualitative approach using an evaluability checklist. This tool facilitated iterative improvements in intervention design, implementation planning, and evaluation readiness, ensuring interventions were robust and contextually relevant. Additionally, efforts were made to qualitatively measure the impact of the evaluability assessment through an evaluability impact matrix. EA significantly influenced intervention design by identifying gaps and guiding real-time adjustments. Six of the seven interventions were successfully implemented with enhanced planning for unforeseen events, showcasing the iterative benefits of EA in the design phase. The iterative nature of EA allowed for real-time adjustments that enhanced program robustness and adaptability. Insights into the checklist’s gaps, such as underdeveloped resource allocation metrics, are discussed to improve future applications. This work advances EA literature by demonstrating its utility in the design stage and, by reinforcing the early alignment of different components and multiple contexts, provides a replicable framework for planning complex health interventions. Future evaluators are encouraged to adopt this proactive approach for more effective public health strategies.

Nurse retention is a critical challenge across Europe, directly affecting workforce sustainability, quality of care, and health systems resilience. Despite persistent shortages and increasing emigration, evidence on nurse retention determinants within the Portuguese National Health Service (NHS) remains limited. This study aims to identify factors influencing nurses' intention to stay in the NHS, contributing to national and European debates on sustainable workforce strategies. A quantitative, observational, cross-sectional survey was conducted among a representative sample of 1494 nurses working in NHS. A validated questionnaire was developed using a Nominal Group Technique and Delphi Panel with stakeholders, to measure job satisfaction with Likert scales. Inferential statistical analyses, including t-tests and multiple linear regression, examined associations between intention to stay and factors such as job satisfaction, work-life balance, career development opportunities, remuneration, and sociodemographic characteristics. Fixed work schedules, overall job satisfaction, age, satisfaction with work-life balance, and career development emerged as significant predictors of intention to stay. Satisfaction with salary and financial incentives, while low, was not statistically significant. Findings highlight the importance of integrated workforce retention strategies combining organizational improvements, career progression pathways, and work-life balance policies. These findings differ from those observed among physicians in parallel research, confirming the need for profession-specific retention approaches. This study provides new evidence on nurse retention in Portugal, reinforcing the need for human resources policies aligned with European Union priorities on workforce sustainability. Cross-country policy learning and evidence-informed, context-sensitive strategies are crucial for supporting nurse retention and health system resilience.

Background: Evidence suggests that healthcare professionals often feel uncomfortable discussing vaccination with patients, largely due to a lack of training on the topic. In line with the scientific evidence gathered from the VAX-TRUST project, it is crucial to invest in training healthcare professionals and developing political measures to effectively address vaccine hesitancy. This paper explores the importance of training healthcare professionals to address vaccine hesitancy and provides concrete strategies for its implementation. Study design: A quantitative research design was used. Methods: The findings are based on a comprehensive Delphi survey conducted with a panel of 112 experts. Additionally, the study involved practical interventions carried out across seven European countries, engaging a total of 694 participants. These participants included general practitioners (GPs), paediatricians, nurses, as well as medical and nursing students. This robust and diverse dataset provides a well-rounded perspective on the subject matter, ensuring that the insights gained are both extensive and representative of various healthcare professionals across Europe. Results: Three key themes emerged from the findings: the need for effective strategies to address communication challenges with vaccine-hesitant individuals, the importance of using evidence-based communication practices to improve these interactions, and the necessity of integrating social scientific knowledge on vaccination into the training of healthcare professionals. Conclusions: Training healthcare professionals is essential to equip them with skills and knowledge needed to deal with the complexities of vaccine hesitancy. Evidence was gathered on ways to reflect and act to develop this capacity, namely, by increasing the ability to communicate empathetically, responding to patients' concerns with evidence-based information, and to building stronger and more collaborative relationships with them.

