Andreu Segura, Secretary of Catalan Public Health Interdepartmental Plan
Soon we will celebrate thirty years from the first international conference on health promotion held in Ottawa. Some of its most popular recommendations are the appeal of reorienting health services and the need for individuals and communities to take control of their own health determinants -they have taken responsibility.
Both proposals are at the root of the COMSalut project and its most direct antecedents, such as the Interdepartmental Plan of Public Health (Pla Interdepartamental de Salut Pública – PINSAP), one of the innovations of Catalonia Public Health law of 2009, which emphasized the impact that various sectors of society and public administration have on health and, consequently, recognized them as key elements of health policies and, therefore, the health plan. A health plan that, with respect to the health system, promotes the development of organizational formulas and the funding of the services most consistent with the community dimension and the cooperation between providers, such as territorial pacts for managed care groups (MCG) from CatSalut.
The COMSalut has another remarkable record: the AUPA network that currently comprises about 85 primary care teams in Catalonia -that is about a quarter of the total. At the request of the Health Minister, the operating core network coordinator prepared at the end of 2014 a proposal for development of community health in Catalonia that has been the basis of the current project.
In February this year, the Health Department has initiated the project groundwork, prepared by a motivated group, relying on the invited primary care teams and on the respective local public health units, which are the core components of the initiative. With the participation of municipal entities representatives of local administrations, of professionals – through corporations and scientific organizations and third sector companies, on June the 8th, the coordination and monitoring group was established, with a commitment to ensure COMSalut’ development and expansion.
A project that does not increase the health budget because, rather than simply add new interventions to the existent ones, it asserts that all health care activities shall adopt a community approach, as requested by the Ottawa letter. This means getting rid of some activities that fail to add value to the health of individuals and society and instead address the chronic health problems with a community preventive approach; an approach that aims to free up resources and redirect them to local priorities and the most effective and equitable interventions; an autonomy that the Department of Health and CatSalut have formalized with the health providers and primary care teams (PCT) committed through the framework agreement signed on 8th of July .
This first phase of the project involves 16 agreed PCT:
1) Design and develop a strategy of local community based on health needs assessment and identification of resources and assets involving all PCT staff, particularly the health care team;
2) Involving citizens and patients in the maximum possible initiatives.
3) Redirecting all assistance activities towards a community perspective with special interest in the prevention of chronic diseases and care for chronic patients.
4) Implementing specific community interventions in ABS’ vulnerable populations (people experiencing or at risk of social exclusion, unemployment, elderly people living alone, the homeless, promoting physical activities to adolescents at risk).
5) Contributing to the reduction of unfair and avoidable inequalities that affect health and, in general, promote health and health equity.
6) Formulating a map of community assets (facilities, social and cultural activities), especially those that can be most useful for health promotion.
7) Developing community activities related to territorial pacts between suppliers.
8) Promote and locally adapt the programs, initiatives and territorial, interventions of Public Health Agency of Catalonia (childhood obesity, health in the districts, school and health, physical activity plan, etc.).
9) Implement and maintain a system for monitoring and evaluating the objectives and actions (as compatible as possible with the health information systems).
10) Developing and improving existing information systems to facilitate the achievement of the targets and objectives, particularly a history that facilitates the practical consideration of social and community factors.
By the end of the year, we can expect that the teams (PCT + Public Health + Local participants like pharmacies, etc.) will have been up and running; the respective PCT project to the communities will have been presented; the first alliances with both local and regional, public authorities concerned will have been established; the local assets mapping will have been completed, where appropriate, the local targets will have been set jointly with other sectors; the community will have begun designing a new portfolio of services, which means a deep internal reorganization and also a continuous effort for improvement, and in addition of improving, where necessary, the community interventions in progress, a new community intervention with illustrative character for professionals and the public will have been set off.
 1 AUPA (Towards Unity for Health) is an autonomous initiative of the professionals who voluntarily came together to develop a community perspective characteristic of the bio-psycho-social model of health and nursing specialty, called precisely family and community. It comes from APOC group (Primary Care Community Oriented) of CAMFiC (Catalan Society of Family Medicine) and has been maintaining and promoting the social dimension, often underrated but essential if health services are to really contribute to improving the health of the people.
 The list of the 16 PCT by provider: Cervera (ICS), Reus-4 (ICS), Salt (ICS), Pineda de Mar (ICS), Sallent (ICS), Casanova-Esquerra de l’Eixample (CAPSE), Carmel (ICS), Chafarinas (ICS), Sant Gervasi (EBA), Vallcarca (EBA), Roquetes (ICS), Nova Lloreda Montigalà (BSA), La Roca del Vallès (CSSC), Castellar del Vallès (ICS), Castelldefels (CASAP), Barceloneta (PAMEM).