Applying Geoffrey Rose's ideas in Madrid: The reform of the health promotion centres network of Madrid city council

Objective: Madrid City Council has a network of 23 health centres (with more than 700 professionals) that cover each city district. On March 2008 started a process of analysis and reform of this centres, whose first stages and its strategic orientation will be described in this presentation.
Methods: All the centres were visited and an open meeting with the health teams took place. Semistructured interviews with stakeholders and professional groups were conducted. Activity, demand, referrals, staff profile and budget indicators were obtained from the information system. Relevant documents and previous analysis were identified and reviewed. Based on this information, a situation analysis and a proposal for strategic reorientation was presented to several levels of the organisation (management, intermediate control, general staff, communication unit, trade unions), obtaining a new input. Finally, five groups of internal and external experts defined the main strategic framework in the four established priorities (i.e. health needs related to: inequalities in health, aging process, immigration and urban environment) and designed the department health information system.
Results: The analysis identified as strong points: interdisciplinary staff, community health experience and districts social networks knowledge. As weak points: weak programs-based organisation, predominance of clinical model, insufficient target population definition. More than 90% of the centres users were women and Family Planning was the main demand. The main offer was an opportunistic health screening, referring the positive findings to the primary health care system. The proposal has been to strengthen health promotion orientation of the centres. Applying Geoffrey Rose ideas, we have started to combine population strategy (e.g. intersectorial work for obesity prevention) with a high risk strategy (e.g. identification of population at high risk for diabetes). Social determinants and “glocalisation” perspectives were deeply considered in the strategy.