Vaccine hesitancy presents significant challenges to public health, exacerbated by a lack of cohesive policies in Europe. Recognized as a complex social phenomenon influenced by various factors, vaccine hesitancy threatens health systems and public trust. This paper analyses the political background and current gaps in policies addressing vaccine hesitancy, with a specific focus on the role of healthcare authorities, organizations and professionals in shaping effective responses. The VAX-TRUST project, funded by H2020 and conducted in seven European countries, provides a framework for translating social scientific research into actionable strategies within healthcare settings. Using methodologies such as the Delphi method, the project developed the ASTARE model, which encompasses six dimensions: Awareness, Support, Training, Agency, Recognition, and Engagement. These dimensions guide tailored recommendations to strengthen the capacity of healthcare professionals, organizations, and authorities in addressing vaccine hesitancy, enhancing public trust, and vaccine confidence and uptake. The paper highlights the necessity of evidence-based, collaborative, and adaptive policies that raise public awareness, counteract misinformation, and support healthcare professionals. Effective policymaking requires understanding legislative processes, leveraging scientific evidence, and fostering stakeholder participation. By emphasizing context-sensitive interventions and culturally informed strategies, this study provides a comprehensive approach for health systems to address vaccine hesitancy and improve public health outcomes across Europe.

The global health and care workforce (HCWF) is facing an evolving crisis, requiring urgent and sustained action. There is a critical need for enhanced workforce planning, management, and leadership, which are currently at risk of being overshadowed by political inertia, particularly in the post-COVID-19 context. A comprehensive approach tailored to the specific needs of different countries is outlined here, offering actionable insights for policymakers and stakeholders to address the HCWF crisis effectively. Key areas for critical analysis and improvement include identifying major challenges, developing policies that effectively address the HCWF crisis, and strengthening the implementation of evidence-based policies. These areas are detailed based on recent developments in the international debate, with the aim of providing comprehensive guidance for understanding the problems and identifying clear actions for improvement.

This article presents the design of a seven-country study focusing on childhood vaccines, Addressing Vaccine Hesitancy in Europe (VAX-TRUST), developed during the COVID-19 pandemic. The study consists of (a) situation analysis of vaccine hesitancy (examination of individual, socio-demographic and macro-level factors of vaccine hesitancy and analysis of media coverage on vaccines and vaccination and (b) participant observation and in-depth interviews of healthcare professionals and vaccine-hesitant parents. These analyses were used to design interventions aimed at increasing awareness on the complexity of vaccine hesitancy among healthcare professionals involved in discussing childhood vaccines with parents. We present the selection of countries and regions, the conceptual basis of the study, details of the data collection and the process of designing and evaluating the interventions, as well as the potential impact of the study. Laying out our research design serves as an example of how to translate complex public health issues into social scientific study and methods.

AbstractThe 2030 Agenda for Sustainable Development highlighted the growing attention to the adequacy of health planning models to sustainable development. A re‐reading of the results of a round table debate on “sustainable planning”, which took place at the 5th National Congress of Tropical Medicine (Portugal, 2019) under a participant observation strategy, framed by the findings of a “synthesis of better evidence” literature review and cross–referenced with the reflections of different authors and experts about the momentum created by the COVID–19 pandemic, underlined the challenges to sustainable health planning that have emerged and are projected beyond the current pandemic context. Variable perceptions of the term “sustainable health development”, leading to the potential loss of their relevance in guiding the elaboration of policies and strategic plans, and the potential higher effectiveness of the participatory approaches of health planning in achieving sustainable health were highlighted in the debate and literature, in general and in public health emergency contexts. Those results gained new relevance during the current COVID–19 pandemic, bringing back to the forefront a reflection of the inadequate planning framework that has usually been used to understand and respond to global health challenges, despite the already existing experience, evidence and support instruments.

