Healthy Andalusia

Healthy Andalusia


Andalusia, one of the largest regions in Europe, is located in the south of Spain, with its coastline bathed by the waters of the Mediterranean and the Atlantic.

Main figures

With a size of 87,597 square kilometers, and a population of 8,302,923 inhabitants (Dec 2009), Andalusia is the most populated autonomous community in Spain. 16,25% of the population is younger than 15 years of age and 14,75% is older than 65. There are 526,942 immigrants living in the region (50% from the EU, 24% from America, 21% from Africa). 1,531,668 Andalusians live in Spain outside Andalusia, and there are 140,000 more outside Spain.



IMPROVE THE PUBLIC HEALTHCARE SYSTEM, based on the values of universality, access to good quality care, equity and solidarity.

MODERNIZE HEALTH ORGANIZATIONS, making them more flexible and citizen – centred, ensuring clinical governance and transparency.




Quality as the driving force:

  • A strongly coordinated and efficient public system in continuous growth.

  • Quality-driven for response time, accessibility, continuity, familiarity, comfort, human touch, high technology, safety and efficient performance.

Accesibility and Transparency:

  • More and better-informed citizens with increased freedom to make decisions, take greater responsibility for their own health, and gain equal opportunities through transparent and accurate information.A strongly coordinated and efficient public system in continuous growth.

Social Control:

  • Active social participation on an individual and collective basis.

  • An organization that listens to its citizens and allows them to participate in decisions making.

Professional Participation:

  • Obtaining, recognizing and stimulating commitment from professionals is the key to success and to secure their essential participation.


CITIZENS at the Center of the Health System

Citizens are the center of the Andalusian Public Health System. They show great satisfaction at the health care they receive, towards both the professionals and the organization. These results are measured by means of an annual user - satisfaction survey.

Different measures have been designed to empower citizens and patients with new rights in health care:

  • SECOND MEDICAL OPINION: in cases of serious illness, citizens have the right to demand a qualified second opinion, which is provided by experts within 30 days since of application.

  • LIVING WILLS: Andalusian citizens have the right to record their wills on a specific Registry regarding limits to health care in situations where communication is not possible. Physicians have the obligation to consult this registry before applying special treatment to patients who are unable to communicate.

  • DIGNITY IN THE PROCESS OF DEATH (DEATH WITH DIGNITY ACT): to guarantee adequate healthcare during life’s final process based on suffering prevention and respect for each person’s dignity and free choice. Includes: home palliative care, single rooms in hospitals or palliative sedation if necessary.

  • DENTAL CARE FOR CHILDREN AND PREGNANT WOMEN: free for 6 to 15 year-olds and women during pregnancy.

  • DENTAL CARE FOR HANDICAPPED: the coverage by the public dental care services has been extended to handicapped people.

  •   SURGERY WAITING LISTS: the Andalusian government was the first in our country to introduce the legal right to a guaranteed maximum waiting period for surgery (180 days). Recently it has been updated, reducing the waiting time for the most common interventions to 120 days. The information is available at the Department of Health web page.  
  • OUTPATIENT SPECIALIZED CARE AND DIAGNOSTIC PROCEDURES WAITING LISTS: legal rights have been extended to guarantee a maximum delay for outpatient specialized care (60 days for first referral from the primary health physician) and the most common diagnostic procedures (30 days).

  • PREIMPLANTATIONAL GENETIC DIAGNOSIS (PGD): the Public Health Care System has included PGD to avoid the transmission of genetic disorders. This service is offered in a public hospital.

  • GENETIC COUNSELING: new integrated genetic units providing genetic testing and counseling are being implemented. This is one a number of measures listed in the Andalusian Genetic Plan.

  • CHILDREN NEEDS IN HEALTH CARE FACILITIES AND SERVICES: health care facilities and services are being adapted to the special needs and requirements of children and newborns who are accompanied by a close relative (mother or father) during their stay in hospitals.

  • ELDERLY ANNUAL CHECK-UP: people over 65 years old are contacted to assess their health status and are offered the health services they may need.



  • PROTECTION OF TEENAGERS UNDERGOING AESTHETIC SURGERY: includes psychological test for maturity before the consent form is signed as well as the obligations for aesthetic units and centres.