Background In Europe, data on population health is fragmented, difficult to access, project-based and prone to health information inequalities in terms of availability, accessibility and especially in quality between and within countries. This situation is further exacerbated and exposed by the recent COVID-19 pandemic. The Joint Action on Health Information (InfAct) that builds on previous works of the BRIDGE Health project, carried out collaborative action to set up a sustainable infrastructure for health information in the European Union (EU). The aim of this paper is to present InfAct’s proposal for a sustainable research infrastructure, the Distributed Infrastructure on Population Health (DIPoH), which includes the setup of a Health Information Portal on population health to be maintained beyond InfAct’s time span. Methods The strategy for the proposal was based on three components: scientific initiatives and proposals to improve Health Information Systems (HIS), exploration of technical acceptability and feasibility, and finally obtaining high-level political support.. The technical exploration (Technical Dialogues—TD) was assumed by technical experts proposed by the countries, and political guidance was provided by the Assembly of Members (AoM), which gathered representatives from Ministries of Health and Science of EU/EEA countries. The results from the AoM and the TD were integrated in the sustainability plan compiling all the major outputs of InfAct. Results The InfAct sustainability plan was organized in three main sections: a proposal of a new research infrastructure on population health (the DIPoH), new health information tools and innovative proposals for HIS, and a comprehensive capacity building programme. These activities were carried out in InfAct and are being further developed in the Population Health Information Research Infrastructure (PHIRI). PHIRI is a practical rollout of DIPoH facilitating and generating the best available evidence for research on health and wellbeing of populations as impacted by COVID-19. Conclusions The sustainability plan received wide support from Member States and was recognized to have an added value at EU level. Nevertheless, there were several aspects which still need to be considered for the near future such as: (i) a commitment of stable financial and political support by Member States (MSs), (ii) the availability of resources at regional, national and European level to deal with innovations, and (iii) a more direct involvement from EU and international institutions such as the European Centre for Disease Prevention and Control (ECDC), the World Health Organization (WHO) and the Organisation for Economic Cooperation and Development OECD for providing support and sustainable contributions.

Healthcare assistants have a supporting role of more qualified professionals. They are a considerable and unknow part of the Portuguese health workforce. The professional profile and the Technical Healthcare Assistant course, published in 2010, brought changes that have not yet been studied. part of an investigation that analyses these policies, this study aims to contribute to the understanding of the national and international contexts of definition and implementation of these measures. Through interviews and documentary analysis, a description and analysis of the evolution of the profile, activity and training of Health Assistants in the public sector from 1971 to 2019 was carried out, a three-stage course punctuated by changes in their professional categories, designation and functions. Aligned with national and European qualification strategies, the profile of Health Assistant Technician, in addition to a clear activity description, boosted a basic training offer that did not exist until then. Contrary to what was seen in other countries, it did not give rise to legal mechanisms to regulate activity or access the labor market, nor did it have a direct impact on the status of healthcare assistants in the public sector.

Introduction: The weaknesses of Guinea-Bissau’s health system have long been highlighted. The purpose of this study is to contribute with evidence for decision-making on the reform of the country’s healthcare map, by analyzing the availability and readiness of services at the facilities that may become part of a Hospital Complex in Bissau, proposed in the National Health Development Plan.Material and Methods: We analyzed 13 public and private facilities with inpatient capacity, located in Bissau and Biombo. Service Availability and Readiness Assessment (SARA) tools were used for data collection, treatment and analysis.Results: A comprehensive overview of these facilities has been provided, describing their general capacity to provide care and their readiness to implement it, along with the availability and readiness of specific services: diagnosis, family planning, mother and child health, obstetrics, communicable and non communicable diseases, blood transfusion and surgery. We observed a greater concentration of beds and professionals in the facilities of public sector, the only that provides all the specific services analyzed. Private sector services with agreements to supply the public sector have higher readiness levels and the private sector has the lowest operating capacity.Discussion: Findings reflect the lack of equipment, infrastructure and resources, the predominance of the public sector and the growth of the private for-profit and non-profit sectors, as well as inadequacies in planning and regulation. Similarities and differences between our findings and those described in the literature for other African countries are identified.Conclusion: This study reinforces the relevance of developing integrated and rational responses of health services and provides evidence for this.

Introduction: Information and Communication Technologies (ICT) can contribute to the development and consolidation of health systems. From the analysis of three cases, this article seeks to contribute to the knowledge about the opportunities that ICT represents in the lusophone space, describing and identifying good practices, difficulties and opportunities to reinforce a common agenda. Material and methods: From expert presentations at a round table on the ICT Contribution to Health Services in low-income countries and a narrative literature review, interventions in Cape Verde, Mozambique and Guinea-Bissau are analyzed and discussed. Results and discussion: The examples analyzed, despite differences in maturity, show common factors of success (professional qualification, political support) and difficulties (high investment, resistance of professionals), as well as benefits introduced in health systems (savings, higher access), challenges and opportunities for the future (sustainability and partnerships). Conclusion: The ICT use in these health systems shows different maturities, as higher the greater the bet in the training of professionals, in access to resources and financing, in the prioritization policies to promote national telehealth centers. The reinforcement of partnerships in the CPLP to share solutions and knowledge are guarantees of higher growth and sustainability.

Abstract Background New developments and technologies require skilled professionals to manage and use public health information in most efficient ways. However, currently training in specific fields is lacking and large inequalities exist in Europe in terms of the availability and training of qualified professionals. Methods In order to set up a sustainable EU HI training program for HI professionals, core modules need to be selected to provide adequate training across Europe. This study a scoping review and is doing a survey on current existing HI programmes and aimes to identify the main educational components needed to train HI professionals. The databases of Pubmed and Ebsco were searched for the scoping review. The survey is being circulated to representatives of InfAct in 28 countries. Based on the results a baseline HI training programme for practicing public health professionals will be proposed. Results Initial search identified 249 papers. After the exclusion of duplicates and unavailable documents, 53 papers were selected for review. Only 5 papers were found related to the European context. However the results from other papers could be extrapolated. The results were organised in 3 domains: organisation, people and technology dimensions. The development of HI capacities is often done through multiple and sequential interventions, which are adapted to the needs, conditions and resources available within each HIS. Thus, the importance of aligning training with working processes and usability in professional practice is key. This can be challenging, as HI functions are diverse across Europe. The results of the survey will be presented when processed by the time of the workshop. Conclusions There is a need for qualified skilled professionals in HI taking into account a changing global environment. Most of HI capacity building programmes are yet to reach maturity, and this review and survey identify a set of important areas for further development of the HI training programme.

Abstract Background Sound and reliable information is fundamental to decision-making across all health system. New information technologies can contribute to a more accurate and efficient public health action, requiring new and more sophisticated skills to support this change. Considering the European context, where public health professionals vary by country and cover different areas, and the need for a skilled workforce, the objective of this study is to identify the basic educational components required for a public health information specialist. This study is part of the ongoing research under INFACT Joint Action. Methods A scope review (Pubmed/Ebsco, free access texts, no time restrictions) was carried out in order to answer the following question: Considering the set of activities of public health, what are the main topics and trends of the literature on both Human Resources and Health Information Systems (HIS) training? Abstracts were read by two reviewers and the select texts analyzed using HOT-FIT framework for HIS. Results Among the 53 records, it was possible to identify different study designs and elements related to different contexts and HIS. There is a trend for new publications, with a significant increase since 2014. The content analysis showed more frequent themes in three main categories - Human, Organization and Technology, allowing identifying a wide range of public health professionals and their educational needs. Conclusions Results reinforce the link between information systems and public health, showing the importance of regular HIS as data source for monitoring population health, specific events and determinants, management and research activities and during the stages of the planning cycle of public health activities. The proper workforce capacitation emerges as a success factor for HIS implementation, as well as several professional profiles that carry out public health activities and the areas where it is necessary to strengthen their training. Key messages There’s growing interest in the use of technologies for the development of public health information systems. Workforce needs to develop specific skills for the technological challenges in Public Health.

Introduction: In recent decades, countries and health systems have been paying increasing attention to planning practice for sustainable development. Recognizing the specific challenges facing health planning,this article aims to contribute to the reflection on the concept and procedural and methodological characteristics of sustainable health planning, based on the main messages gathered in a panel discussionof the 5th National Congress of Tropical Medicine. Material and methods: We used the panel presentations and discussion interventions, in addition with documentary sources resulting from a narrative literature review. All material was subject to documentaryanalysis. Results and discussion: Participatory approaches to health planning, integrating community participation and intersectoral action, with a particular focus on reducing health inequities and achieving universal coverage, were considered to be among the most effective to achieve health and well-being goals aligned with the principles of sustainable development. Conclusion: Social and community mobilization in the health planning process seems to contribute to the selection and implementation of health strategies in the context of sustainable development.

The adoption of the Sustainable Development Goals and the achievement of universal health coverage in Europe make a health workforce fit-forthis purposes more necessary than ever. Several examples of WHO initiatives or distinct measures implemented in different countries show that there is a knowledge base for strengthen the health workforce that seems to be underutilized by policy-makers, which raises questions about technical and political difficulties in sharing, integrating and implementing innovation. With these questions in mind, the Institute for Hygiene and Tropical Medicine (Lisbon) convened a conference to take stock of some innovations in education, teamwork, skills-mix, recruitment and retention, planning, management and governance and to discuss their contribution to improve the performance of the health workforce. Additionally, participants reflected on facilitators and barriers to changing the health workforce. The authors of this paper gathered the take-home of the event. This article presents the main messages drawn from the presentations, intersecting them with literature, and discusses the issue of the use of evidence to inform policy and decision-making in relation to health workforce development. It emphasizes the need to promote innovation through evidence-based and agenda-driven strategies, which considers sociopolitical contexts, population needs and stakeholder engagement.