Family support measures

  • Chronic homecare plans and community nursing activities
  • Extension of Rehabilitation units throughout the territory, including mobile units for home rehabilitation care
  • Improvement of mental health care services

The citizens voice

  • Area Health Committees by province
  • Annual survey on user satisfaction
  • Virtual Office –InterS@S-, where the user can choose a primary health care physician or center, update his/her personal data, make requests,…
  • Call center: single telephone number, where demands and suggestions can be made, as well as asking for medical appointments or basic medical advice
  • Citizens’ expectations Bank: web site to foster citizens’ participation as well as associations and other health system stakeholders


PROTECTING Health and Promoting Wellness


How the way the health in all policies strategy is implemented in all departments of the regional government. Specific objectives for each province are defined, and local action plans on health are promoted to develop this strategy in each municipality.

New Public Health Law: promoting healthy lifestyles, preventing disease, and establishing citizens’ rights, obligations and responsibilities regarding public health. Tackling health inequalities and including health impact assessment.

Specific Health Promotion Programmes:

  • Environmental Health Plan: surveillance, prevention and control of environmental factors affecting health

  • Water Quality activities

  • Food safety and quality

  • Chemicals safety plan

  • Heat-wave effects prevention programme

INTEGRATED AND COMPREHENSIVE PLANS have been designed to compile the different measures and actions adopted in a wide range of fields in response to major health problems. Some highlights of the different Plans are detailed below.

  • DIABETES CARE PLAN: information for the public and patients, improved health care services, including early detection for major complications (retinopathy), prevention and health education, citizen participation, training and research.
  • ONCOLOGY PLAN: health promotion activities, oncology day care in all hospitals, palliative care, new radiotherapy units, improved social and emotional support. Research and training.
  • CARDIOVASCULAR DISEASE CARE PLAN: secondary prevention and rehabilitation programme, pediatric surgery, adult congenital cardiovascular disease unit, training and research.
  • MENTAL HEALTH PLAN: mental welfare promotion, information for the public, increased accessibility, community mental health units, day care units, training and research.
  • TOBACCO PLAN: media campaigns, web portal and telephone service supporting tobacco cessation, training programmes for health professionals, education and work, special smoking cessation units at primary and specialized care, special situations (mental health patients, prisons), training and research. Legal actions (suits) against tobacco companies.
  • DEPENDENT PEOPLE STRATEGY: designed to support people with special needs. Coordinated with the Social Welfare Department.
  • ALZHEIMER’S DISEASE PLAN: in collaboration with associations of relatives and caregivers, includes different programmes designed for the needs of these patients and their families, such as healthcare, family support, stimulation and reeducation, training, volunteering and research.
  • PHYSICAL ACTIVITY AND HEALTHY FOOD PROMOTION PLAN: promotes physical activities and healthy food through local interventions, mainly in four scenarios: healthcare services, schools, community and workplaces.
  • INFANT OBESITY PLAN: includes more than a hundred preventive, healthcare, training and research measures. School dining rooms support services.
  • ACCIDENTS HEALTHCARE PLAN: different measures in order to reduce accidents, and to minimize their consequences.
  • PATIENT SAFETY STRATEGY: designed to improve management, training and information systems. Includes an Observatory on Patient Safety and a registry on adverse events.
  • GENETICS PLAN: establishes a network for providing genetic services for the population, identifying and optimizing the available resources, and opening new lines for the development for research and health care.
  • RARE DISEASES PLAN: early identification of rare diseases, structured health care network within the health system, coordination with different units involved.
  • PALLIATIVE CARE PLAN: designed to attend patients at end stages of their diseases under a common protocol and to support their families and close carers.
  • PAIN CARE PLAN: standardizes care and pain relief throughout the Andalusian health system.
  • ASSISTED REPRODUCTION PROGRAMME: extension of public health care services of assisted reproduction techniques in the public hospitals and centers for those who need them, including women without male partners.
  • DELIVERY AND BIRTH PLAN: promoting healthy and safe delivery based on international evidence and recommendations.
  • HIV/AIDS AND STD PLAN: treatments closest to the patient, promoting early detection of infection and healthy lifestyles when HIV is diagnosed.
  • EARLY CHILDHOOD INTERVENTION PLAN: for children with developmental delays and/or disabilities and their families. Includes early detection and involves prevention and specialised therapy services for the child aimed at achieving personal autonomy; for motor, intellectual and sensory disabilities as well as autism spectrum disorders.



During 2010, a new edition of the Quality Plan of the Regional Ministry of Health will be launched, following the First (2000) and Second (2005) Quality Plans. The Healthcare Quality Plan echoes the vocational search for a different, more modern organization; one that is placed at the service of the Andalusian public, that strives to provide a public service committed to guaranteeing the best possible care, imbuing the Andalusian Public Health System with an entrepreneurial attitude with a view to taking on new challenges to ensure survival of a public healthcare system that is caring, fair and sustainable.

The Healthcare Quality Plan pivots on three scenarios: citizens, professionals and an integrated scenario.

  • CITIZEN SCENARIO: pointing to the public’s central role in the system, as well as the duty to establish a set of guidelines to safeguard that principle. The building of a more efficient and safer healthcare system implies the creation of an environment of trust, shared with the patient for personal decision making and co-responsibility in the use of healthcare services. The interaction between citizens and the system in a more individualized, transparent and interactive manner continues to be enhanced.

  • PROFESSIONAL SCENARIO: health professionals are the main asset of the APHS. The plan seeks to assure the commitment to professional autonomy and participation within their personal development and knowledge management. Indeed, clinical management, process-based management and skills management, continue to be vital tools that need to be enhanced by implementing actions that will lead to their definitive consolidation in the system. Professional accreditation (based on the Andalusian Accreditation Model), fostering R+D within the healthcare system, facilitating new tools for knowledge management, redefining professional competences according to new professional roles, adapting the organization to its professionals, and reshaping the healthcare system as a healthy, comfortable and safe workplace are the objectives in this scenario.

  • INTEGRATED SCENARIO: the healthcare system is considered as the meeting point for citizens and professionals. Clinical management is contemplated as an extended model, fostering professionals’ autonomy, decentralisation of services and a more horizontal organization with the citizen as an active part of the model. The integrated scenario development strategy is based on the sharing of values by citizens, professionals and the organization.

The Andalusian Public Healthcare System works in a complex environment, with many relationships with different institutions and agents: education sector, knowledge generation and transfer, ICT, science and technology, economic growth and social development,…


RESEARCH and Innovation

To invest in knowledge is the key to progress

Using this principle as its starting point, over recent years the Regional Government of Andalusia has launched a series of unprecedented measures to join the front line of health research and thus enter the knowledge society. Biomedical Research (basic and clinical research) is becoming one of the main cores of development for Andalusia and its Health System and is already an acknowledged hallmark of the APHS identity. These measures are based on the commitment of the Ministry of Health for the Andalusian Regional Government to generate knowledge in the fields that allow the scientific community to improve the quality of life of the population, as well as develop new strategies of diagnosis and treatment of illnesses that are still considered to be incurable. This has been made possible through the Strategic Plan for Research, Development and Innovation which focuses the main objectives of the Regional Government of Andalusia.

Map of health research at Andalusia region

Organizations devoted to Health Research

Andalusia has a group of infrastructures devoted to Health Research: new thematic research centers, biobanks, multidisciplinary health research centers, healthcare centers and management structures: the Network of Research Management Foundations of the Andalusian Public Health System, coordinated by Fundación Progreso y Salud1, the central agency which supports and manages Public Health System research in Andalusia and also effectively instigates health research and innovation in the region.

In addition, the Regional Government has developed the Andalusian Iniciative for Advanced Therapies2, promoted by the Regional Ministry of Health in collaboration with the Regional Ministry of Economy, Innovation and Science. Its objective is to promote the development and clinical practice of new research outcomes-based therapies related to the three main research programs in this field being carried out in Andalusia:

  • Andalusian Research Program for Cell Therapy and Regenerative Medicine

  • Andalusian Research Program for Clinical Genetics and Genomic Medicine

  • Andalusian Research Program for Nanomedicine

People, the real protagonists of scientific advancement

In order to foster professional training and formation for new scientists, more than 50 formation and return agreements have been signed with prestigious institutions such as the National Institutes of Health (NIH) from the United States, the Cell Reprogramming Laboratory of the Michigan State University, the Salk Institute of California, the French CNRS, the German Cancer Research or the Centre for Integrated Genomic Medical Research of Manchester (UK) in which research on the priority areas of the Andalusian Regional Government takes place.