Considerada pela OMS como epidemia global e um dos maiores desafios da saúde pública do século XXI, a obesidade é uma doença crónica com múltiplas causas, com destaque para as comportamentais, nomeadamente alterações ao padrão alimentar e sedentarismo. Constitui fator de risco de várias patologias, como diabetes tipo 2 ou cardiovascular, contribuindo para diminuição da qualidade de vida dos indivíduos e aumento dos custos com a saúde. O excesso de peso tem efeitos negativos imediatos na saúde individual de crianças e jovens, aumentando o risco de apresentarem obesidade e suas comorbilidades na idade adulta. O crescimento do problema em idades infantojuvenis e a maior facilidade na introdução de mudança nos seus comportamentos sustentam recomendações para uma intervenção prioritária junto destas faixas etárias. Diversos estudos evidenciam agravamento do problema na população portuguesa, sendo a prevalência entre crianças e jovens das mais elevadas na Europa. Este facto, associado aos custos individuais, sociais e económicos da doença, constitui foco de interesse para quem estuda os sistemas de saúde, tendo‐se procurado, com esta investigação, compreender a evolução das políticas e estratégias de prevenção e combate à obesidade infantil e dos jovens ao nível do planeamento estratégico em Portugal. Recorrendo a uma metodologia qualitativa, fez‐se a análise dos conteúdos e estrutura de um Corpus Documental, que incluiu, entre outros, a Estratégia de Saúde para o Virar do Século (1998‐2002), Plano Nacional de Saúde 2004‐2010 e a versão preliminar do PNS 2012‐2016, complementando‐a com consulta pontual a informadores‐chave. Os resultados permitem uma visão sequencial do planeamento estratégico em Portugal e mostram que ao aumento de prevalência de excesso de peso na população correspondeu um ganho de importância do problema nas preocupações das autoridades de saúde. Verifica‐se ainda que a preocupação com o aumento da prevalência em crianças e jovens se refletiu mais tardiamente nos documentos estratégicos. Conclui‐se também que o assumir do problema enquanto prioridade política surge após a aprovação da Carta Europeia de Luta Contra a Obesidade, de que Portugal é signatário, sendo possível estabelecer correspondência entre os princípios deste documento e as orientações estratégicas do PNS 2012‐2016. Considered by WHO as a global epidemic and one of the greatest public health challenges of the twenty‐first century, Obesity is a chronic disease with multiple causes, especially behavioural changes like dietary changes and sedentary lifestyle. It is a risk factor for other conditions, such as diabetes or cardiovascular diseases, associated with the decrease of life quality of individual and the increase of health costs. Overweight has immediate negative effects on individual health of young people, increasing the risk of Obesity and its co‐morbidities in their adult age. The fact of being a growing problem among children and youth, coupled with a relatively high permeability of members of these age groups to behavioral changes is at the basis of recommendations to a priority intervention with these groups. Several studies show that the problem is growing among the Portuguese population, being the prevalence among children and youth one of the highest in Europe. This fact, together with the individual, social and economic burden of the disease, is of interest to those who study the evolution of health systems. With this investigation, we tried to understand the evolution of policies and strategies for preventing and combating Obesity among children and young people at strategic management level in Portugal. With a qualitative methodology, we analyzed the semantic and content of a set of documents, including the Health Strategy (1998‐2002), the National Health Plan 2004‐2010 and the draft of the National Health Plan 2012‐2016, complementing it with ad hoc query with key informants. Our results permit one overview of strategic planning in Portugal and show that the increasing concern of Portuguese health authorities with the growing impact of Obesity in the population. However the concern with its increase among children and young people risen later in the strategic documents. We established that the problem became a political priority after the approval of the European Charter on Counteracting Obesity, of which Portugal is a signatory member, and it's possible to find a correspondence between the principles of the European Charter and the strategic guidelines of the National Health Plan 2012‐2016.