Scientific Research and Development, a shared commitment

Universities, public research institutions and other organizations, including pharmaceutical and biotechnology corporations, participate in every health related initiative launched by the Regional Government of Andalusia. The interest of biotechnology companies for Andalusia in terms of health has grown in parallel to the consolidation of the Andalusian Public Health System as a well-structured and centralized model.


e-HEALTH Strategy

The Andalusian Public Healthcare System has adopted corporate information systems as a strategy to cater for the ever-increasing mobility of citizens and the participation of many complex multidisciplinary teams of professionals involved in the healthcare processes. All this, linked to the integrated concept of health and the leading role of the citizen in democratic societies, leads to the concept of the Single Health Record and the use of unified procedures.


    Diraya is an Electronic Health Record system on a regional scale that integrates the healthcare information for each patient on a single regional record. The system is based on a single Health Record Number which links all patient information. Primary care centres, specialist outpatient clinics, emergency rooms and private chemists in the region are connected to this system. We are currently working on the inpatients module.

    The health record has a structure based on a series of centralized data shared by all clinical stations (problems, allergies, personal background, drugs, diagnostic tests...) and a local facility which contains the episodes generated in each record.

    The centralized appointment system contains the schedules of the primary health care centres, outpatient clinics and diagnostic tests. It is a web module, so the patients can make an appointment with the primary health care staff through a call centre or via internet. Additionally, the primary care centres can access the schedules of specialists and arrange appointments with them required.

    The electronic prescription (PRESCRIPTION XXI) is based on a central module of dispensation that collects all patient prescriptions. The doctor can prescribe the full treatment plan for a maximum of one year. Patients can go to any private pharmacy with their card, enabling the chemist to access their treatment sheet and provide the medication according to the plan, box by box. This means that the patients don’t have to go back to the doctor to renew their prescriptions, avoiding 15% of consultations. Likewise, the doctor can consult the dispensations and verify if the patient is following the treatment.

    There are currently more than 7.5 million health records in Diraya and 840 primary care centres are connected, covering 97% of the region’s population. The outpatient clinics and emergency rooms of 26 hospital organizations and 3,500 private chemists are connected to the system. In the public health system, more than 17,000 operators use Diraya every day.

    In 2009, there were 37.8 million primary care consultation sheets, 2.7 million emergency episodes representing 76%, 790,000 outpatient episodes (this process is still growing. In March 2010 alone, we had 103,000). 93 million appointments were managed by Diraya, 82 million primary care (5.6 million were managed by users on the internet) and 11 million specialized care appointments. There were 70 million prescriptions and 89 million dispensing procedures. 2009 was the first year where the number of electronic prescriptions was higher than the number of computer-printed prescriptions.

    In 2009, Diraya was included in the EHR IMPACT study, evaluations of good practice cases of interoperable health record and ePrescribing systems, commissioned by DG INFSO and Media of European Commission.


    Information and Service Center, available 24 hours a day every day of the year. Multichannel access to the Public Health System of Andalusia, designed to satisfy the information and service needs of citizens and health professionals, improving the response capacity of the health system and making it faster. It services include medical appointments for primary care, information on the Andalusian Public Health System, information about the health smart card, dental health programme, free choice of hospital, second medical opinion, community link nursing, living will statement, health campaigns, monitoring of fragile patients after hospital discharge or heat waves, and medical advice. It also offers SMS information services (health campaigns, appointment reminders, health prevention measures,...), information on tobacco (quit-line), citizens’ service line for health technology and devices.


    A health information service using multichannel platforms such as internet, mobile phones, TV and other media. A new model of communication in health, based on innovation, assuring accuracy and quality of information and accessible through different channels and platforms (2600 LED screens in all healthcare facilities, 400 videos).


    Strategy for the identification, sharing and acknowledgement of innovative professional practices. It includes a network of agents among the health professionals in the organization. It promotes the development of innovation forums, ideas contests and best practices identification and diffusion.


    Created as a network focused on the identification, process, synthesis and dissemination of innovative practices in Spain and the world. Accessible via web, it supports knowledge management, as well as collaboration among excellent initiatives. Developed in open source technology.


ANDALUSIAN Public Healthcare System

Activity figures 2009


More info

Última revisión:  23/05/2016

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